Margarita in hand and red lipstick perfectly applied, I am not the stereotypical image of a doctor. When I tell the guy on the barstool next to me that I work in the ED, of course he assumes I'm a nurse. This scenario or some variant transpires nearly every time I meet someone in a social setting.
One would think the scenario would be different in the professional setting, without the margarita and red lipstick, in all my doctorly glory. Just last week I went to see a 9-year-old patient wearing my stethoscope around my neck and the standard black physician scrubs with “Sandra Simons, MD” embroidered prominently on my chest. I initiated my H&P with “Hi, I'm Dr. Simons. What happened to your toe?” The patient's dad began fishing his ID out of his wallet. “Son, answer the registration clerk,” the dad responded. Could he not hear me clearly say “Doctor?” Did he not see what I was wearing? Why would a registration clerk be asking about his son's toe? Moreover, is it really still that unfathomable in 2015 that a young(ish) woman entering an exam room could really be the doctor?
“Doctors are usually frumpy old men” (actual patient quote) is the common sentiment. When my niece was 3, she told my sister that she couldn't be a doctor because doctors are boys. She gleaned this, presumably in preschool, despite having a female pediatrician and a physician aunt. My sister was horrified that gender stereotypes are still being propagated today, and within a year, I was visiting my niece's preschool during career week to give little girls a better example.
It's not just the young impressionable kids who have biases about gender. Even the old and educated have been engrained with societal expectations about gender norms. At a conference recently, a gray-haired physician looked at my name tag, and said condescendingly, “You're an MD? Good for you!” Offended to hear such gender stereotyping in my own profession, it took every ounce of restraint not to fire back with, “Just because I lack the stereotypical doctor's Y chromosome and gray hair doesn't mean I couldn't run circles around you in an ED,” but I bit my tongue.
The Powerful White Coat
It's sad that as a woman I try not to take off my white coat at work because if I do no one will know I'm the doctor. When I'm at my desk in scrubs with my coat off, I get interrupted countless times with “Excuse me, miss, can I get a ________ (blanket, pillow, cup of coffee, cell phone charger, directions, you name it).” The nurses tell me the male docs get no such interruptions when they sit at the same desk in the same scrubs. If I want people to know my role, I am condemned to wear my hot, cumbersome, fomite-disseminating white coat as much as possible in the ED to counteract my lack of testicles.
Even when they do realize I'm the doc, I still get those incredulous looks conveying skepticism about my competence. Patients immediately ask me how long I've been a doctor or where I trained before I can even address diagnosis or treatment of their complaint. It reeks of “prove you're qualified.” In a moment of frustration, I recently asked an older male colleague how many times patients had asked where he trained. His answer was, “Maybe five times in the past 10 years.” I had been asked five times that week.
Normally I just laugh it off, but in this new era where Press Ganey is king, it's becoming a real patient satisfaction issue when patients don't realize the physician saw them. Whose problem does it become when people are too dense to realize the knowledgeable woman in scrubs is a doctor? Mine, of course. I've recently been encouraged to reaffirm I'm the doctor when I leave a patient room. One-third of all U.S. physicians are women and this number is steadily increasing, yet the onus is still on female physicians to help patients move beyond old-fashioned stereotypes. My gender may become a patient satisfaction liability if I don't enlighten less-informed patients that you can indeed have a vagina and a medical degree.
The hardest part of being a woman in medicine, however, isn't overcoming assumptions that I'm not the doctor but overcoming assumptions that I should act a certain way at work because I'm a woman. Society expects not only certain gender roles (male doctors, female nurses), but also certain behaviors from genders (strong men, more agreeable women). Assertive men are powerful leaders, but assertive women are bitches. Female physicians grapple with the competing identities of female gender and assertive leader, often feeling “damned if we do, damned if we don't.”
We may not be perceived as “real leaders” when we present ourselves in a warm and feminine way, but we may be disliked if we present ourselves in a masculine, assertive way. If we show even mild forms of anger, we are more likely than men to be viewed as emotionally out of control. Fortunately, we female emergency physicians fight these behavioral stereotypes every day, empowering ourselves to run our departments. We act the way we need to, not the way people expect us to, when people are dying.
No, I'm not going to be sweet and demure when someone is dying. No, I'm not the registration clerk. No, you don't need gray hair and testicles to be a physician. We've come a long way with gender equality, but we all still harbor archetypal culturally engrained gender biases in the recesses of our brain. Every time I have to say, “YES, I'm really the doctor,” it reaffirms that we'll never completely clean the cobwebs of cavemanism from the corners of our unconscious. As much as we may try to be more enlightened, it is human nature to judge a book by its cover, and gender stereotypes will always be a challenge for women in medicine.
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