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ER Goddess

ER Goddess

Beyond #MeToo: Women's Bias Against Women

Simons, Sandra Scott MD

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doi: 10.1097/01.EEM.0000533726.07813.da
    bias, gender, #metoo
    bias, gender, #metoo:
    bias, gender, #metoo

    It's hard to tread on eggshells wearing roller skates. Yet, at my last job, as I zoomed around the ED on the kind of shift that prompts EPs to tell each other, “I hope you brought your roller skates,” I still felt like I had to tiptoe around the nurses.

    One night, as I hurried into a room with the ultrasound, I asked a nurse, “Will you please call the pharmacy to ask what bladder agent they have while I scan her bladder because there's none in the Pyxis and the urologist wants her to have one?”

    She responded, “The number is 4720.”

    Another night, working single coverage with a full ED, I asked a different nurse to do a straight-cath for urine on a pediatric fever patient.

    “Are YOU going to help me hold the kid?” was her response.

    Yet another night, I asked the charge nurse, “Would it be possible to get assistance with a pelvic exam?”

    “That's the least of my concerns right now!” she scolded.

    Those are some of the interactions I remember from a nursing culture no EP ever wants to encounter, one laden with hostility. Each of these communications could be chalked up to someone having a bad day, but incidents like these happened more consistently with this particular group than any other group of nurses with whom I've worked. I knew there was animosity when I found my article about the pros of being a female doctor hanging in the breakroom with underlining beneath statements that could be unflattering if taken out of context. (EMN 2016;38[1]6; I had also written an article about the drawbacks of being a woman in medicine. (EMN 2015;37[12]:8; Of course, that article was not posted.

    Fortunately, difficult nurses are the exception. The vast majority are hard-working, professional, and make going to work a lot more fun. Like all EPs, I owe many successes in patient care to the nurses in the trenches with me, and I am sincerely thankful for their efforts. I am also beyond grateful to have recently found the gem of an ED where I currently work with a group of welcoming and friendly female nurses.

    Even though I'm in a happier work environment now, the pains I sustained getting there merit some discussion. It only takes a few toxic people to affect your overall attitude about work negatively. None of us wants to have our ability to do our job encumbered by interactions like those I described, and most doctors try hard to avoid such antagonistic dynamics with nurses. But I feel that I have to try harder than my male colleagues to avoid them with female nurses.

    Cognitive Bias

    Changing jobs has allowed me to reflect on the female doctor-female nurse tension that has been a legitimate and difficult issue throughout parts of my career. When I started this new job, I didn't change who I am or how I doctor, yet I'm significantly happier at work, which makes me think that changing to a less belittling and more supportive nursing culture is what made the difference. I have talked to other female EPs in town and to numerous female EPs on social media, and my experiences with female nurses resonate with them. I also began to look at what's been written already, and numerous articles and studies verify that I am not the only female doctor who has experienced this.

    Do women discriminate against other women? Yes. It may be more palatable to attribute sexism to a few rotten apples, but cognitive bias about gender is a fundamental human trait. Women, often unknowingly, have cognitive gender bias too, and they treat other women differently from men.

    Yale scientists in one study were presented with identical resumes for a lab-manager job that differed only in the gender of the hypothetical applicant. Female scientists were just as likely as male ones to favor male over female candidates for potential job offers. (Proc Natl Acad Sci U S A 2012;109[41]:16474; Yet another study found that women reported higher levels of incivility from other women than from their male counterparts. (J Appl Psychol 2017 Dec 14. doi: 10.1037/apl0000289.) The study concluded that “women are ruder to each other than they are to men.” That study also asked participants to complete trait inventories of their personalities and behaviors to determine if any factors contributed to women being treated uncivilly. The research showed that women who defied gender norms by being more assertive and dominant at work were more likely to be targeted by their female counterparts. (University of Arizona News. Feb 19, 2018;

    A study that has resonated with many female physicians is one that found female nurses were more willing to serve and defer to male physicians. (Int J Equity Health 2003;2[1]:1.; They were more comfortable communicating with female physicians and spoke on a more egalitarian basis, but also exhibited more hostility. The study concluded that the traditional power imbalances in the doctor-nurse relationship diminish when the nurses and doctors are female, suggesting that these imbalances are based as much on gender as on professional “hierarchy” (their word). Another study reported that female doctors are met with less respect and confidence and are given less help than their male colleagues, something the authors described as “an erotic game.” (Soc Sci Med 2001;52[2]:189.)

    This is a lot of food for thought and a conversation we need to continue. Just like the sexual harassment described in #MeToo stories happens with a small minority of men, the “mean girls” variety of nursing culture happens with a small minority of nurses. It saddens me to reflect on the “mean girl” culture I experienced. It's hard to tell if unconscious biases and prejudices influenced nurses' attitudes or if I were to blame because of my assertive behavior. Either way, multiple moments of nurse-doctor tension added up over time, and it was like death by 1,000 cuts. I came away doubting myself and believing the problem could be that I'm a “bitch,” not the pervasive undercurrent of sexism in medicine.

    We women need to get past the “mean girls” mentality, forgive each other, and band together. With all the attention we are putting on #MeToo and getting men to treat us better, we forget that we need to treat each other better. If we're going to discuss male bias, we should take a hard look at our own cognitive gender biases as well. Even good people who actively discourage bias may nonetheless harbor subtle yet damaging sexist stereotypes of which they are unaware. Thinking about and discussing our natural gender biases should motivate us all to try harder to overcome them. My hope is that women in medicine will stop tearing each other down and start finding more ways to boost each other up.

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