Woman in White

Welcome to Women in Medicine, the newest addition to The Pulse!  With this section we hope not only to explore some of the challenges that women face as professionals, but to also celebrate the female leaders of today and their many accomplishments.  Each monthly installment will be dedicated to bringing you relevant articles, discussions and lectures.  We invite all ideas and ask that you post any comments you may have. We need your involvement to help this section thrive.  Enjoy!

To kick off the new year, our first installment of Women in Medicine is dedicated to the important issue of gender roles in medicine.  We’d like to start off by sharing one of our own personal experiences with this issue:

It’s a usual day in the urgent care section of the ED - BUSY. I am carrying a few patients at once and am working on my computer when the nurse comes up to the desk and asks me, "Did you see this patient?" I quickly look at the name and say, "Yes I saw her. We’re just waiting for the attending to see her." She looks at me and says, "Well the patient is getting upset because she says no doctor ever saw her." I look at her confused and I say, "Well I always introduce myself as Doctor, I can go talk to her again if you like." She replies, "No I’ll go see her again and let her know."

A few minutes later the nurse comes up to desk again with the patient in tow, looking very upset.

The nurse points to me and asks the patient, "Is this the person who saw you?" The patient replies, "Yes that’s the person." The nurse then says, "Well that’s your doctor." I was taken aback. This wasn’t the first time this had happened to me. I do look very young and am often mistaken for a nurse. It has happened so often I had started to wear a white coat to see if that helped the situation.

Undoubtedly the above story sounds like a familiar one to many who are reading this. To further explore gender roles, we would like to share with you an article from Academic Life in Emergency Medicine (ALiEM) entitled “The Case of the Woman in White.” Similar to our own personal experience above, this article presents the reader with an all too familiar case: two residents, a male and female, are struggling to overcome the assumptions their patients and colleagues make based on their appearance. Given their youthful looks, both have been mistaken for anything but a physician in the past. However, the female resident is starting to feel as if these experiences go beyond a simple misunderstanding based on age. She questions whether gender bias is still affecting women in medicine.

Read the article with several commentaries and replies from different female physicians.

This article prompted us to to conduct a survey regarding gender roles in our very own Emergency Department at SIUH.  All attendings were asked to fill out a brief survey covering gender issues. Survey questions, answers, and a discussion of the results are listed below:

 

Gender Roles in the Emergency Department

1. What is your gender?

  • Male - 52%

  • Female - 48%

2. Do you wear a white coat while working in the Emergency Department?

  • Yes - 44%

  • No - 30%

  • Sometimes - 26%

3. Why do you wear a white coat while working the Emergency Department? (Select all that apply.)

  • To cover your clothes - 29%

  • To be recognized as a physician - 38%

  • To have somewhere to hold your things - 52%

  • Other (please specify) - 24%

    • I don’t wear a coat.

    • To keep warm / I feel cold.

    • I am required to, otherwise I would not.

    • I don’t wear it because too many non-clinicians wear it.

4. Do you believe that women have a harder time being recognized as a physician in comparison to men?

  • Yes - 96%

  • No - 4%

  • Other (please specify) _______________________________________

5. Do you believe that a white coat helps patients distinguish you as a physician versus another type of healthcare provider (i.e. nurse)?

  • Yes - 64%

  • No - 36%

  • Other (please specify) _______________________________________

6. Have you ever been mistaken for another healthcare provider?

  • Yes - 78%

  • No - 22%

  • Other (please specify) _______________________________________

7. If yes to the above question, how often does this occur?

  • Almost always - 8%

  • Often - 24%

  • Sometimes - 28%

  • Rarely - 24%

  • Never - 4%

  • Does not apply - 12%

8. If you have been mistaken for another healthcare provider, how have you reacted to the situation?

  • Politely explained I’m not a nurse or a Miss.

  • Sometimes I tell the person that I am the supervising doctor, sometimes I ignore the “nurse" comment as it is innocent and does not affect patient care or my ego.

  • I usually hardly correct them unless when caring for them.

  • It doesn’t bother me.

  • Jokingly answered “Nope I’m the Doctor.”

  • I think it’s funny.

  • Correct the patient and repeat again that I’m their doctor.

  • Clarify what my role is.

  • I simply clarify if necessary, usually only if my pt or their family. Otherwise I just answer the question, get the blanket, etc.

  • Ignore it.

  • I inform the patient that I am their doctor.

  • I simply say, "actually I am the doctor in charge today."

  • I’m fine with it.

  • It doesn't bother me. Sometimes I correct them, sometimes I don't. For example, if someone says, "nurse, can I get a blanket?" I just give them a blanket.

  • I gently told the person I was a physician.

  • Very simply no. And then I introduce myself.

  • Smiled and corrected the person. It happens rarely because my first sentence is an introduction of who I am and what my role is.

  • Just make sure they know i'm their doctor so that they don't think that they haven't seen a doctor and complain to the ancillary staff or nurse or charge nurse or through the patient complaint emails or the press ganey that they never saw a doctor.

9. Have you ever had a patient question your abilities or competence based on your gender?

  • Yes - 7%

  • No - 89%

  • Other (please specify) - 4%

    • They do based on apparent age.

    • For obstetric / gynecologic issues.

    • I think it's hard to know if it was gender based or presumed age based.

Discussion: We received a total of 27 responses. Approximately half of respondents were female and half were male. The following is a comparison of female versus male responses:

  • Of the 44% of respondents who answered “yes” or “sometimes” to wearing a white coat, 68% were female.

  • Of the 38% who answered that they wear a white coat to be recognized as a physician, 63% were female.

  • Almost 100% of respondents felt that women have a harder time being recognized as physicians in comparison to men.

  • Of the 64% who felt that a white coat helps to distinguish them as a physician versus another type of healthcare provider (i.e. nurse), 50% were female and 50% were male. The association of “white coat” with “physician” appears to be a gender-neutral concept.

  • Of the 78% who admitted to having been mistaken for another healthcare provider, 62% were female. Reactions to this situation ranged from ignoring the mistake, clarifying roles, and correcting the patient despite having already introduced themselves as the patient’s doctor at least once.

  • The majority of respondents (89%) denied ever having a patient question their abilities or competence based on gender, which is an encouraging result. Several respondents did admit to having their abilities questioned based on age, an issue consistent with the “Woman in White” article above and likely even more prevalent in the Resident Physician population. Interestingly, one male respondent admitted to having a patient question his competency concerning obstetric / gynecologic issues. This is a reminder that both female AND male biases exist in medicine.

We would like to thank all of our survey participants for their contribution. Once again, please feel free to post comments regarding the “Woman in White” article, the results of our survey, or any thoughts you may have on gender roles and gender bias in medicine.