Women are Rising: are we ready?

The tide is turning and women are rising, but are we ready?

That in Medicine there should be gender equity in student admissions, in pay, in job opportunities, is a given. Though not yet a reality in Australia or many other countries, although it may seem slow coming, we are working towards it. We women are no longer a minority in Medicine, and it is our time to rise and influence Medicine for true change to occur.

As well as having more women in senior positions in Medicine, what is most important is that those qualities we consider innate to, and even the exclusive domain of women – caring, nurturing, compassion and healing – are given highest priority in our hospitals and indeed all arenas of medical care by men and women alike. We would like to see a change in the culture of Medicine so that we all bring these qualities into our work and that we value them as highly as we do our technical and diagnostic skills.

Anne and I attended a meeting earlier this year welcoming young doctors to our local hospital at the beginning of their first rotation as qualified doctors. During the ensuing discussion, several experienced clinicians spoke of how they cared for their patients, a surgeon holding hands with her patients as they went into theatre, a GP speaking of the beauty of his long-term clinical relationships with his patients. What came through was a love for Medicine and for the people they worked with. It was an uplifting, joyful meeting.

I reflected afterwards on the experience ahead for these enthusiastic young doctors, particularly the women amongst them. I pondered on the fact that despite amazing advances in Medicine, we have failed to create a compassionate and supportive environment for these young doctors to thrive in. It is well overdue. Well overdue for those women and men who have already been badly hurt by Medicine, collateral damage in patient care. There is something very wrong with our Medicine of today where patients are dissatisfied and doctors are burned out. Change is needed. Can the women of Medicine influence the culture of Medicine to make it more caring, more compassionate to patient and doctor alike? Can we, the women and men of Medicine, rise to the challenge?

It is time for new solutions to an age-old problem

At that same meeting, a young oncologist remarked that she had never experienced gender bias. Indeed, this may be so in some areas of the medical community, but it remains an issue in other specialties, and in leadership and academic postings.

“Women are rising” is the opening statement in a recent Lancet article ⁽¹⁾ in support of change for women in Medicine and the health services, and indeed across the world. The recent revelations in the global media and the #metoo campaign ⁽²⁾ have once again highlighted the fact that disadvantage, sexism and discrimination are the experience of many women and, indeed, in some countries, most women.

There has been gender equity in medical school entrance in many Western countries since the 1980s. Like women in other sectors, we are paid less in comparison to our male colleagues and we are under-represented in many specialties, particularly surgery. We are under-represented in management roles and in academic positions, particularly in leadership positions. The Lancet article suggests that women’s education and potential are being lost at great cost to science and society – a waste of intellectual capital, lack of diversity in agenda setting and the restriction of women’s goals and rights.⁽¹⁾

The literature has identified many reasons why this should be so, including penalties for motherhood, unconducive graduate research environments, lack of recognition, lack of support for leadership bids, fewer promotions and resources, and exclusion of women from the “old boys’ club” cultures of science and medicine that nurture the fraternity, networking, and promotion of men.⁽¹⁾

When, in 2015, the level of bullying and sexual harassment amongst surgeons reached the media, I felt as a profession, unlike the shocked public, the men and women of Medicine felt not shock, but shame that what we had witnessed and tolerated for years, had been made public. It took this public exposure for the Colleges not only to apologise to those who had experienced this, but to put in place policies for future practice.⁽³⁾

There is evidence that patient outcomes when treated by women equal or surpass those of our male colleagues, so our ability is not in question. Academically our achievements are high but we remain under-represented in top positions in academic institutions.

It is not that there has been no progress. I think back to Elizabeth Garett-Anderson, the first woman to qualify as a doctor in England in 1865 and how she fought for her position, setting up a hospital for women, staffed by women, shortly after qualifying. One hundred years later bringing gender equity into medical school entrance overcame a major hurdle. Now for nearly 30 years, both male and female medical students have become accustomed to training and competing on an equal playing field, perhaps challenging any perceived bias against women in the profession and paving the way to attitudinal change in the workforce. Most men within our profession are very respectful of their female colleagues. Gone are the days when women were accused of “sleeping their way to the top.” In our regional hospital, here in Lismore, the Director of Medical Services is a woman and we have as many women surgeons as we do men. Two of the three medical schools I work with have had a woman in the Dean’s position and two of the Professors of General Practice are women – all very impressive women. However, nationally and internationally the facts are clear – despite equal potential there is poor career progress and under-representation of women in senior positions.

The result is that women have not been able to influence the changes that are needed in Medicine despite graduating in equal, and sometimes higher numbers for nearly 30 years. This is not a new problem, but it is time for new solutions. We are a respected profession and as such are role models for others. What is happening to women in our profession is a microcosm of what is happening to women in other professions, indeed to women in all walks of life across the globe – a reflection of the disempowerment and silencing of women. It is time, women are saying across the globe. Yes, it is time for the women of Medicine to come into their power and work together with men to make Medicine all that it has the potential to be.

Solidarity

It took great courage for many women to reveal their experience of abuse in the #MeToo campaign, and it has created a wall of solidarity – we will no longer tolerate this behaviour.

In Medicine, we too need unity. We cannot change the biology of women; we give birth, but this should not jeopardise our careers. We should no longer need to fight to prove we are as capable clinically and managerially as men – that is a fact, it does not need to be debated. We should not be subject to bullying or sexual harassment, nor should we ever be the perpetrators. Our colleges and training bodies need to take women’s family choices into consideration – for they are our families, after all.

This is not about women confronting all men, it is not about women fighting against men for their rights. It is about the men and women of medicine standing up together and saying these behaviours cannot be tolerated. It is about the men and women of medicine working to create a new culture in Medicine, one which cares deeply for patient and doctor alike. It is indeed a time for women to rise and take on the challenge of changing the culture of medicine.

The new “Physicians Pledge” includes the clause:

• I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient ⁽⁴⁾

As a profession, we should not tolerate any form of discrimination against anyone, including not only our patients but our colleagues. We should support those who do speak up and those who are afraid to speak out because they believe that by doing so they will make the situation worse or jeopardise their careers. Women are no longer a minority and we need to be willing to stand together with our male colleagues and to change the culture of Medicine if it is not supportive of all of us.

We are role models for all women in our society, let us be the catalyst for change moving towards a society where men and women are truly equal, where the qualities each bring are valued and supported and where each supports the other.

How can we create a culture in Medicine that supports women?

What has not changed is the fact that our doctors, particularly women, experience high levels of stress, burnout, mental health problems and suicidality in their work as doctors.

I think back to the Medicine of 50 years ago when I entered medical school. We could not even imagine the breakthroughs in medical science, the new technologies or expansion in pharmacology that we would see over the span of our careers.

I dream of a time when this amazing science can be coupled with the true art of Medicine – the caring and compassion our patients need, when our hospitals and clinics are places of love and healing and when our doctors and other health workers feel fully supported and valued in their work.

We think of the qualities of caring, nurturing and tenderness to be feminine qualities, but the majority of men and women entering medicine do so with the desire to serve humanity by offering caring and healing. Somehow this gets lost in the force of evidence based, technicalised and business driven Medicine.

By better supporting women in Medicine to be who they truly are, we are supporting them to bring that tender loving care back into medicine because the Medicine of today desperately needs it. We need to value caring and nurturing, not think about it as a ‘placebo effect’ but an integral part of treatment, healing and recovery.

So let us start to give value and priority to compassion, care and nurturing, so that not only will our patients feel more cared for but that we know the generations of doctors to come will feel fully supported in their new careers.

Let us accept our role as leaders and let women lead the way in restoring the care to health care, to the practice of Medicine.

References:

1. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32903-3/fulltext
2. www.abc.net.au/news/2017-10-16/what-is-the-metoo-campaign/9055926

3.https://www.surgeons.org/news/racs-apologises

4. https://wire.ama-assn.org/delivering-care/global-physician-ethics-pledge-gets-biggest-makeover-decades