A group of physician-scientists from the Mayo Clinic recently published a rather thought-provoking study, that I believe is relevant to my last two blog posts. The group reviewed the video recordings of the Department of Internal Medicine's Grand Rounds at both the Arizona and Minnesota campuses. For those of you who are not familiar with academic medicine, speaking at Grand Rounds is quite an honor. Most academic departments hold Grand Rounds on a weekly basis. Speakers from around the country are invited to speak on their particular area of expertise. Even the most well-established physician-scientists only receive 1-2 invitations to give Grand Rounds on an annual basis, so it is one of those unique privileges that indicates that "you have hit the big time." What the group found surprised me, at least at first. They reviewed 321 speaker introductions (in most cases, someone from the speaker's specialty gives the introduction, reviewing the speaker's academic credentials and curriculum vitae) over a 2-year period. Male introducers used professional titles for female physicians only 49% of the time (i.e., rather than introducing the female physician as "Dr. Jane Doe", the individual would introduce the female as "Jane Doe"). Male physicians were introduced by professional title 72% of the time. Conversely, female introducers used professional titles in the vast majority of cases (96% of all introductions, regardless whether the speaker was male or female versus 66% of all introductions for male introducers).
So, what's the big deal? Actually, it is a really a big deal. It would be one thing if we all just dropped the formalities and introduced physicians by their first and last names all the time - but we don't. Using the professional title, "Doctor" is still a sign of respect. By introducing female physicians by their first and last names only, we are subconsciously saying that we do not respect them as much as we do male physicians. We marginalize female physician's professional contributions and status when we treat them differently. Like it or not, there is a discrimination bias in academic medicine (whether intentional or not, it doesn't matter). Female physicians are less likely to hold more senior academic rank (Professor versus Associate Professor and Assistant Professor) and are generally paid less compared to their male colleagues. It's just not right. We need to do better.
After reading this particular study, I actually thought to myself, "Have I ever introduced a female physician for the first time by her first and last name, rather than using the term "Doctor"? I apologize profusely if I have ever done that in my career. I asked one of my female colleagues what she thought of the study and whether she had ever heard me introduce female physicians differently than male physicians. She thought about it briefly, and told me, "I think I have even done that." She told me how she usually calls male surgeons by their last name (e.g., "We should ask Walker if he is going to take our patient to the OR today...") and female surgeons by their first name (e.g., "We should ask Molly if she is going to take our patient to the OR today..."). Subconscious biases seem to affect us all.
It seems so simple to fix this particular issue, but I know that it is more complicated than that. Subconscious biases seem to affect us all. We may treat female physicians differently and not even know that we are doing it - but that does not excuse the behavior. Since reading this study, I have been very explicit whenever I introduce a female physician (think to myself, "Doctor, Doctor, Doctor"). When we speak about physicians (in general), we need to be careful to use gender neutral language (use the pronoun "her" more than you use the pronoun "him" as an example). The journal, "Annals of Surgery" recently retracted the publication of the presidential address of the European Surgical Association because the author (in this case, the incoming president of the association) exclusively used pronouns such as "he" and "him." These biases don't just impact physicians - we need to be more explicit about using gender neutral language when we talk about nurses (historically, a profession dominated by females).
Prejudice. Bias. Even overt racism. The solution has to start with simple things. The solution has to start with us. We need to do better. We can do better. And we will do better.
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