I am new to twitter. I am new to writing about being a woman in medicine, a woman in surgery, and a woman in orthopaedics. I am NOT new to the feeling so beautifully summed up by Dr. Loren Rabinowitz in the New England Journal of Medicine on June 14, 2018. In her piece, “Recognizing Blind Spots-A Remedy for Gender Bias in Medicine,” Dr. Rabinowitz blew me away by describing an occurrence so familiar to me, a world in which patients receive the care from excellent women physicians without understanding that we are actually physicians. She tells a story in which a family, grieving and making difficult decisions about a loved one, assumes that her junior resident is the physician in charge because he is a man. Dr. Rabinowitz continues to put the patient and family ahead of herself, making a conscious decision to avoid a talk about sexism with an “overwhelmed soon to be widow.” She learns that her intern did not step up to tell the family that she was the senior doctor, because he was the recipient of bias related to the color of his skin. She writes, “We had both sat through medical school lectures on implicit biases as they relate to patients and health disparities,” without realizing that “it might be our obligation to educate patients about their unconscious biases regarding their health care providers.”
The first month of my internship at Ben Taub Hospital, in Houston Texas, numbed me and desensitized me. Within my first week of functioning as a “doctor” I was sticking a chest tube into a patient in shock room 1 just above his tattoo of a swastika. Many times the unstable patients went directly to the surgical ICU from the shock room. But not this man. He stayed in the ER with me for a few hours. His visitors also had swastikas. It didn’t occur to me to be scared of them. I was too tired. And scared of making a medical mistake. Of course I said nothing. To them, to the nurses, to the other doctors, really even to myself. This was a sick man and it was my job to take care of him. Maybe I was smart enough to know that there was no way to change him, and nothing to be done. Words would have been wasted. This was my lesson, and I carry it with me to this day. It is not always as blatantly obvious as a jewish intern saving the life of a neo nazi. Sometimes it is a woman surgeon taking care of a patient who thinks a surgeon should be a man. And now we have the term “micro-agression.”
I have become a “communication expert.” I have the honor of being a part of a group called the Clinician Patient Communication team within Kaiser Permanente. We coach other doctors about connecting with their patients. This makes patients happier and more satisfied. And it also makes doctors happier and more satisfied. So when I meet a patient who needs surgery, I like to show off my communication skills. I approach the “s” word (surgery) gingerly I tell them I know this is routine for me, but a first time rodeo for them. I patiently tell the patient and their family about the risks and benefits, the pros and cons, the details of the tools and anatomy and recovery. I am sure to address fears. This is my wheelhouse. Except when I get to the part where I ask if they have any other questions, and they ask when they will meet the surgeon.
I have decided, after 15 years, not to introduce myself as Dr. Weiss. It feels like a power play. It doesn’t feel like me. I walk into the room and shake hands with everyone, even little siblings. I introduce myself as Jennifer Weiss, one of the orthopaedic doctors. I do not mention that I am assistant chief. I was taught not to brag. And I call them Mr. or Ms. (or Dr.) if they are 18 or older. I sit and talk at eye level. I listen with respect. I connect. I ask about their lives. Where do they go to school? What position do they play? Do they like their work? Are they sad about their injury, or scared? This is the reason I became a doctor, after all, to actually connect with these people. And introducing myself as Dr. Weiss seems to make the field uneven for me. Plus, i still look over my shoulder for my dad when I say “Dr. Weiss.” Imposter syndrome is a topic for another day, but I guess I have it?
So I thank Dr. Rabinowitz for her compassionate words about women in medicine and our blind spots. I need to improve my balance, I can connect with, respect, and relate to my patients, yet it is my responsibility to help them also understand that I AM THEIR SURGEON. I have the privilege and responsibility of cutting into people’s bodies to help them heal. Whether they are a neo nazi or sexist or racist, I took an oath. And I need to get over my fear of bragging…
Congratulations Dr. Weiss! Excellent blog. Thank you.
Thank you for reading, Dr. Smith!!
Love it. Definitely it is important to talk about your accomplishments without worrying about bragging. That is who you are, what you’ve learned, what you have added to the world. It is also important to have a fan club happy to hear about your accomplishments to reinforce how special you are.
I’m working on it!! Thank you for always vocalizing your support. Lucky to know you.
So much of our upbringing comes into play in our many roles and defining ones responsibilities to self and patient is ever changing. I applaud you for continuing to grow not just educationally but also emotionally and personally.
Bri, allowing our individualism to be part of our patient care is so important. You are SPOT ON in this comment!!
I will just continue to brag about you, for you!
Reid Nichols, the feeling is mutual 🙂
Jennifer,
Speaking from the patients’ point of view, they DO WANT to know who is who. Obviously, if they know they need a doctor and think they are going to have an operation, why the heck WOULDN’T they prefer to know they are speaking to a doctor, and to their surgeon. Although you think you are being “patient-centered”, you have been more concerned about yourself (your distaste for boasting) than about their right to know that they are talking to “an expert”, the person “in charge”.
Yes, there are downsides to the word “doctor” — because research has shown that role disparity can suppress the patient’s ability to talk straight with you.
So reducing the perception of disparity is part of our job — to act like an approachable regular human being instead of like an arrogant jerk. Sounds like you have been doing that. But you also have the responsibility to reassure them that YOU, the expert, are the one talking to them. You are BOTH the surgeon AND the one who is genuinely interested in them and their concerns, the one who has an expert understanding of their bio-medical problem, what needs to be done about it, AND who really cares for them on a human level — so they can relax and put themselves in your hands.
As a now 71-year old person who has had plenty of experience on both sides of the white coat, there is definitely a internal experience of surrender when I have had to put aside my autonomy and CHOOSE to put my life / well-being / future into the hands of another. The patients DESERVE to know about your expertise and your personal effectiveness so they feel comfortable with that surrender.
On the other hand, the majority of my own professional work has been devoted to seeing the short-comings of the medical professions in terms of understanding the impact of symptoms, illness and injury on patient’s everyday lives and livelihoods. We have an invisible boundary around the stuff we think about and feel responsible for — and the world is not clear about that at all. For example, very very very few physicians feel any responsibility at all for minimizing life disruption and time away from work, and don’t have any sense that job loss is a very very poor outcome for a working age person. And yet those things are actually amenable to active management, and how a physician talks to patients and writes things on forms can make a big difference! Other members of the healthcare team are often more prepared to do that — and sometimes it is actually an insurer-based or employer-based professional who can do it.
thank you so much for this. I am grateful for your experience “on both sides of the white coat” and your wisdom about this. The balance sometimes evades me, keeping the patient at true north is my best barometer.
I think it IS appropriate for us to introduce ourselves as “Doctor,” to avoid ambiguity about our role in patients’ care, and to let patients know that they’re not just talking with another nurse before they finally see the physician. BUT, we can do this ONLY if we respect patients by addressing them as “Mr.” or “Ms.” (I am disgusted by current use of patients’ first names only.) I am careful to make good eye contact, to listen (to obtain a good history as well as to understand their perspective on their conditions), and to explain things thoroughly, and I will often walk them through a differential diagnosis and approach to diagnosis and treatment.
I completely agree with addressing patient with Mr. or Mrs. or Ms. Someone from our organization created a pilot for the maintenence staff to be empowered to call patients by their first names, along with nursing staff. I am saddened by this. I like the idea having the staff feel freer to approach and relate to the patient, but not by using first name!