Years ago, the president of Harvard University was criticized for suggesting that women are under-represented in STEM fields because of “innate differences” between them and men. In fact, research has documented differences in brain size, relative sizes of different areas of the brain, and neurological function between men and women. Newborn girls respond more to the distressed cries of other babies than boys do and increase eye contact and mutual facial gazing by 400% in the first 3 months of life, while boys show no change. Girls have 11% more neurons in brain centers for language, a larger hippocampus (the hub of emotion and emotional memory foundation), more mirror neurons, and larger gray matter volume in areas that correlate with self-reported scores on empathy. These observations have been cited as reasons why women excel in nurturing activities and have been used to restrict women from professions that are thought to require greater mental and/or analytical ability.
In her well-researched and referenced book, The Gendered Brain, neuroscientist Dr. Gina Rippon makes the case that it is actually a difference in the socialization of the two sexes, compounded by brain plasticity, that likely accounts for these differences. She recalls when the nurse brought her newborn daughter and her roommate’s newborn son to them shortly after their deliveries. The nurse handed the boy to her roommate, exclaiming, “Cracking pair of lungs!” As she handed the girl to Dr. Rippon, she said, “Here’s yours. The loudest of the lot. Not very ladylike!” Just minutes after their birth, girls and boys were being judged differently for the exact same behavior. Lest we believe this is an isolated anecdote, notice what people say to young children. We often comment admiringly on a little girl’s dress or how “pretty” she is and express admiration for the actions or strength of young boys. As social beings who depend on adults for survival, children learn quickly which traits are expected of them and modify their behavior based on these expectations. The toys and activities we encourage in each gender create further distinctions. Girls are given dolls, with whom they practice language and caring activities, Boys are given balls and vehicles that require greater eye-hand coordination and visual-spatial ability. Our plastic brains respond appropriately, with an increase in volume, neurons, and efficiency in the areas associated with these tasks. That this is true is demonstrated by studies that show that, when girls are given video games to play, their visual-spatial capabilities improve as well.
Girls are also taught to “be nice” – to not jeopardize relationships or cause discomfort for others. When girls encounter conflict, they often respond by changing the game they are playing. Boys are encouraged to engage in rough and tumble play – to “be tough” and stand up for themselves. In this way, boys develop a competitive advantage in learning to tolerate the psychological distress of conflict. Thus, it may not be “innate differences” but the response of our brains to more frequent performance of certain tasks that creates the differences seen in brains and behavior.
The effects of socialization go on to impact our professional interactions. Women physicians are more often ignored by female staff or criticized for being demanding or condescending when they ask for assistance, while the same staff responds to male physicians’ requests without complaint. An ED physician recently expressed her frustration with patient experience reports citing her for not smiling enough or failing to apologize for keeping patients waiting. Checking in with her male colleagues, she discovered that, while they have the same wait times and don’t smile any more than she does, these criticisms never appear on their reports. I could write a book from the stories I’ve heard from women physicians about the different ways in which they are judged and treated: these painful and frustrating experiences are common and pervasive.
Women walk a fine line in the medical arena. We need to be recognized and trusted for our skill, competence, and leadership in order to do our jobs well. Yet, if we show too much or not enough emotion or concern, if we speak too directly, if we act too confidently, we are judged harshly. And while most women in medicine recognize that this problem exists, few men are aware of it. Since leadership positions remain occupied primarily by men, this leaves women physicians feeling devalued, frustrated, bewildered, and unsupported in finding solutions.
What solutions are possible? We can begin to combat these differences by intentionally exposing children to both types of toys and activities and rewarding the full range of appropriate behavior, regardless of the child’s gender. When opinions that would limit a person’s potential are expressed, we need to counter with broader views of human behavior and roles. We can be more sensitive to gender bias and speak out when we see it. By elevating more women to decision-making roles, we will ensure that their perspectives are included in the important decisions ahead. We must support each other when we see inequity and encourage each other to work toward our full potential, despite the discouraging messages we encounter.
Since half of our physician workforce will soon be women, it’s essential that we recognize the problem and look for meaningful approaches to correcting it. We already have a physician shortage – losing more doctors because of an unwelcoming culture would be tragic and dangerous. Let’s look at our biases, expectations, and the different ways in which men and women are judged and treated and begin to challenge this inequity in our workplaces. Pinkification should have no place in the delivery of healthcare or the practice of medicine.
One of the major transformations in medicine is the increasing number of women who have entered the field: the AMA claims that “
early age to always appear strong and tough and derided for “acting like a girl” if they show sensitivity or indecision. Both genders are labeled weak when they cry. We are often admonished, “Don’t be emotional.” Yet, the truth is that emotions are a part of everything we do.
choose our response. In our response lies our growth and freedom.” Unfortunately, our responses are often unconsciously triggered by prior experiences. If we were rejected by a group in our adolescence, we might feel rejected whenever we don’t feel a warm welcome. If we experienced dishonesty earlier in our lives, we may find it difficult to trust again. That we are limited to these automatic responses is a myth, as it ignores the space between stimulus and response. Realizing that can bring us not only a greater range of potential responses, but true freedom in our lives.
beautiful, resonant bass notes to the song. A short time later, I noticed the pianist motioning to me and realized I had missed the place in the music where the key changes. I was playing all the wrong notes! Again, I chose to be amused by my inexperience rather than go down the path of negative self-talk, and chose the joy of learning from this new experience. Later, I noticed the drummer exaggerate his movement so I would know when to play the last note, rather than coming in at the wrong time as I did during rehearsal. I chose the joy of feeling supported, enhanced by gratitude for his kindness.
earth. We are definitely not used to this habit of moving in two different directions at once. In fact, we are encouraged from an early age to decide on one path and move in that direction only. Young athletes are advised to concentrate on one sport, lest their potential competitors improve and leave them behind. As medical students, we are encouraged to decide on a specialty early in our training, so we can do research and add clinical experience to our CV and thus appear to be a more dedicated applicant for residency. We expect our politicians to be sure of their positions and uni-dimensional in their stances on issues or we judge them to be “wishy-washy” or not committed to the cause. By not allowing ourselves to stretch into other directions, we contract and weaken. We don’t learn to appreciate, engage and benefit from the full range of our capabilities. We fail to develop the trust and confidence in ourselves that only comes from knowing how far we can stretch. Ask any yogi and they will tell you how much space and strength develop when we learn to grow in opposite directions.
This is why I designed the True Story Physician Coaching Program. Based on the transformational Break Through to your Great Story program developed by Lucid Living, this new, four-month virtual program is designed specifically for women who want more joy in their life as a physician. Women who are ready to discard old beliefs that have prevented them from living the life they dreamed of. Women who are willing to look at the ways in which they have kept themselves trapped in repeating cycles of despair and overwork by telling themselves that “this is just the way things are.” Women who yearn to create a new story – a story that reflects what is true about their desires, talents, and strengths – and realize their dream of living authentically, with passion and joy.
be…happier, healthier, more productive, more prosperous, more fun, filled with more time with the people we love. Chances are, without an intentional and deliberate approach, 2019 will be a lot like 2018.
I can offer innumerable examples of people NOT being seen. Physicians who aren’t valued for their excellent patient care because they are viewed as less productive than some of their peers. Budding leaders who are passed over because those in leadership positions don’t take the time to notice their skills and desire to contribute. Even our daughter’s basketball coach, who never appreciated which players were best at guarding, dribbling or sinking 3-point shots and let the talents of the girls go unutilized. It’s frustrating to not have people recognize what we have to offer – to not “see” us. It makes us doubt our own value. We wonder if we’re not seen because there’s nothing remarkable to see.
Doctors Coaching Doctors - Helane Fronek, MD Coaching and Consulting 