The “pinkification” of girls and why it matters to women in medicine

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.

Advertisements
Posted in physician coach, physician coaching, women in medicine | Tagged , , | 2 Comments

Celebrating September: Women in Medicine Month! A physician coach looks at the important contributions and challenging obstacles faced by women physicians

Starting medical school in 1978, I could not have anticipated the changes I would see in our profession during my career.  HMOs, RVUs, EHRs, corporate medicine structures, patient satisfaction/experience scores and productivity metrics did not exist or did not dominate the landscape, as they do now.   Evidence-based medicine and physician burnout were not overriding concerns.  These seismic shifts have redefined what it means to practice medicine and are prompting an increasing number of physicians to question whether they want to remain in the clinical arena.  I also could not have suspected that we, as a profession of educated, thoughtful individuals, would be so resistent to change in many important ways as the fabric of our profession shifted.

Group of medical doctorsOne of the major transformations in medicine is the increasing number of women who have entered the field: the AMA claims that “Medicine is increasingly a female profession, with the number of women physicians growing 43 percent in the last decade to more than 376,000 nationwide.” Women now constitute nearly 50% of medical students in the US and it’s expected that this number will continue to rise.  A recent New York Times article, “How Medicine Became the Stealth Family-Friendly Profession,” (New York Times 8/21/19) explains that the ability to work part time or choose specialities that offer more control over their time is one reason why women are entering the profession in greater numbers.  They state that “Female doctors are more likely than  other professionals to have children and keep working.”

That sounds great, doesn’t it?

As with any situation, there is more complexity than this rosy picture portrays.  Although women predominate in some specialties (OB-GYN, Pediatrics, etc.) and comprise increasing numbers in many others, the culture in which we practice has not adapted in ways that would make women feel welcome, included, or valued.  As Caroline Criado Perez explains in Invisible Women, men are the default in our culture.  Since the profession of medicine was created and practiced exclusively by men for many years, it is, understandably, not always supportive of the unique needs and challenges of women.  For this and other reasons, women experience burnout at higher rates than men (relative risk 1.6), have greater rates of suicide than women in non-medical professions, and find that their choice of profession compromises their chance of marriage and opportunities to have children.  Women are still vastly under-represented in leadership roles than men.  Implicit bias pervades our culture, such that women physicians are often seen as less competent and less worthy of investment than their male colleagues.

As I routinely tell the medical students I’ve taught (and anyone who cares to listen), being a physician is one of the best things I can imagine to do with one’s life.  There are few other professions where we can make a difference in the lives of almost everyone we encounter – treating or curing the diseases our patients come to us with is a thrilling and gratifying experience.  And even if we cannot improve our patients’ disease, we can listen and show kindness as they find ways to live their lives with it.  The conversations we have with our patients are often deep and meaningful and the relationships feel intimate and sacred.  The continuous intellectual stimulation and challenge of medicine offer opportunities for life-long learning and growth.  Yet, I am not of the mindset that we must “love it or leave it” when it comes to considering whether our profession is the best it can be.

As more women enter our profession, we have an opportunity to truly transform the culture of medicine – in ways that will improve patient care and enhance the career and life satisfaction of all physicians, both men and women.  Women can lead the way in redefining the ways in which we work, how we interact with each other, and what we prioritize. We all have both masculine and feminine traits, although these traits are more common in the gender they are associated with.  Since medicine was created by and for men, it is heavy in masculine traits.  By balancing the masculine traits of domination, competition, reliance on logic, productivity, intellect, will and commitment with the feminine traits of receptivity, collaboration, empathy and intuition, creativity, curiosity, imagination, and courage, we will expand our abilities, tools and options. This will allow us to better meet the challenges of the future and provide a more welcoming environment for all those in our field.

In celebration of Women in Medicine month, please join me in examining the important ways in which women contribute, as well as the continuing obstacles they encounter as they attempt to do so.  Our goal will always be to find solutions and new perspectives, so that all physicians – men, women, and those under-represented in medicine – can feel welcome and valued, provide the best care to their patients and the most healthy and loving environments for their families, and appreciate themselves for who they are and what they contribute to our profession and the world we live in.

Posted in physician burnout, physician coach, physician coaching, women in medicine | Tagged , , | 1 Comment

3 Simple Steps for Befriending and Harnessing Your Emotions

 

Our culture derides emotions. One common belief is that emotions are bad, and not to be
trusted. As doctors, we are taught to remain detached from our emotions, lest they affect our clinical decision-making or we appear less than strong in front of patients. And each
gender has its own limiting rules about emotions. While men are labeled assertive for showing anger, women are given less appealing adjectives. Men are instructed from an Collage emotion of peopleearly 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.

Our excitement spurs us to become involved and work hard on something we’re passionate about.  Our fears hold us back from being all that we can be.  We eat, sleep, communicate, and work differently if we’re happy than if we’re sad.  Emotions also help us connect with people who are like-minded; together, our efforts may accomplish more than if we acted alone.  Emotions even influence clinical outcomes.  Years ago, I cared for a woman with advanced rheumatoid arthritis. She had diminished vision, limited use of her hands, and very painful hips.  Due to financial difficulties, the family’s washing machine was repossessed and my patient had to wash her family’s clothes by hand.  I became determined to find additional services for her and ensure she had access to necessary medications. These efforts, born from my compassion, positively affected her clinical course.

Our emotions are a crucial source of information and the best indicator of what’s true for us.  While we can usually think ourselves in or out of different thoughts and beliefs,  it’s harder to change our emotions.  How many times have people told you to not be sad, or to not be angry?  I bet their suggestions did nothing to change your emotion – except, perhaps, to make you feel angry, frustrated, and unseen.

This is because our emotions are triggered when there is an issue at stake that matters to us.  And that means that we can use our emotions as a compass to guide us toward living in alignment with what is most important to us.

Unfortunately, we are often taught to hide our emotions, lest we “make a scene,” hurt someone’s feelings, or burn bridges.  The truth is that we usually fail.  We’re betrayed by an unconscious eye roll, our body language, the sarcastic tone in our voice, a rise in the pitch or quickening of the cadence of our speech. If emotions are going to make themselves known anyway, we can use this simple, three-step process to intentionally put them to use, creating the outcomes we want.

Step #1:  We often recognize we’re feeling an emotion when something changes in our body. If our heart starts racing, we might be excited or fearful.  If our jaw clenches, we might be angry.  If a smile comes to our face, we know we’re happy.  Once we become familiar with these signs, we can use our bodies as an early warning system to let us know what emotion we’re feeling.

Step #2:  We feel an emotion when something we care about is at stake.  After we decide what emotion is present, we can ask ourselves what issue feels like it’s being threatened or honored.

Step #3:  Once we understand the issue, we can construct a statement that reflects our position – why we’re feeling the way we are.  In this way, we can skillfully speak out, without acting out.  A statement might include a reference to the emotion we’re feeling, the issue that’s at stake, and why we are concerned or excited about what’s happening.

Emotions are a wonderful part of life.  While most of us prefer the highs of happiness, excitement, love, and joy, we wouldn’t appreciate them as much without the contrast of sadness, disappointment, loneliness, and despair.  And since emotions provide the best clue to what’s important to us, it’s crucial that we befriend them, appreciate them, and learn to let them guide us to a life that feels congruent with who we are and what we value most.

 

This work was joyfully developed in collaboration with my friend and fellow coach,  Deborah Munhoz

Posted in Doctor Coach, emotional intelligence, physician coach, physician coaching | Tagged , , , , | Leave a comment

Beware the trap of comparison – physician coaching helps us find the right metric

Group of people doing yoga warrior pose at white studio with gesture of will. Fitness class, sport and healthy lifestyle concept
Yoga is considered a gentle form of exercise – so I was frustrated when my back muscles cramped and I found myself in bed, unable to stand or walk after a class.  A wise bodyworker asked me to describe what I had done during the class.  “I saw someone move deeper into a pose, so I thought I could go deeper too,” I replied. Laughing, she said, “You’re not practicing yoga, you’re doing competitive stretching!”

I had to admit she was right.

How much of our behavior is driven by comparisons with others? How often do we feel compelled to purchase a new car, accessory, or electronic device after someone else buys one? How many of us suffer from FOMO – the fear of missing out – so we take on a new activity or role we don’t have time for, say yes to an event we don’t want to go to, or volunteer for something we have no interest in, in order to “keep up” or not miss out?  How much time is consumed by self-doubt as we worry we’re not “as good as” another person at work or in our life?  My parents’ typical response when I reported a test grade, “What did everyone else get?” instilled the belief that it was important to come out on top of any comparison.  The competition of medical education and training further ingrains that goal in our minds.

Here’s the truth: comparisons are set ups. While striving to do as well as or better than others can motivate us to study, practice, or improve, it tricks us into reaching for the wrong goal.  Yes, winning is usually more fun than losing. But winning alone, without also doing our best, enjoying the fun, or achieving some growth through the experience, is often hollow and unfulfilling.  And if our sole trophy is the sense of being better than someone else, the joy we feel quickly fades, leaving us with the anxiety that we may not come out on top next time.  The pressure to continue to triumph may even undermine our further attempts to succeed.

Freeing ourselves from the trap of comparison is simple – although not as easy as we might hope. The hard part is challenging the belief that our worth or importance is tied to being equal to or better than someone else.  The first step in changing this pattern is to recognize when we’re comparing.  This gives us the opportunity to ask some important questions: What feels joyful, interesting, or meaningful in doing this? In what ways will I learn and grow through this experience or effort?”  We can then refocus our attention on that. The metrics we measure ourselves by must always reflect our values and bring us a sense of fulfillment; they must reward our efforts, celebrate our growth, and allow us to feel more connected to who we are and what matters to us.  In this way, our efforts are never eclipsed by another’s and we remain focused on the right goals – following our passion, learning and growing, and experiencing the adventure and exhilaration of living an authentic life.

 

 

Posted in mindfulness, physician burnout, physician coach, physician coaching | Tagged , , , , | 1 Comment

What will YOU choose? A physician coach chooses joy

Viktor Frankl, the psychiatrist who wrote Man’s Search for Meaning, is thought to have said, “Between stimulus and response there is a space.  In that space is our power to
Options Just Ahead on Yellow Highway Signchoose 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.

As a relatively new bass guitar player, it felt both exciting and terrifying to play in a band with experienced musicians.  I worried that the professionals, after investing so much time and energy and dedicating their career to this pursuit, would feel disrespected.  Who was I to think I was good enough to play with them?   I worried I would ruin the sound, depriving our guests of the delight of hearing really great music.  As a high school cello student, I played in an orchestra far above my skill level.  I reveled in the beauty of the music, and during passages I couldn’t play well I kept my bow an inch above the strings so I wouldn’t create dissonant sounds.  As the only bass guitar in the band, that option wasn’t available. And yes, I worried that I would make a fool of myself.  “She’s awful!” I imagined people whispering.  Yet, the draw of being surrounded by the music I love and being a part of its creation was too much for me to pass up.

Making a mistake was a given – there was no way I could know how to adapt to live musicians who, unlike the YouTube videos I practiced along with, played things differently every time. I knew I would screw up, and probably many times.  And I decided that, in every moment I remembered I had a choice, I would ignore any negative feelings and instead choose joy.

The time came to take the stage along with the band.  Having rehearsed my first song over 100 times, I felt I knew it well.  I looked at my friends in the audience, surveyed my bandmates, and suddenly realized that they had already started playing! Choosing joy, I quickly jumped in and began playing my part, exhilarated to be contributing the Flex3.1.19JOYbeautiful, 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.

It would be dishonest to say I don’t have feelings of inadequacy, not measuring up, or feeling like a fraud.  We all struggle with those at times.  What has become clear is that, while we have these human feelings, we can choose to put our attention on another feeling instead.  There are so many options available to us – love, awe, curiosity, compassion, contentment – the list is long.  I chose joy.  What will you choose?

Posted in mindfulness, physician coach, physician coaching | Tagged , , , | Leave a comment

Want more resilience? Physician coaching helps you find the strength in holding opposites

Lengthening and stretching the body is one goal of yoga practice.  As you stretch your arms up toward the sky, you also imagine pushing your legs down into the Silhouette of a beautiful Yoga womanearth.  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.

When we deny ourselves the experience of exploring other options, opinions, or activities, we also prevent ourselves from developing the resilience that’s necessary to adapt and adjust to what life brings. Instead of being resilient, we become brittle.  The truth is that we are all much more complex and colorful than the uni-dimensional version we allow the world to see.  To maintain this facade, we often need to neglect important parts of ourselves.  We become disconnected from all that we are, and that disconnection leads to burnout.

David Richo’s Practice of Befriending the Shadow offers a method for stretching our minds and spirits, much like yoga stretches our bodies.  Richo asks if we can be “committed in a relationship while still remaining free,” “angry at someone while still remaining loving toward this person,” ” aware of my faults while still remaining high in self esteem,” “responsibly in control of myself while still remaining spontaneous,” “flexible while still remaining true to my standards.” Many of us may wonder if this is possible; we may even feel an instant resistance to this idea.  All too often, we fall into an “either/or” or “all or none” stance that forces us to turn our backs on an entire side of our personality or option for our life.  We are unable to forgive a person for their mistake and lose valuable friendships.  One error causes us to lose our self-esteem and self-confidence. Our lives become more stressful as we fear that one spontaneous act or relaxation of our rules may call our character into question.

We can challenge our habit of closing ourselves off and, instead, intentionally begin to stretch ourselves.  What’s something you’ve wanted to do, but told yourself you can’t because it wouldn’t be in keeping with the persona you let the world see?     Would you be willing to discuss an issue you feel strongly about with someone who holds the opposite opinion, bringing an open mind and honestly hoping to discover something you might agree with?  Is there someone who has angered you, with whom you might have a conversation to hear their side of the story?  Have you doubted your ability because you’re not perfect? What do you know about your capabilities and successes that you might employ as a counterbalance?

By making a conscious effort to look at the other side – to stretch ourselves in both directions – we make more space in our lives, become more resilient, and strengthen our ability to live full and rich lives.

Posted in mindfulness, physician burnout, physician coach, physician coaching, Resilience | Tagged , , , | Leave a comment

Announcing the True Story Group Coaching Program for Women Physicians!

Women physicians are a unique group.  We’re smart, caring and talented.  Many of us wonder why we’re not as happy as we thought we’d be.  We used our intellect to succeed in a challenging course of study, only to find ourselves in a career that is fraught with biases that limit our opportunities, work that doesn’t stimulate us, and demands that leave little time or energy for the excitement and promise we imagined life would hold.  In our dreams, we were helping people, making a difference, and living with passion. Now, we wonder why the life we lead has so little joy. We try to solve this dilemma with the same skills that allowed us to succeed in school – hard work, perseverance, ignoring our desires and needs.  When this doesn’t work, we feel confused and stuck.

What if you could unlock this mystery and find greater freedom in your life in the next
six months?

Portrait of happy traveler girl with raised up handsThis 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.

Designed for busy women physicians, the program includes a preliminary, individual strategy session with me to define your personal goals for the program, eight, 75-minute live group phone calls and two, 60-minute individual coaching sessions.  There will be homework between sessions to aid you in applying what you’re learning to your own life, and a private online group for you to share your insights and receive support from the group in between sessions.  While your time investment will likely be around 5-6 hours/ month, the skills and perspectives you gain may save you countless hours in the future!

To sign up or learn more, email helanefronekmd@gmail.com.  And feel free to forward this to any woman physician who might be interested!

Posted in physician burnout, physician coach, physician coaching, physician fulfillment, physician work life balance | Tagged , , , , , | Leave a comment