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.