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Two Flints to Spark the Fire

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Day to day aspects of clinical medicine, mountains of paperwork, narrow deadlines and high expectations; these form just part of the daily life of a doctor. For doctors in training, balancing this stress with annual job applications in an increasingly competitive climate of specialty training has resulted in a high pressure, tense environment where hard work and diligence no longer constitute sufficient progress towards receiving a coveted advanced training position. The support of a mentor becomes essential.

I was well aware that I had chosen a career within a specialty which is largely male dominated and strived to establish my own professional relationships, explore research opportunities and attempt to balance higher education with my clinical responsibilities. Though I met many inspiring female doctors along the way, my earliest mentors were all male physicians. I remember looking up to junior and senior female doctors and found myself wanting to emulate them after completing medical school, but distinctly remember thinking, “where are the female mentors?”

Although I worked with many female colleagues, I felt very much alone in my desire to pursue cardiology and certainly did not receive external validation that this was an achievable goal. Regardless, I decided that if others had done it before me, then why couldn’t I? So I worked very hard as an intern; in my mind, this was the expectation. I enjoyed it thoroughly. However, it wasn’t without challenges.

In the formative years of my training, I recall the most dreaded part of my work was making referrals to advanced trainees- the institution I worked for during the time was notorious for being “tough” (which, in today’s terms, might constitute bullying). Interactions with senior colleagues were highly variable, however my most harrowing interactions involved inimical referrals to female doctors.

One such experience involved a referral to the endocrinology registrar, a female doctor only 3 years my senior. I found a quiet place so as not to be disturbed or distracted. I prepared meticulously. I had all the notes arranged in front of me. I rehearsed what I wanted to say, the format and reason for the referral, and made sure to have all relevant results readily available.  My consultant, a dual trained endocrinologist and general medicine physician had requested a formal endocrinology opinion to optimise glycemic control in a type 2 diabetic patient. The request seemed reasonable enough to me.

My heart was racing as the phone began to ring. I reminded myself that I was prepared. The tone of voice on the other end of the phone was blunt, abrasive and unpleasant. I tried not to let this crumble my resolve. I made the referral as rehearsed. Then came a barrage of questions: “Why are you wasting my time? Do you feel uncomfortable managing basic diabetes? Have you discussed this with your own registrar? Why can’t your medical team manage this?”

I remember feeling completely intimidated by the encounter; it really shook my confidence and has left a lasting impact. In the end I felt I had to fall back on the historically reliable line; “my consultant, who is an endocrinologist, requested a formal opinion from your service.” I felt powerless to raise the issue within the institution, due to the crippling fear of compromising my career opportunities and because this behaviour had clearly become normalised.

Even now, as an advanced trainee, I still encounter unpleasant experiences with other women. More recently, during my advanced training, I began to notice that I was being bullied by a senior female physician, who treated my male colleagues respectfully and in a collegial manner. If I’m being honest, I have been reduced to tears on multiple occasions by this particular senior female doctor. Whether I stand my ground and speak with confidence and conviction, or ingratiate myself, I have been unable to strike the balance and improve our rapport. Regardless that her role is within a different field to mine, the regular overlap in the provision of care we provide to patients relies upon a good working relationship.

This is not a perception.

The Workplace Bullying Institute 2017 US survey suggests that females perpetuate bullying a third of the time and target females twice as much as male colleagues (67% vs 33%). I remain completely mystified as to how women, who have been through the early, difficult stages of training, could treat other women in this way. Shouldn’t women in medicine be championing other women? Particularly those with more experience, who should be encouraging, nurturing and supportive of upcoming junior female doctors? It is important to recognise how profound the impact of both positive and negative interactions can be on confidence, beliefs, values and development.

I raise my experiences to demonstrate that incivility can occur at all career stages and levels of seniority. Moreover, the purpose in sharing these stories is not to promote victimisation or to find blame, but to recognise the origins of this pattern of behaviour, and to seek future-focused solutions. Facilitating open channels of communication and encouraging positive interactions may enhance our understanding of each other’s circumstances; as it may well be that someone else is dealing with a unique set of frustrations and insecurities in a profession still struggling to achieve gender parity.

We have reached a pivotal period in which issues of gender and discrimination are a high priority and are now openly and readily discussed. Gender discrimination systematically and primarily affects women. But this includes bias of women towards and against other women.

Why does this happen?

Clambering towards the top.

In some specialties which remain male-dominated, there is often the perception that there can only be one or very few successful women. There isn’t room for more. We need more examples of positive female role models who actively champion women in order for women to feel comfortable pursuing any specialty and in the broader context, into any industry.

Incivility in the workplace: who are the perpetrators?

Contrary to traditional beliefs, there are emerging theories suggesting that incivility towards women extends beyond gender discrimination, and that some women consciously mistreat other female colleagues through unprofessionalism, disparaging or condescending remarks and by exclusion or ignoring individuals. The basis for this behaviour seems to relate to a perceived threat to pursuing and achieving advances in career opportunities.

Prescriptive stereotyping.

Women in professional roles tend to be assertive, formidable and opinionated; conventionally, these traits are admired and revered, however, in some contexts this may be seen as contravening the societal norms attached to gender roles and may result in women suffering criticism from both male and female colleagues.

The competitive edge.

Competition in and of itself it not necessarily a bad thing; it drives us to be better and provides motivation to strive for our goals. The big question is, how do we stay competitive and motivated without it transforming into a negative driving force that adversely impacts our productivity and relationships? Women are more likely to compare themselves to other women, which may further engender incivility, rather than promote mentorship and collaboration.

We must stop this.

Women in medicine should be encouraged to champion other women loudly and proudly, until we are able to change the negative perceptions that surround us.

When women support each other, the benefits unequivocally extend to individuals, organisations and the wider community. Mentorship provides reciprocal benefits by facilitating access to opportunities and networking, recognising the achievements of emerging talent and elevating female mentors as emerging leaders in their own right. Organisations that embrace mentorship create a culture of support, where talent and diversity is recognised and celebrated.

Connections among women within medicine are fundamental across all levels to progress efforts towards achieving gender parity, reduce the perceived threat, allow individuals to positively channel competitive traits and promote a culture of civility, strengthening the alliance between women in medicine.

“We need women at all levels, including the top, to change the dynamic, reshape the conversation, to make sure women’s voices are heard and heeded, not overlooked and ignored.” (Sheryl Sandberg, Chief Operating Officer, Facebook)

Author: Louise Segan, MBBS

Louise Segan, MBBS

Dr Louise Segan MBBS is an Advanced Cardiology Trainee and Barwon Health and Research Fellow at the Baker Heart and Diabetes Institute in Victoria, Australia. She has an opinion on almost any subject and firmly believes in the need for gender diversity within Cardiology.


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