Female surgeons feel unfairly judged when they act in ways that conform to the behavioral norms of their profession rather than traditional gender norms—a double standard that they believe contributes to conflicts with other health care workers, according to new research.
These interprofessional conflicts can harm female physicians’ well-being and professional reputations, contribute to burnout, and affect patient care, according to the authors. “These conflicts made people physically sick and made them dread coming to work,” said co-author Dana Telem, MD, MPH, the director of the Michigan Comprehensive Hernia Program and a professor of surgery at the University of Michigan, in Ann Arbor. “You can easily see how that translates into diminished success, satisfaction or wellness.”
Investigators conducted semi-structured interviews with 30 female surgeons across the United States who experienced a conflict that led to action by a nonphysician. Many participants reported that conflicts arose with other professionals in the hospital when female surgeons felt their actions mirrored those of male surgeon mentors or peers but were unwelcome because they are women.
One participant said: “If you get upset or react to a situation, you’re considered emotional or reactionary, whereas if a man does it, they’re being assertive or advocating for their patients.”
Another participant said: “I think there is an inherent tension between women physicians and women nurses.”
And another: ‘‘It can affect patient care because it makes you not want to go back to the scene of the crime, if you will. I was probably less interactive in trying to engage the team in conversations about patient care.’’
Two reports from the interviews were published in JAMA Network Open (2020;3[10]:e2019843) and Annals of Surgery (2020 Jul 7. [Epub ahead of print]).
Study co-author Lesly Dossett, MD, an assistant professor of surgery at the University of Michigan, said the idea for the project came from conversations and private social media channels in which female surgeons said they were stressed about interprofessional conflicts. The women said they had been written up or reported for issues that were sometimes presented as safety concerns, but the surgeons believed the conflicts arose from sex bias. On Twitter, as the study was being conducted, women from various professions started the hashtag #whyiwaswrittenup, intended to demonstrate inequities in standards for professional conduct.
Although sex equity in surgery has been well studied, most interventions are directed at surgeons or hospital leadership rather than the broader community of health care providers. “But there is an equity experience for women surgeons that doesn’t come from surgeons or health-system leaders,” Dr. Dossett said.
The reports found:
- Interprofessional conflict experienced by female surgeons was primarily due to breakdowns in communication, breaches of protocol or the surgeons’ response to perceived performance-related issues.
- The reporting of events often surprised female surgeons, as they had not perceived a significant conflict with staff. Participants said they did not believe the reports reflected malicious intent but felt these conflicts reflected a bias and gender scripts of society at large.
- Female surgeons said these conflicts had substantial personal and professional implications, describing feelings of self-doubt, depression, frustration, devastation, humiliation and anxiety, as well as physical symptoms (e.g., gastrointestinal distress, loss of appetite, insomnia, burnout and exhaustion).
- Participants believed patient safety mechanisms are frequently misused for addressing personal complaints. These reports should undergo an internal informal complaint process separate from the adjudication system addressing events that affect patient safety.
Stephanie Bonne, MD, an associate professor of surgery at Rutgers New Jersey Medical School in Newark, was one of the first surgeons to use the hashtag #whyiwaswrittenup on social media, encouraging women to share their stories.
Dr. Bonne said these studies put “science behind things that women surgeons have been talking about for years, which is that the experience of being a woman in surgery is very different than being a man.” She hopes these reports will encourage everyone to speak out when they see discrimination against colleagues.
The authors acknowledge that this work has significant limitations. The design is decidedly one-sided: Investigators relied on female surgeons to self-identify workplace conflicts, and they did not interview other staff regarding their experience of conflict with female surgeons. This study also did not look at questions of race/ethnicity, experience level or other factors. Similar studies of male surgeons have not been conducted.
The authors plan to conduct future studies with nonphysician staff and male surgeons for additional perspectives.
But these reports help the surgical community address inequities, said Thomas K. Varghese Jr., MD, the executive medical director of the Huntsman Cancer Institute and a professor of surgery at the University of Utah, in Salt Lake City. “Overwhelming evidence of gender discrimination, disparities, injustice, and of women and minorities being treated unfairly” exists and has for a long time, he said. Qualitative studies take the surgical community one step closer to meaningful change, he added. “That’s really the bigger question: What are you going to do about it? This is a brave first step to deep dive, explore and disentangle these issues,” he said.
He added that speaking up remains a key component of promoting a safe workplace culture. He and the study authors said patient safety reporting procedures should not be used to respond to personal conflicts.
This article is from the March 2021 print issue.
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