Ramblings on healthcare, medical education, and life with a spinal cord injury
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Having a Disability vs. Being a Woman

Which is worse? Just kidding. And yes, the title of this is just a bit inflammatory. But bear with me, it has a purpose. And, well, it’s a pretty funny title.

When I first started the clinical portion of medical school, I wondered how patients would respond to a medical student who entered using a wheelchair. I worried that they would all look at me funny and talk down to me, and think I was just there to observe, and not to participate. And sure, over the last several years, I have gotten the occasional odd look. But it’s rare. Much more rare than I thought. People most often don’t show any visible reaction, and are quite good at getting down to business and telling me all about their bowel movements.

Once in a while, I’ll get comments filled with just a bit too much adulation. I know they mean well, but I’ve gone into a room to examine a patient and had another person in the room tell me, “oh, it’s SO wonderful you’re doing this! Wow, that’s just amazing!” And I do understand that a doctor who uses a wheelchair is not an everyday occurrence, so I don’t have any negative feelings at all toward people who take it a bit too far. I know they mean well, and I appreciate the sentiment. But there comes with it the subtle back-handed complement based on the idea that they’re surprised I’m not a shut-in living in my apartment.

But to get back to my original point, the overwhelming majority of my patients just treat me the same as anybody else. And even when traveling around the hospital when not wearing my white coat, people see the scrubs or the tie with a stethoscope, and I tend to always get “Good morning, doc!” Or, “Hey, doc! How’s it going?” (The first time someone I didn’t know said that to me, I couldn’t help but crack a big smile.) So I’ve come to realize that, at least when in that setting, I am seen as a doctor. It took a while to realize that, but I have. And I suspect that imparts some confidence that I subsequently can draw on, making my presence that much more appropriate and easy to realize. People do see me as a physician, even when I introduce myself as a medical student – which I only have to do for two months more!

What does this have to do with women?

I went into a patient’s room during third year with a resident I was working with, who was a woman. The resident proceeded to explain what was going on, and what the treatment approach would be. And as soon as she was done, the patient turned to me and asked if it was the right approach. The patient didn’t say, “well, she’s a woman, she doesn’t know, is that right?” And I could have chalked it up to just asking for another opinion. Until it happened several other times with other residents, in other hospitals, with different patients. And always only when I worked with female residents, never with male residents.

Just today, I went into a room to see a patient I’d seen yesterday. Yesterday, the patient referred to me as his doctor. Today when I entered with my female attending, he was on the phone and said, “I’ll have to call you back, the doctors and nurses are here.” All of the nurses in the hospital wear all white scrubs. The attending had on a white lab coat, and was dressed in appropriate doctor clothing. The women appear to notice it as well, as whenever I see that kind of thing happen, the women tend to quickly use the word ‘doctor’ and re-state their role. Never in a confrontational manner, just an introductory statement.

On one of my interviews, we were on the hospital tour, walking around in our nice little penguin suits, as a man passed us. He looked at us, smiled, and commented on how good we all looked in our suits. He congratulated us on being, “future doctors and nurses.” One of the female applicants quipped something funny in response, and seemed to have gotten that kind of comment before.

I’ve come to feel over the course of the last several years that I have seen more overt biases toward women in healthcare than I have to a man who uses a wheelchair. Perhaps that’s because people have pre-existing ideas of what a nurse is supposed to be, while nobody has ideas about doctors who use a wheelchair. Interesting side note, one of the executive producers of the TV show House said that House was originally intended to use a wheelchair, not a cane. But Fox rejected that idea. And now back to our regularly scheduled program..

The stereotype of a nurse certainly is of a woman – and it would seem to be a correct assumption to make more than 94% of the time. These nursing statistics, from Minority Nursing Magazine, are quite interesting. According to them, men only account for 5.8% of the nursing population. And the average age of RNs is 46.8. So if one is going to make any assumptions about the gender of one’s nurse, assuming your nurse is a woman is probably a pretty safe bet. Not that I would encourage anyone to generalize, of course.

But assuming that any woman one sees in the hospital is a nurse is not quite so safe. According to the AAMC (American Association of Medical Colleges), 48.3% of medical degrees awarded in the US in 2010 were to women. That doesn’t mean 48.3% of physicians are women, since there’s a lot of graduates practicing from older classes that were significantly more male. But it means we’re doing a much better job of balancing things now.

It’s something that I feel I’ve observed enough to have noticed it, and of course, now I remember each incident even more vividly since I’ve seen it several times already. And certainly, people come to every encounter with their entire life’s experience. I guess that when I started medical school, I never would have guessed that I would see such overt assumptions made about women in this day and age, without at least as many overt assumptions about me.

But it turns out, I was the one making the overt assumptions about me.

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