The Milky Way Mind: Ending gender bias in medicine, leadership and the workplace

By Whitney James, MD – Girl Neurosurgeon

“What we have found consistently, is that when we present women and men with exactly the same credentials, qualifications and backgrounds, for a job that is traditionally male, held by men in our culture, thought to require male attributes, we consistently find that the woman is seen as more incompetent than the man.”

– Madeline Heilman, PhD, Department of Psychology, NYU

A couple of weeks ago, I was honored to be the keynote speaker at Kaiser Permanente’s Women in Medicine Symposium in San Diego, California. Some of my key messages:

  • Presently, fewer than 1/5 of our elected leaders are women.
  • Fewer than 1/20 of Fortune 500 CEOs are women.
  • In 1966, only 6% of medical student graduates where women. In 2016, 46% of medical school graduates were women.
  • Yet still, in 2018, only 1 in 5 full professors of medicine is a woman.
  • Only 15% of Department Chairs in medicine are women.
  • Only 3% of Chairs of Departments of Surgery are women.

Women in traditionally male fields, such as medicine, often find themselves in a catch 22. Either they are perceived as “too nice”, which comes across as “weak” and “incompetent”. Or, they are perceived as competent, but “unlikeable”, “untrustworthy”, “not a team player”. Sometimes, the perception can oscillate back and forth between “weak” and “unlikeable” many times during the course of a work day. Shankar Vedantam has an entire Hidden Brain episode devoted to this very topic, and definitely worth a listen.

One of my key messages in my talk was that nothing is going to change without the support, backing and motivation of the majority group, in this case men. In any situation of discrimination, the discriminator must be the one to question their own perceptions and subconscious biases, recognize them, and be committed to opening their minds to alternate possibilities. It should not be on the shoulders of the discriminated to change their behavior so as to conform to the majority group.

Ending gender bias in medicine, leadership and the work place can’t just be on the women aiming for the corner office.

It has to be on all of us.

What Is It?

Case courtesy of Sumer’s Radiology Blog.

This is an axial T1 MRI with contrast demonstrating a glomus jugulare tumor growing out of the left jugular foramen. Three cranial nerves traverse the jugular foramen – the glossopharyngeal (CN IX), vagus (CN X) and accessory (CN XI) nerves – and these nerves can be unilaterally affected in the setting of a glomus tumor.

What Is It?

This is a T2 MRI C spine demonstrating a “swan neck deformity” – draping of the spinal cord over a kyphotic deformity of the cervical spine. Typically, extensive cervical fusion is required for correction and prevention of deterioration in symptomatic patients.

What Is It?

Case courtesy of Dr Alexandra Stanislavsky.

This is a CT head demonstrating agenesis, or absence, of the corpus callosum. The corpus callosum is a broad band of axons interconnecting the two hemispheres of the brain. Agenesis of the corpus callosum, although rare, is one of the most common brain malformations in human beings. It can be completely asymptomatic, or it can be associated with autism, seizures, and motor, auditory and/or speech symptoms. The anterior corpus callosum has been noted to be more pronounced in musicians and left handed and ambidextrous people.

What Is It?

Case courtesy of Dr Roberto Schubert

Baastrup’s syndrome (aka “kissing spines”) results from osteoarthritis of spinous processes (usually lumbar). The spinous processes rub up against each other which leads to hypertrophy and sclerosis. This can cause a patient pain that is exacerbated with extension and relieved with flexion. The disease is named after Christian Ingerslev Baastrup, a Danish radiologist (1855-1950).

What Is It?

Case courtesy of Radswiki.

This is an axial FLAIR MRI sequence of a third ventricle colloid cyst. These cysts are benign in nature, however they can quickly cause a deadly hydrocephalus by blocking the foramina of Monro and CSF flow out of the lateral ventricles. The hydrocephalus, or ballooning, of the lateral ventricles can cause herniation of the medial temporal lobes across the tentoirum cerebelli, and eventually herniation of the brainstem through the foramen magnum, resulting in death. Treatment includes placement of an external ventricular drain (“EVD”) in the lateral ventricle to relieve hydrocephalic pressure on the brain, followed by endoscopic surgical removal of the colloid cyst.

Trust & Lies: The Predicament of Modern Medicine

Trust is absolutely pivotal in the practice of medicine. Patients need to trust their physicians. Physicians need to trust other members of the medical community. The medical community needs to trust the medical literature and evidence-based guidelines. But what if much of day-to-day medicine is actually rooted in subtle lies, bias, faulty perceptions and misconceptions?

The Lies We Tell – Social Bias, Myths and Blindspots in Medicine is a brilliantly written piece by Dr. Charles Odonkor and a worthy read for any aspiring medical student or young physician. It is a call to first, be honest with yourself. It will be the next generation of physicians’ unique challenge to “reconcile the disharmony between stated ideals vs. the realities, which often arise in the imperfect science and art of medicine.

Part 2 to the above series, here.

More to come on the topic of trust in medicine in the coming weeks.