What is "Professional"?

What is "Professional"?

08-03-2020
Emma Goldberg via NY Times

In medicine, you feel so scrutinized already. When you add the extra layers of gender and race, it’s exhausting.” — Carmen Simmons, 27, a fourth-year medical student When Dr. Christle Nwora, 26, was applying for her medical residency — the hands-on training that immediately follows medical school — she knew that every facet of her education would be subject to scrutiny like her grades and her performance on rotations. But she also worried that parts of her identity and appearance beyond her control would be judged, too.

“How do I wear my hair?” she asked her mentor, as she prepared for her residency interview. “Am I making a political statement if my hair is in an Afro instead of braids?”

To Dr. Nwora, an internal medicine and pediatrics resident at Johns Hopkins Hospital in Baltimore, the idea of “professionalism” in medicine is one coded with racial and gendered assumptions. The archetypal doctors she was exposed to were so often white and male — from the faculty at her medical school to the fictional doctors on television shows. “When I think about a medical professional, I think about a white man in a white coat with a prescription pad,” she said. “I don’t think about people who look like myself and my friends.”

She saw those “professional” stereotypes underscored in the publication of a study, in the Journal of Vascular Surgery, about so-called unprofessional social media content among young vascular surgeons. The piece ran online in December 2019 but resurfaced last week because it was set for publication in the journal’s August print issue.

For this study, whose seven authors comprised six men and one woman, three male researchers created “neutral” social media accounts to search and follow vascular surgeons in training. Next, they reviewed the Facebook, Twitter, and Instagram profiles of 235 graduating vascular surgery trainees and flagged content that they viewed as “unprofessional.” By their definition, this included photos showing doctors with alcohol or in “inappropriate/offensive attire,” including “underwear, provocative Halloween costumes, and provocative posting in bikinis/swimwear.” They also viewed controversial political comments, particularly “stances on abortion and gun control,” as unprofessional.

Hundreds of medical professionals, male and female, responded by flooding social media with photos of themselves in bathing suits, some with alcohol, with the hashtag #MedBikini. Some posted pictures that showed off their cesarean section scars; others captured moments at the beach after all-night hospital shifts. One man shared a picture of himself boating on a lake, with the caption: “How unprofessional is this life jacket?” Many of these posts highlighted the sexism in admonishing doctors for wearing bikinis and noted that the paper was reviewed by an all-male editorial board.

“I’m sure there are hundreds of pictures of male physicians in swimming trunks and that’s never been picked up as unprofessional,” said Dr. Janis Orlowski, chief health care officer of the Association of American Medical Colleges. “I do believe there’s an underlying gender issue here.”

The journal retracted the study and apologized on Twitter, acknowledging the “errors in the design of the study with regards to conscious and unconscious bias” in a note signed by the editors. (Both of them Peters.)

But to many physicians and medical trainees, the study served to spotlight the gender biases they’ve long encountered in the field. Or in the words of Eshani Dixit, a third-year medical student at Rutgers New Jersey Medical School: “It said the quiet part out loud.”

A 2019 report in the New England Journal of Medicine found that sexual harassment, gender discrimination and verbal abuse have contributed to high rates of burnout among female doctors. The survey of 7,400 surgical residents found that 65 percent of women experienced gender discrimination on the job, either from patients, attending physicians or other staff, and 20 percent reported sexual harassment. A recent international salary survey found that female doctors make 20 to 29 percent less than their male counterparts.

Some of the barriers that women face in the medical workplace are subtle, according to Dr. Adaira Landry, an emergency medicine physician in Boston. Dr. Landry said she has sometimes been mistaken for a nurse or custodial services worker because her colleagues and patients are not accustomed to seeing a Black female doctor. She knows that standards are not applied equally when it comes to appearance, either. She recalled the discomfort she felt when she heard a white attending physician ask a Black female trainee to cover her dreadlocks because it “wasn’t a professional look.”

“I can’t and don’t want to change my hair, facial features and body frame,” Dr. Landry said. “That’s who I am. But if those are seen as unprofessional, what does that mean for me?”

Dr. Landry noted that comments about professionalism in medicine are often couched in language about making patients feel comfortable. Yet research has shown that patients feel more at ease when treated by doctors who look like them.

A 2018 study found that Black patients have better health outcomes when they are seen by Black doctors. The study found, for example, that Black patients seen by Black doctors were more likely to agree to preventive care, like cholesterol tests and diabetes screenings, and to feel “comfortable and relaxed.”

And slowly, the medical field is growing more diverse. Last year was the first in which women ever so slightly outnumbered men in medical school. The number of Black medical students has also been gradually on the rise. And a new generation of doctors is challenging some of the old norms and assumptions of the profession, including through the #MedBikini campaign.

Carmen Simmons, 27, a fourth-year student at Meharry Medical College, a historically Black medical college in Nashville, felt a jolt of anxiety when she first saw the article about unprofessional social media content. She immediately thought of a photo she had tweeted of herself with six medical school classmates, all in red bathing suits, celebrating their first licensing exam at the beach. It was captioned: “We’re all your future,” with their specialties listed: “OBGYN, Family, Peds, Derm, Radiology, & Surgical Doctors.” As the #MedBikini campaign got underway, Ms. Simmons wanted to share the photo again. She feared that it might threaten her job prospects, but when her classmates gave her permission, she retweeted it.

Carmen Simmons, a fourth-year medical student, retweeted a photo of herself, third from the right, with six medical school classmates, with the caption: “We’re all your future.”via Twitter To Ms. Simmons, that felt like an act of protest against the standards of professionalism she had been taught, which she felt were being dictated predominantly by white men. “In medicine, you feel so scrutinized already,” she said. “When you add the extra layers of gender and race, it’s exhausting.” As she weighed the professional risks of reposting her picture, she decided: “If a residency program doesn’t take me because I participated in #MedBikini, maybe it’s not the place I should be anyway.”

Other physicians thought the journal article overlooked the value of social media platforms in the medical field, platforms that can be used to help educate young patients and bolster trust in scientific expertise.

Dr. Danielle Jones, a gynecologist in College Station, Texas, uses her TikTok and Instagram accounts to teach viewers, especially teenagers, about issues like contraception and vaccine safety, under the handle Mama Doctor Jones. She believes social media can help make doctors seem relatable and enable more open communication with patients.

Dr. Jones was also troubled by the study’s critique of physicians who post political comments on issues like abortion. As a gynecologist, she feels she should have free rein to post information about reproductive health services, which by the study’s standards might be deemed unprofessional. Amid a national wave of Black Lives Matter protests, she noted that many doctors feel an obligation to speak out against racial injustice on social media.

“People are fearful of physicians because we’ve been put on this pedestal,” Dr. Jones said, noting that she was wearing a swimsuit during her phone interview for this piece. “I don’t think it’s good to pretend we’re some elite group of people who don’t have a glass of wine or go to the pool.”

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