Editor’s Note: This account is filled with wise and valuable observations that can benefit those in training and in practice.
“I never felt gender bias was personally aimed at me, so I was able to ignore it.” I can truthfully say after a career of over three decades, it has been wonderful. I absolutely would choose orthopaedic surgery again as my profession.
My favorite memories are about patients. One was a woman with an infected nonunion of a femur fracture. I participated in a team who worked for 24 hours to debride the infection, add a vascularized fibular graft and do free tissue transfers for coverage. The team worked beautifully together. The woman survived her surgery, and my understanding is that she ultimately regained function.
Another is of a woman from a distant continent who came to my hospital with a painful fracture nonunion. I operated and she went on to heal and do “great.” She later returned to see me and was accompanied by a translator. After her exam, she asked if she could take my picture. She said, “I want to hang it up in my village” so she could remember me and let others know about her good fortune.
Orthopaedic surgery is a powerful profession. As surgeons we do such useful work. I am discouraged when medical students tell me of having been overtly or covertly dissuaded from entering a surgical field. The young women are reportedly asked on residency interviews or on their applications, how they will manage a family and a career. Institutions have changed policies, but in many instances, attitudes have not. This is ironic since the medical school I work with is affiliated with a medical system containing many female surgeons. Is it possible that the question is aimed at “rattling” the interviewee? Or is it a probe searching for weakness?
My daughters are medical students, and one plans on going into surgery. They tell me about sexist stereotypical behavior which is known to be wrong but persists.
When I look back on my career, my male colleagues and mentors were wonderful to me. Despite that, I always felt a bit lonely. They were able to “mentor” but not to “nurture” me. Women who do orthopaedic surgery would benefit from more nurturing.
My observation is that in everyday life, when I communicate with men about a problem, we define it and then go about solving it. With women, the approach must be modified. There must be talk about their day and their families, etc. before the real problem solving begins. Otherwise, I may be seen as uncaring or “not nice.”
This parallels communication in the operating room. Although there may be regional differences, male surgeons are expected to give orders and even be a little arrogant. This doesn’t fly for women. The message must be softened so that work can be accomplished. Nursing and OR technologist culture is an enigma. I have had many nurse supporters but also those who were not. Even though we both had the best interests of the patients in mind, I believe I was being misunderstood and perceived as a negative force. Deciphering these communication differences and barriers would enhance the efficiency of the work we do and make it more enjoyable for all.
An observation about the “performance vs trust axis” which is important for teams; this includes the make-up of residency programs. I have observed “lower performers” being accepted over those higher on the scale. Those less gifted may be trusted to work well on a team over those who stand out and may be “toxic”. High achieving women may fall into the potentially “toxic” category and lose out on entry into a program.
Here are my suggestions for those beginning their careers”
- Focus on communication. Listen to the person in front of you and then try to get them to focus on what you are saying.
- “Read the room.” This takes practice.
- Focus on the task, not yourself. Try to keep ego out of it.
- Being part of the team is not hard, becoming team leader is. Be ready for criticism and less support than you experienced as a team member.
- If you have an interest in doing orthopaedic surgery, “go for it.” Be an independent thinker. Speak to those who balance a surgical career and a family to learn how it can be done rather than letting outsiders’ perceptions sway your decision.
- Being a bit of a “loner” may be helpful during the years of training and even practice. Be prepared to get your nurturing outside of training and work.
- In the final analysis, it’s all about caring for the patient.