I’m in line in the hospital cafeteria, about to order a burrito bowl. Ahead of me is a tall, middle aged guy, ordering with confidence. His arm is on his hip, and he’s taking up so much space, I can’t even see the chef on the other side of the counter. I mimic his body language, placing my hand on my hip, reminding myself to take up space, as he shifts to make room for me. I think to myself, “I’d like to have half this guy’s confidence, even while ordering my lunch.” Then I wondered: am I allowed to have confidence as a female physician?

When it comes time for me to order my chicken, rice and beans, I wonder if the chef thinks I’m bossing him around too much.

Origins of the female physician: goody two shoes

This might not apply to you, but I for one was a play-by-the-rules, goody two shoes to get into medical school. I learned early on that I needed to play by the rules in order to succeed. To be accepted, medical school applicants must get perfect grades and do what they’re told, or face rejection. In addition, as women, we walk a particular tightrope of our own. We shouldn’t be meek, nor should we be bossy. That’s because society doesn’t give us the same leeway to make mistakes or exert ourselves as it allows others. 

Can female physicians enforce boundaries with confidence?

Maybe that’s why when a technologist asks me a wayward question during a case, I slap it down, with a curt “No.” I want to be sure I’m clear, and I’m heard.

The other tech, a traveler, laughs, mimicking me: “NO.”

The truth is, I don’t want to be peppered with questions while doing a case. If I need something, I’ll let you know. I appreciate the offer to help, but really, it’s just a distraction. And to me, any distraction is a safety issue in the IR suite. 

That’s why my procedures are safe: I don’t allow distractions. But someone new to the environment might think, “Hm. She’s a bitch…”

Truth is, when it comes to patient safety, I border on one. Why?

Not everyone sees the details or has the knowledge I do as the physician. On a team, one member can prevent another from making a mistake. But as head of the team, I’m ultimately responsible for everything. It’s my license on the line, and everyone respects that. My responsibility is to take care of the patient, not make sure everyone thinks I’m nice. 

Different rules for women in different places

But out in the world it’s not so cut and dry. We ladies have to conform to what society deems appropriate behavior for women. There are more bystanders, waiting to admonish us for our cultural gaffes. Even if you reject this idea of how women should or should not behave, consider the resistance you face in your own life when being forward, succinct, or direct.  

Women, whether they’re in charge or not, are expected to sugar coat things, smile, and take the extra time it takes to ensure everyone is comfortable at all times. They must be nurturing, communal, and put relationships over their own needs. But men aren’t held to this standard. They can be thoughtful, but it’s optional.

Men can be transactional in relationships. But what’s considered acceptable behavior in men somehow isn’t for women. I suspect it’s because in our society, we don’t value women’s time as much as we value men’s. Yet with all the responsibilities women face as breadwinners, workers, and caregivers, we don’t have the time or bandwidth for these extra expectations. And often, if we try to meet them, we become depleted.

Learning to find confidence in my voice

I wonder if this is why, as I recorded my first audio training for students and residents, when I played it back, I just couldn’t sound confident enough. I’ve always spoken with a hesitation and carefulness I wish wasn’t there. And that was amplified when I listened to my recorded voice.

My words tiptoe on eggshells. I mumble and swallow my statements to avoid stepping on toes. As a byproduct of this style, I often have to repeat myself more than I’d like. How liberating would it be to be heard every time: to speak like I’m throwing spaghetti at a wall. That’s how voice coach Hillary Blair of Articulate described it, when I attended one of her eye-opening workshops. 

Depending on the industry, the same ‘leadership behavior’ in a man is unbecoming of a woman. A man can be forceful, authoritative, and powerful, but a woman displaying the same behavior can be judged as abrasive, pushy, or bossy… even if she’s literally the boss. As a society, we penalize women for displaying traits that would get a man promoted. It’s no wonder we have such a leadership gap in medicine, politics, business, and beyond.

Leading as a female physician

Sometimes I marvel how I’ve come into leadership, despite the odds. I seem to have escaped some of the traps and obstacles holding other women back. I’ve been around my institution long enough to be considered when other people have moved on; I’ve been there to fill the leadership void. Part of the reason I’ve been allowed to rise into leadership is probably my progressive Southern California environment. I doubt it’s just my capabilities alone- since countless eligible women are kept out of leadership for flimsy reasons. 

In a way, the IR suite is my refuge from the chains of gendered expectation. I say what I mean, and I get shit done. Sometimes, I curse under my breath. Don’t get me wrong- the patient is sedated, not under general anesthesia, so there’s always a level of decorum. But in that room, people understand the importance of clear, succinct directives, and what I say goes. Patient safety is paramount, and I’m its steward. So the cultural expectations on me are temporarily lifted when I’m operating in our surgical micro-culture. 

So the question is, how can I transfer that confidence from the IR suite to the rest of the world? I just want to order a burrito bowl without apologizing.