This week, if you were on social media, you likely witnessed or heard about the #medbikini outcry. This was a response to an article published in the Journal of Vascular Surgery (JVS). In the article, the authors, nearly all male, used fake social media accounts to troll the online presence of recently graduated vascular surgeons. According to the article, “Potentially unprofessional content included: holding/consuming alcohol, inappropriate attire, censored profanity, controversial political or religious comments, and controversial social topics.” It made me think about double standards in medicine. The authors judged “inappropriate attire” to include “pictures in provocative Halloween costumes, and provocative posing in bikinis/swimwear.” It’s double standards like the ones exhibited by the now-retracted JVS article that helped to ignite the #medbikini outcry. Clearly, women are tired of being targeted and criticized in medicine.

The article brings up a number of questions. 

Are they right? Should we be careful? 

Are we in a new era, in which doctors have to censor themselves so as to avoid potentially offending a patient or community member? Using this blog as an example, I vociferously encourage women to advocate for themselves and their best lives in medicine, even if it means going against the grain sometimes. Even if it means talking about specific instances of gender bias I’ve experienced. It’s a risk I take, to validate and support the next person who faces a similar event.

My mission to demystify life in the male-dominated fields of medicine has always been stronger than any fear of criticism I’ve had. Because I remember what it felt like to look into a veritable black box of a future. I knew that my male role models, as great as they were, couldn’t quite show me what life would look like for me, should I choose a similar path. That’s because we operate in a man’s world, in which they enjoy greater leeway. Men are doubted less and paid more. Until that’s not the case any more, I’m going to keep writing about it.

Our online presence

It’s true, patients can judge us based on our online presence. Yet because of human nature, people are more likely to post a complaint than a compliment online. People write negative reviews for even the most skilled, personable, and compassionate physicians. In the internet age, no physician is immune. A bad review can soil my online presence at any time, whether or not someone encounters that photo of me in a bikini on Facebook.

The kind of professionalism, or self-censorship suggested by the JVS article is a way to keep women small, afraid, and in their place. The criteria used to judge these surgeons was based on subjective constructs of a patriarchal society. Provocative poses? Who is to judge that? Does the image in this article depict a provocative pose, or a woman enjoying the water? Constructs like the ones upheld in the JVS article have held women down for eons. In the #medbikini outcry, women said, “That’s enough.”

Do subjective judgments of professionalism stop at photos of swimwear? 

You know they don’t. Somehow photos of surgeons in bikinis are potentially unprofessional, while photos of men in swimwear are not. This is a double standard, with deep roots in our culture. It’s not far from the double standards in the popular Hulu series, The Handmaid’s Tale. Men in this fictional society enjoy myriad freedoms, while women are relegated to specific roles depending on their ability to breed. Some of these roles amounted to sexual and reproductive slavery. Women are so much more than our bodies or our ability to bear children. This should be more obvious, but it’s still not to some in medicine. Our personal choices do not determine our professionalism.

If women can’t relax in a swimsuit or hold an alcoholic beverage without fear of retribution, it’s no wonder they burn out at a higher rate than men. The JVS article is a mere glimpse into the judgments and biases women in medicine face each day. Really, they are can’t relax or go “off the clock,” even in their social media profiles? The mere idea is stifling. In the end, while the article strived to “warn” newly graduated surgeons of the potential perception of their social media presence, it used highly subjective criteria and simply reiterated stodgy old ideas about how a lady should behave. 

What bothers me most is that by these standards, women are not free to live their lives without being judged for it– yet advertising execs can sexualize and objectify women every day. It’s okay for women to wear ‘inappropriate attire’ if it suits men. In this way, women’s sexuality provides pleasure, profit, or both. Yet women may not enjoy living comfortably in their own skin. For some, that’s too powerful. It’s threatening.

Implicit bias & double standards in medicine

Sadly, sexism is still a daily threat for women in medicine. Personally, as a woman in a male-dominated field, I have often felt the need to suppress who I am at work. That’s why I wrote about my personal evolution in my forthcoming book on finding your place in medicine, which will be available in October. I share encouragement and hope for those who feel they need to stifle their personalities to avoid judgement as a woman and/ or minority in medicine.

What the article suggests is not sustainable. We must be ourselves, without censorship or fear.

This week pummeled me. I was on call, and had three nights of interrupted sleep. I woke for case after case, handling it with all the speed and grace I could muster. By Friday night, as my toddler fought off bed-time, I was spent in a way I haven’t felt in years. I tapped out, calling on my husband to finish the nighttime routine. Under the fatigue of my week, I could hardly breathe. We sacrifice a lot to do this work, and in return, I demand the right to be myself. It’s takes too much energy to be someone else.

As we perform our duties, my female colleagues and I know we may receive less pay for the same work as the guys working alongside us. With this knowledge, I feel indignant that people would judge us for what we do or wear outside of work. Enough is enough.

My experience

As a trainee in a conservative environment, I was always self-conscious about what I wore, and whether it looked good enough or was professional. And with the stress of training, I intermittently gained and lost a few pounds, making my clothing tighter than I would have liked at times. I was probably judged for this, but I was doing the best I could with what I had. 

Six years into my attending career, I have relaxed my previous standards. As I pop into work for a paracentesis in the middle of a Saturday on call, I throw a white coat over a sleeveless frock. No longer will I live in fear of a co-worker seeing my shoulders.

My advice

I don’t have any simple answer for gender bias. Acknowledge that it’s insidious, and it’s not going anywhere. Everyone, from those responsible for teaching trainees and students to employers and administrators should educate themselves to improve upon their own biases. Men and women alike must stay awake to the internalized misogyny in our culture, lest we penalize women for it. 

If you find yourself on the receiving end of a double standard, don’t take it personally. Don’t make it mean anything about your skills or your potential. It’s more likely that it has to do with the limitations of the person perpetrating the bias. As a woman in medicine, my approach, through all the awkward growing pains, was to simply do my best. Sometimes, deflecting and ignoring these kinds of double standards can get you through a period of training or transition to a better environment. In the meantime, focusing on your work can turn down the volume on the outside noise.

Gritting it out

My other piece of advice is to stick it out. Don’t let other people’s small-mindedness keep you from achieving your dreams or goals. Over time you’ll gather experience which will help you to recognize when bias could be at play and teach you some tools to deal with it. When I interviewed Aneesa Majid, MD, MBA for my upcoming book, she shared how she was somewhat oblivious to the male-dominated nature of her field, and how that might affect her path.

“It wasn’t until I began working in private practice that I witnessed the obstacles of being a woman in a male-dominated sphere first-hand, particularly as the only female within a practice. It was such a problem in my first practice that it spurred me to leave. However, this set me on a course into leadership, to learn more about how unconscious bias affects organizations and culture. My early experiences helped to strengthen my voice both for myself and others. Now, I use that voice to help other women, and to mentor those who are coming up through the ranks.” 

Life after #medbikini

We are in a new era. Women outnumber men in medical schools. It’s about time women stopped being penalized for being who they are, especially as they become the majority. 

Yet the old thought patterns persist, keeping outdated ideas alive, sometimes concealed behind a benevolent veil. It’s up to today’s women in medicine to pierce the veil and scrutinize the advice and backhanded compliments they receive in their careers. The authors of the now notorious social media article are “among the leaders in vascular surgery. The old boys. They continue to set a tone – they will decide what’s appropriate/professional,” according to an accomplished physician leader in my specialty, whom I look up to very much.  

“I know them and was trained by people like them. ‘Dr. S,’ they’d say, ‘You lack leadership skills.'” Now, at the top of her field, she reports that success is the best revenge.  

She asserts, “Women– with everything that they represent– undermine the hierarchy. These guys must continue to minimize and criticize everything feminine to maintain their sense of power.”

You must realize this as you find your way in medicine.

Physicians are people, for better or worse

Beyond the gender equity issues in medicine highlighted by the #medbikini crisis, there is a problem in our society. Our medical system is broken, and many blame doctors for it. When a pre-authorization delays cancer care for weeks, the insurance company isn’t held liable for that. Yet if a physician makes a mistake, they could lose their reputation, privileges at their hospital, their livelihood, and their well-being. It begs the question…

Are physicians allowed to be people?

When we fully allow it, we are better off for it. Physicians who aren’t afraid to be seen holding a cocktail, or those those who enjoy the occasional vacation are likely better caregivers in the long term compared to those who don’t stop to recharge. Doctors shouldn’t be martyrs. Yes, we signed up for sleepless nights, six-figure student debts, and a level of responsibility some wouldn’t wish on their enemies. But we didn’t sign up for a life in a box.

We didn’t sign up for excess judgment or vilification. We didn’t sign up for fear of online shaming. So stahp it with the double standards in medicine. If your fellow doctor displays her humanity, applaud her for it. Have her back– fiercely. Be inspired by her.

Some who defended the JVS article noted that the public expects physicians to uphold a higher standard. It’s true: people expect perfection of us… even beyond perfection. Sometimes they expect miracles. And while I attest that some things that happen in my department can appear miraculous, sometimes I could use a little grace. So if the public wants to judge me by my social media profile, have at it. Go ahead. Tomorrow, if you’re in an accident, I might save your life.