HUMANITIES | ENCOUNTERS

Sexism in medical care: “Nurse, can you get me another blanket?” n Cite as: CMAJ 2020 February 3;192:E119-20. doi: 10.1503/cmaj.191181

ne weekday afternoon, you doctor.” In case you worry about accusing respect from a nurse in earshot and do begin bedside patient rounds an unaware octogenarian of sexism, a justice to your hours of interprofessional after listening to a seminar on diplomatic yet equally effective reply education lectures together. O“Women in Medicine”: in your opinion, a might be: “I’m a doctor. I wonder why somewhat antiquated topic in the new many people make that mistake.” This Male solidarity era of modern, equitable health care. The crafty yet subtle rhetorical question will routine is predictable yet impressive as convey the same message. With a cool Medicine is a collegial profession that you weave from room to room: a mind, even sexist remarks can lead to extends to including solidarity from male thoughtful greeting, an attentive inquiry helpful education while preserving both bystander allies. When a patient turns off about symptoms, an elegant physical doctor and patient dignity. their phone, muttering, “Sorry, I have to examination. You even examine for whis- go — Dr. Male is here with his nurse,” pered pectoriloquy! Your silver-haired Professional admiration Dr. Male might chime in and support his Oslerian mentors would have beamed female colleague: “Actually, this is my new with joy at your clinical prowess. Excel- Nurses are indispensable clinicians and colleague, Dr. Female,” or “Ms. Medical lent job! As you head toward the door, their contributions to patient care should Student, a soon-to-be doctor.” Indeed, a the patient asks, “Nurse, can you get me be celebrated. If a patient demands, quick response from a credible mascu- another blanket?” “Nurse, please stop the IV machine from line voice can be quite convincing for This interaction is frustrating but no beeping,” you might credit your nursing some patients. This strategy is particu- surprise for female physicians who are colleagues by saying, “The nurses are ter- larly helpful for patients who require repeatedly mistaken for nurses or other rific, but my responsibility is to be your repeated clarifications by the female health care professionals.1 Examples of doctor.” Indeed, silencing the screeching medical student explaining that she is other patronizing, gender-stereotyping IV remains a nursing superpower. This not a volunteer, nursing student or comments from patients include calling conveys tact, and may potentially earn music therapist. female doctors “honey” or “sweetie,” viewing young female physicians as inex- perienced, asking intrusive personal Box 1: Repertoire of responses to “Nurse, can you get me another blanket?” questions, and tacitly presuming men are Strategy Objective Suggested response physicians.2,3 The persistence of sexism despite rising female representation indi- Feminist Question sexist “That’s a potentially sexist assumption; I’m cates that professional membership critique assumptions and educate really a doctor.” patients alone is insufficient.4 Systemic change is underway, but why wait in silent bitter- Professional Acknowledge distinct “I admire the nursing staff, too.” admiration contributions of nurses ness?5,6 Here, we offer 7 strategies for the physician who finds herself, once again, Male Encourage male bystanders “Actually, this is my colleague, Dr. Female,” or solidarity to defend female physicians “Ms. Medical Student, a soon-to-be-doctor.” mistaken for a nurse (Box 1). Blunt Address misguided “I can write my name and title on the board, if Feminist critique efficiency comments promptly you like, so everyone can remember.” Convivial Gently correct with “Thank you for the compliment — but as your bedside confidence and kindness doctor, I hope you find my medical skills just as Patient comments are frequently mis- manner excellent!” taken and amenable to corrective discus- sion. When a patient with hemiparesis Superior Establish your boundaries “I hope you are not treating the nurses in this requests, “Nurse, can you scratch my authority against sexist insults frankly inappropriate manner.” back?,” you might respond with, “That’s a Collegial Forgive and joke about “If I was a nurse, there is no way I’d wear these potentially sexist assumption; I’m really a humour awkwardness hideous hospital-issue scrubs today.”

© 2020 Joule Inc. or its licensors CMAJ | FEBRUARY 3, 2020 | VOLUME 192 | ISSUE 5 E119 HUMANITIES E120 vinistic. comments aresometimesgenuinelychau- views ofsomememberssociety.Patient Medicine isnotimmunetothemisogynistic Superior authority and kindnessarenotmutuallyexclusive. responses demonstrate that assertiveness my medicalskillsjustasexcellent!”These ment —butasyourdoctor,Ihopeyoufind broken heartwith“Thankyouforthecompli- my favouritenurse!,”youmaypacifyyour month introducesyoutoherfamily,“Meet tively, whenapatientyouhaveknownfor Here itis.Bytheway,Iamadoctor.”Alterna- a basin?,”youmightsay,“OfcourseIcan! cer moans,“Nurse,canyoupleasefetchme and nauseatedpatientwithmetastaticcan- straightforward response. When a cachectic dition may be considered kinder than a and vulnerablethatsympathyfortheircon- Patients inhospitalaresometimessofrail Convivial bedsidemanner sions fromchattypatientsonbusydays. egy is precise and spares tangential discus- board soeveryoneremembers.”Thisstrat- Dr. X.Iwillwritemynameandtitleonthe forgot tointroducemyselfproperly.Iam follow-up statementcouldbe:“I’msorry,I clinical team.Forsuchpatients,ahelpful struggle to process who’s who in a large your doctor.”Sometimes,patientsmay be coming?,”youcanflatlystate,“Iam “Nurse, doyouknowwhenmydoctorwill you areperformingalumbarpuncture, days. Shouldapatienthappentoask,while Time in clinical care is precious on hectic Blunt efficiency yourself unilaterally:“Ihopeyouarenot 7 You may try to tackle the problem Youmaytrytotackletheproblem CMAJ ally expressesasexistcomment. by apatientwhounwittinglyorintention- help thephysicianwhoistakenbysurprise preplanned repertoireofresponsesmay ies againstbigotryorinsultingcomments.A show youhaveclearprofessionalboundar- cation orengageargument;rather,itisto manner.” Thegoalisnottoinflameanalter- treating nursesinthisfranklyinappropriate Toronto, Ont. Sciences, SunnybrookResearchInstitute, of Toronto;ICES;EvaluativeClinical Department ofMedicine,University Donald A.RedelmeierMDMSHSR Toronto, Ont. Department ofMedicine,University Fizza ManzoorBHSc eventually makethesamemistake! ster are imperfect and susceptible toicians responses acknowledge that most clin help thecolleaguesaveface.These the hospitalelectronicmedicalrecord,to by acommentabouttheawfuldesignof hospital-issue scrubs,” perhaps followed there isnoway I’dwear these hideous a collegialreplymaybe:“IfIwasnurse, be anotherfemaleclinician,inwhichcase years ago.”Theoffendermaysometimes since graduatingfrommedicalschool want me to try that. I haven’t done that Instead, trylighthumour:“Oh,youdon’t his moreworrisomeclinical errors. haps spareyourdraconiancriticismsfor male internasksyoutodrawblood,per- nurse byanotherclinician.WhentheJuly On occasion,youwillbemistakenfora Collegial humour is justifiedifyouarefeelingunsafe. response, suchas“ShouldIcallsecurity?,” | FEBRUARY 3, 2020 eotypes. Plus, you will win allies if you ­eotypes. Plus,youwillwinalliesif

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| ISSUE 5 ­ Amy Yu. Lee Ross, Gillian Spiegle, Chris Yarnell and Sheharyar Raza,SharonReece,JolieRingash, Bombardier, JeannieCallum,AyeletKuper, on selected points: Clare Atzema, Claire following individualsforhelpfulcomments Acknowledgements: Theauthorsthankthe University ofToronto. ence forMedicalStudentsprogramatthe ences andtheComprehensiveResearchExperi- ada ResearchChairinMedicalDecisionSci- Funding: ThisarticlewassupportedbyaCan- aspects ofthework. published andagreedtobeaccountableforall content, gavefinalapprovaloftheversiontobe revised itcriticallyforimportantintellectual ­Manzoor draftedthemanuscript.Bothauthors conception anddesignofthework.Fizza Contributors: Bothauthorscontributedtothe 1 References 3 6. 5. 2 4. 7. This articlehasbeenpeerreviewed. 8. . . . Jagsi Vogel Sci USA fairness principleinsocialjudgment. Kang come sexism.AmPsychol2016;71:863-74. women engagingincollectiveactiontoover- Radke 2019 June11). default/files/CMES2017-Complete.pdf picture aman. Cao demic medicalfaculty. ment anddiscriminationexperiencesofaca- Canada; 2017. Ottawa: AssociationofFaculties ofMedicine 2017 Canadianmedicaleducationstatistics. Viglianti solutions. Lancet2019;393:579-86. diversity andinclusioninmedicine:Myths leagues. Headache2019;56:1846-54. Eleven thingsnottosayyourfemalecol- Borrero-Mejias perpetrator. Lancet2018;392:368-70. harassment andabuse:whenthepatientis J , R L SK, Banaji , HR, . 2016; Griffith When peoplehear“doctor,”moststill EM, Kaplan Hornsey 113: MR. Oliverio CMAJ Available: KA,

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