Vital Times 2020 - 82

get the same respect men get when dealing with
emergencies. This is not because women are less
competent or because of their position in the medical
hierarchy; it is because they are women. In a Toronto
study utilizing scripted scenarios, residents were
asked to judge the leadership qualities of a person
leading a resuscitation.1 They were randomized to
watch a film of a resuscitation. The resuscitation
leader was either a male or a female actor. The
second level of randomization included telling half of
the subjects that the resuscitation leader was either
a physician or a nurse practitioner. The female leader,
whether a doctor or nurse, was deemed inferior to
the male leader even though they followed the same
script, they wore the same clothes, and they were the
same race. In other words, residents found a male
nurse to be a better leader than a female doctor even
when the two were doing and saying the same things!
In retrospect, I did not need to rely on the medical
literature to tell me woman physicians are generally
not afforded the same respect as their similarly
experienced male counterparts. All I needed to do
was reflect on my 35 years in medicine with an open
mind. Through the years, I have seen the awards,
appointments, and promotions of distinguished
female physicians dismissed by the graybeards of
my department. Young male doctors refer to support
groups for female patients as estrogen fests. There
was also the resident graduation ceremony when, as
our former chair introduced each graduate, he gave
a quick summary of their successes. For every male
graduate, he mentioned their awards, publications, or
other professional accomplishments. For every female
graduate, he talked about the fact that they had
recently given birth, gotten married, or some other
milestone in their personal life. I did not realize this
had happened until my female colleagues and late
wife started discussing it at the post-mortem after
party. When I recalled the speech, they were correct.
I felt clueless that I had missed this subtle but clear

Evaluating myself in light of this very recent revelation
of my own misogyny, I see that I have unconsciously
internalized the tropes my colleagues and I have
used to justify our biases: " Women don't have natural
leadership skills, " " Women's voices don't command
authority in acute situations, " or " They are too bossy
when they give orders. " I realize misogyny has infected
the base from which I have responded to the world.
Many people may bristle at my characterization of my
reaction as misogyny. However, we can only change
our biases if we first name them, own them, and face
the reality of how our prejudices affect our interaction
with the world. The effects of endorsing the male
model of speech in the operating room go beyond the
undermining of the confidence of our female trainees.
It results in bad patient care. Inclusive leadership is a
better model for the operating room environment than
authoritarian leadership,2 and linguists characterize
upspeak as a more inclusive speech pattern.
Misogyny, conscious or unconscious, has no place
in the hospital. Devaluing an idea or ignoring a
request delivered by a female voice using upspeak
is misogynistic. The next time I am in a room where
a woman is leading the resuscitation, and she is not
given the quiet she asked for, the debrief will focus
on changing the behavior of the noisemakers, not on
the speech patterns of the voice they failed to heed.
More complicated will be uncovering other instances
in which my unconscious biases similarly impede
my ability to teach and mentor and thereby to deliver
optimal patient care. The first step will be listening
more carefully to what the women in the room are
saying, rather than their tone of voice.

Ju M, van Schaik SM. Effect of Professional Background and Gender on Residents' Perceptions of Leadership. Acad Med 2019; 94(11S Association of American Medical
Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions): S42-S7.

2 Minehart

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example of misogyny. Of course, the women in the
audience caught it. It was their daily reality.

RD, Foldy EG, Long JA, Weller JM. Challenging gender stereotypes and advancing inclusive leadership in the operating theatre. Br J Anaesth 2020.

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