Medicine: We know drama. We know gossip.
The romantic gossip is always the juiciest. Medical students date residents, residents date attending physicians, and physicians even date medical students. All the permutations exist. But it’s not just about who “likes you likes you,” there’s bad-mouthing too. The other day I heard that one of the attending surgeons is so unpleasant to work with that the operating room nurses actually have a formal system of drawing straws before each shift to decide who will work with her. In the realm of the ridiculous, a few months ago, a medical assistant found a dead squirrel in the parking lot and, as a joke, put it in her supervisor’s office. And my own personal grievance, last month, the hospital cafeteria ran out of their yummy cornbread muffins for several days in a row and many of us had nothing to pair with our salads. Dra-ma!
Oh, and one more tidbit: Dr. Lazar Greenfield, the inventor of the life-saving Greenfield filter; editor of Surgery News, the official newspaper of the American College of Surgeons (ACS); and president-elect of the ACS, published an editorial in the February edition that suggested that semen was a better Valentine’s Day gift than chocolate.
The romantic gossip is always the juiciest. Medical students date residents, residents date attending physicians, and physicians even date medical students. All the permutations exist. But it’s not just about who “likes you likes you,” there’s bad-mouthing too. The other day I heard that one of the attending surgeons is so unpleasant to work with that the operating room nurses actually have a formal system of drawing straws before each shift to decide who will work with her. In the realm of the ridiculous, a few months ago, a medical assistant found a dead squirrel in the parking lot and, as a joke, put it in her supervisor’s office. And my own personal grievance, last month, the hospital cafeteria ran out of their yummy cornbread muffins for several days in a row and many of us had nothing to pair with our salads. Dra-ma!
Oh, and one more tidbit: Dr. Lazar Greenfield, the inventor of the life-saving Greenfield filter; editor of Surgery News, the official newspaper of the American College of Surgeons (ACS); and president-elect of the ACS, published an editorial in the February edition that suggested that semen was a better Valentine’s Day gift than chocolate.
Whoops. Greenfield has since apologized and resigned from both of his positions.
Earlier this month, due to complaints, the article was removed from the website. (Thanks to the interweb, you can still find it here.) But it’s worth exploring exactly what was so offensive. For those who haven’t read it, his whirlwind tour begins by exploring the mating habits of fruit flies. He then jumps to the reproductive behavior of microscopic rotifera, followed by a comparison of the synchronization of menstrual cycles between straight women and lesbians. He finishes it all off by explaining that women who have unprotected sex, and therefore exposed to more semen, are less depressed than women who use condoms. He concludes, “So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.”
Dr. Pauline Chen’s recent piece in the New York Times drew attention to the article and though many have also joined in the criticism, it’s not entirely clear what they are upset about. According to comments from online users, some think it was too sexually explicit. Others think it was misogynistic. At the same time, several female surgeons have jumped to Greenfield’s defense, pointing out that he has always supported women and increased the percentage of female faculty during his time as head of the Department of Surgery at the University of Michigan.
Instead of singling out Greenfield, Chen focuses on the larger implications of the editorial. She points out that publishing the piece “raise[d] questions about the current leadership and its attitudes toward women and gay and lesbian members.” Additionally it illustrates the overwhelming hierarchy in medicine, which precluded people from preventing the article from being published, and dampened criticism afterwards.
As a third year medical student at the bottom of the pecking order, I feel the weight of the massive medical hierarchy all too acutely. However, it also occurs to me that if I had been in the recording studio with Gwen Stefani, I definitely would have said, “Hey, G-loc. Time-out. Yelling how to spell ‘bananas’ belongs on a kindergarten soundtrack not your first solo album.” “Hollaback Girl” was #1 on the Billboard Pop 100 for eight weeks. It’s not unreasonable that folks with more knowledge and experience are designated as such. What makes the medical hierarchy so negative and counterproductive is that this structure frequently extends beyond medical knowledge and high quality patient care. All too often, it also dictates the human worth of each team member and the amount of respect that they’re afforded.
Truthfully, I do not know if Dr. Lazar Greenfield is a misogynist. I have never met him. Like Chen, I don’t think the important debate is whether or not Dr. Greenfield is sexist. The tone of his article suggests that he meant it in a light-hearted, albeit dreadfully misguided, fashion. And that’s what’s so disturbing about this whole debacle. He had no idea that his piece was problematic and either no one else thought it was problematic or no one thought it was a big enough issue to be worth mentioning.
While women have made great gains in the institution of medicine, the publishing of the editorial demonstrates how engrained and invisible the gender bias continues to be. The article that supposedly documents the anti-depressant quality of semen is so poorly designed that the results are as informative as abstinence-only sex education. The fact that Greenfield still used it without any critical analysis reveals his unconscious bias. After all, we believe what we want to believe and don’t question the studies that support our beliefs. If I were Greenfield, I’d be less afraid of female surgeons seeking vengeance and more afraid of the ghost of Archie Cochrane.
In the end, I suspect that Greenfield is a misogynist in the same way that all of us are racist. The days of blatant bigotry are generally over. Mainstream society likes to think that it no longer consciously believes that women should stay at home and that folks of color are inferior. Instead, we grapple with something far more insidious and difficult to eradicate: implicit bias. In other words, it’s doubtful that Dr. Greenfield willfully believes that men are superior to women. On the other hand, it’s also impossible that he hasn’t been affected by the blatant patriarchy that existed when he trained to be a physician, and the more subtle structure that exists today.
The article is not offensive because it is too sexually explicit. However, it is curious that it happened in a profession that emphasizes professional decorum so strongly that medical students are assigned to write essays about it. There is also no implication in his article that men are superior to women. And while it is unequivocally hetero-normative, there is nothing explicitly disparaging to the LGBT community (though one can’t help but notice that his line of reasoning implies that lesbians ought to have, by now, gone extinct via suicide and gay men should not have the higher rate of suicide that they do).
What is problematic about the piece is the reinforcement of the idea that women are dependent on men, compounded by the fact that this was in the context of sexual interactions between men and women. In a world where rape is routinely used to exert control and power and women are explicitly and implicitly told everyday that they need men and that without them, one cannot be a happy and fulfilled, it is not unreasonable to be sensitive to the inference.
Despite recent attempts to push sociocultural sensitivity, the mammoth institution of medicine has deep roots in its good ole’, white boys’ club. This editorial is as much a reflection of the institution of medicine as it is of Dr. Greenfield.
As a third year medical student you’re not only indoctrinated into the world of clinical practice, you’re enveloped in the culture of medicine. In a world of subjective grading, you fall in line, telling yourself it’s only temporary. But it’s not long before you find yourself saying things you never thought you would. One day you wake up and behavior that you once found appalling is not only acceptable, but preferred.
Earlier this year a classmate of mine told me about delivering a baby with one of the OBGYNs. It was a vaginal delivery and during the process there was some tearing that had to be repaired. As the new baby was introduced to his parents, the attending and my friend sat at the foot of the bed. The physician trimmed some torn tissue. “Fish food!” he exclaimed as he threw it against the wall. Then as he went to stitch and repair the tear, he turned and said with a collusive smile, “Sometimes the dads ask if, while I’m at this, I can just throw in an extra stitch!” I don’t think that physician considers himself a misogynist. To him, he was making a “medical joke” so benign that he felt comfortable saying it in front of the woman.
Ultimately Chen is correct when she points out that the hierarchy in medicine is problematic because it allows injustices, inequities, and mistakes to occur without criticism. But to stop there would be letting us, the younger generation of doctors, off the hook. By pointing to the hierarchy as the main problem, we imply that it’s the old guard that is flawed and that if we were in charge, things would be better. What she overlooks is that we have to be self-critical as well because that’s the thing about implicit bias - it just sneaks up on you.
Every moment we spend training in the current culture of medicine is a step closer to internalizing it. The medical profession values being “tough,” so crying is of course a sign of weakness. Recently I found myself in the middle of a conversation between a fellow and a resident. Our conversation was about a game that’s sometimes played by residents. The object is to collect the most points, which are awarded for making a colleague cry in public. And though I recognized how wrong it was, I found myself laughing along with them as they recounted their personal anecdotes of both crying and garnering points.
It wasn’t until hours later that I realized in horror how I had changed. There is nothing amusing about a game based on upsetting and publically embarrassing other people. It’s perverse and a year ago I would have thought such a game was too inhumane to be remotely funny. Without active reflection, we will simply inherit and perpetuate the system before us. Already, only one year into my clinical training, I can see that in my classmates… and I can see it in myself.
Earlier this month, due to complaints, the article was removed from the website. (Thanks to the interweb, you can still find it here.) But it’s worth exploring exactly what was so offensive. For those who haven’t read it, his whirlwind tour begins by exploring the mating habits of fruit flies. He then jumps to the reproductive behavior of microscopic rotifera, followed by a comparison of the synchronization of menstrual cycles between straight women and lesbians. He finishes it all off by explaining that women who have unprotected sex, and therefore exposed to more semen, are less depressed than women who use condoms. He concludes, “So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.”
Dr. Pauline Chen’s recent piece in the New York Times drew attention to the article and though many have also joined in the criticism, it’s not entirely clear what they are upset about. According to comments from online users, some think it was too sexually explicit. Others think it was misogynistic. At the same time, several female surgeons have jumped to Greenfield’s defense, pointing out that he has always supported women and increased the percentage of female faculty during his time as head of the Department of Surgery at the University of Michigan.
Instead of singling out Greenfield, Chen focuses on the larger implications of the editorial. She points out that publishing the piece “raise[d] questions about the current leadership and its attitudes toward women and gay and lesbian members.” Additionally it illustrates the overwhelming hierarchy in medicine, which precluded people from preventing the article from being published, and dampened criticism afterwards.
As a third year medical student at the bottom of the pecking order, I feel the weight of the massive medical hierarchy all too acutely. However, it also occurs to me that if I had been in the recording studio with Gwen Stefani, I definitely would have said, “Hey, G-loc. Time-out. Yelling how to spell ‘bananas’ belongs on a kindergarten soundtrack not your first solo album.” “Hollaback Girl” was #1 on the Billboard Pop 100 for eight weeks. It’s not unreasonable that folks with more knowledge and experience are designated as such. What makes the medical hierarchy so negative and counterproductive is that this structure frequently extends beyond medical knowledge and high quality patient care. All too often, it also dictates the human worth of each team member and the amount of respect that they’re afforded.
Truthfully, I do not know if Dr. Lazar Greenfield is a misogynist. I have never met him. Like Chen, I don’t think the important debate is whether or not Dr. Greenfield is sexist. The tone of his article suggests that he meant it in a light-hearted, albeit dreadfully misguided, fashion. And that’s what’s so disturbing about this whole debacle. He had no idea that his piece was problematic and either no one else thought it was problematic or no one thought it was a big enough issue to be worth mentioning.
While women have made great gains in the institution of medicine, the publishing of the editorial demonstrates how engrained and invisible the gender bias continues to be. The article that supposedly documents the anti-depressant quality of semen is so poorly designed that the results are as informative as abstinence-only sex education. The fact that Greenfield still used it without any critical analysis reveals his unconscious bias. After all, we believe what we want to believe and don’t question the studies that support our beliefs. If I were Greenfield, I’d be less afraid of female surgeons seeking vengeance and more afraid of the ghost of Archie Cochrane.
In the end, I suspect that Greenfield is a misogynist in the same way that all of us are racist. The days of blatant bigotry are generally over. Mainstream society likes to think that it no longer consciously believes that women should stay at home and that folks of color are inferior. Instead, we grapple with something far more insidious and difficult to eradicate: implicit bias. In other words, it’s doubtful that Dr. Greenfield willfully believes that men are superior to women. On the other hand, it’s also impossible that he hasn’t been affected by the blatant patriarchy that existed when he trained to be a physician, and the more subtle structure that exists today.
The article is not offensive because it is too sexually explicit. However, it is curious that it happened in a profession that emphasizes professional decorum so strongly that medical students are assigned to write essays about it. There is also no implication in his article that men are superior to women. And while it is unequivocally hetero-normative, there is nothing explicitly disparaging to the LGBT community (though one can’t help but notice that his line of reasoning implies that lesbians ought to have, by now, gone extinct via suicide and gay men should not have the higher rate of suicide that they do).
What is problematic about the piece is the reinforcement of the idea that women are dependent on men, compounded by the fact that this was in the context of sexual interactions between men and women. In a world where rape is routinely used to exert control and power and women are explicitly and implicitly told everyday that they need men and that without them, one cannot be a happy and fulfilled, it is not unreasonable to be sensitive to the inference.
Despite recent attempts to push sociocultural sensitivity, the mammoth institution of medicine has deep roots in its good ole’, white boys’ club. This editorial is as much a reflection of the institution of medicine as it is of Dr. Greenfield.
As a third year medical student you’re not only indoctrinated into the world of clinical practice, you’re enveloped in the culture of medicine. In a world of subjective grading, you fall in line, telling yourself it’s only temporary. But it’s not long before you find yourself saying things you never thought you would. One day you wake up and behavior that you once found appalling is not only acceptable, but preferred.
Earlier this year a classmate of mine told me about delivering a baby with one of the OBGYNs. It was a vaginal delivery and during the process there was some tearing that had to be repaired. As the new baby was introduced to his parents, the attending and my friend sat at the foot of the bed. The physician trimmed some torn tissue. “Fish food!” he exclaimed as he threw it against the wall. Then as he went to stitch and repair the tear, he turned and said with a collusive smile, “Sometimes the dads ask if, while I’m at this, I can just throw in an extra stitch!” I don’t think that physician considers himself a misogynist. To him, he was making a “medical joke” so benign that he felt comfortable saying it in front of the woman.
Ultimately Chen is correct when she points out that the hierarchy in medicine is problematic because it allows injustices, inequities, and mistakes to occur without criticism. But to stop there would be letting us, the younger generation of doctors, off the hook. By pointing to the hierarchy as the main problem, we imply that it’s the old guard that is flawed and that if we were in charge, things would be better. What she overlooks is that we have to be self-critical as well because that’s the thing about implicit bias - it just sneaks up on you.
Every moment we spend training in the current culture of medicine is a step closer to internalizing it. The medical profession values being “tough,” so crying is of course a sign of weakness. Recently I found myself in the middle of a conversation between a fellow and a resident. Our conversation was about a game that’s sometimes played by residents. The object is to collect the most points, which are awarded for making a colleague cry in public. And though I recognized how wrong it was, I found myself laughing along with them as they recounted their personal anecdotes of both crying and garnering points.
It wasn’t until hours later that I realized in horror how I had changed. There is nothing amusing about a game based on upsetting and publically embarrassing other people. It’s perverse and a year ago I would have thought such a game was too inhumane to be remotely funny. Without active reflection, we will simply inherit and perpetuate the system before us. Already, only one year into my clinical training, I can see that in my classmates… and I can see it in myself.
