Guest Blog: Conflicting Goals and Role Models

I’m still on vacation (we all know how important work-life-balance is!), so this week another awesome colleague of mine, Hanne Watkins from the University of Melbourne, is filling in and reflecting on role models and conflicting goals in the male-dominated world of academia.

I had gotten pretty far in my academic career – all the way to Honours – before I had a female role model. The fact surprised me then, and troubles me now. Had I really gone through all of High School and undergrad without having a female professional to look up to?

It is also possible, however, that I did have female role models before that, but that I hadn’t realised they were female. It sounds silly when I put it like that, but I think I can explain. Prior to my Honours year, I might have had role models – teachers, writers, researchers, politicians – who I looked up to as figureheads in their respective professional and public domains, but where their gender (and mine) was irrelevant to their position as “my role model”.

But regardless. In Honours, the gender of my role model was suddenly relevant. She (let’s call her K) was a lecturer at my uni; she was smart and friendly and gave me career advice. These are all (arguably) gender-neutral activities, so I don’t want to overstate the centrality of the gender aspect of her role. Gender became salient to me, however, for two reasons. First, because K herself often talked about gender, feminism, and academia. Second, because she was over forty, single, and childless.

Going by cultural stereotypes, “forty, single, and childless” sounds like a woman’s nightmare. But K wasn’t living a nightmare. She was happy, she was an academic, she was smart and friendly and gave me career advice – and I wanted to be like her. Prior to meeting K, I had on some (mostly unconscious) level assumed that children would inevitably enter the picture at some point in my future. She freed me from that illusion, by showing me an alternative reality; a reality I wanted for myself as well, and which, thanks to her, looked achievable! Maybe it doesn’t sound like much, but at the time it was something of a revelation.

I’m not overly familiar with research on role models. But, I believe one theory suggests that for role models to “work”, you first have to have a desired goal, then you have to see someone who has achieved that goal, and then you have to perceive a “fit” between yourself and that person. (And some of the causal arrows probably go in both directions.) K ticked all the boxes. I wanted to be a childless academic in the future, K was that person now, and I was like K in that we were both female. (And, you know, smart and friendly and fond of dispensing advice. 😉 )

For a while, things were going along swimmingly.

Then, something dramatic happened: I started to want to have kids.

By that stage I had met lots of other amazing female academics, some of them older than me, some of them not; some of them with kids, some of them without. So you’d think I could find a role model among them, right?

Unfortunately, it hasn’t been that simple (surprise surprise). Thinking about the research on role models, however, has made me ponder how my predicament can be understood through the theory of role models I described above.

I have two desired goals: have children, and be an academic. I’m not willing to give up either goal, which means my combined goal is to be an academic who has children. As I said above, I have met plenty of women (and men!) who have achieved that goal. However, I wouldn’t describe any of them as my role model for this combined goal. Instead, it’s as if my goals obstinately generate their own, separate, role models.

On the one hand, I aspire to be like some awesome academics I know; whether they have children or not seems irrelevant. With some of them, I perceive a fit – they are “like me” in some ways, and so they are the ones I would call my role models, and they are the ones who inspire and motivate me.

On the other hand, I aspire to be like some awesome mothers I know; what else they do seems irrelevant. Unfortunately, with none of these do I perceive a fit – because none of them are academics. This makes me feel as if my goal of being a mother is incompatible with being an academic, even if, as I said above, I know this isn’t true.

 

So. In some ways, what I have just written is just another version of the “oh no I have conflicting goals and I will have to find a way to compromise”-dilemma. So I’m sorry that it’s old news.

However, I think the new news, to me at least, is that the theory of role models can help me understand why these goals of mine seem to conflict at such a deep level.

Sometimes, the parenting-working conflict seems to be portrayed as a matter of time-management, organisation, and communication – certainly challenging, but relatively “superficial” things. Seeing the conflict as one between competing role models, however, suggests that it’s not just a about what I might want to do to achieve my goals. It is about who I want to be.

No wonder it’s difficult.

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Guest Blog: Take it Like a Man

Oooh, exciting! This week we have a guest blog! The awesome Tiffany from Surgery at Tiffany’s (a blog which I can highly recommend) has kindly agreed to share her response to out post about whether or not women in surgery are less confident than their male counterparts.

If you are interested in guest blogging on this site some time, please get in touch. It would be great to make guest blogs a somewhat regular thing! But now, without further ado, here is what Tiffany has to say:

When I was accepted into plastic surgery training back in my mid-20’s, I was the only female plastic surgery trainee in the state. There was only one female plastic surgeon working in town, but she was trained overseas and imported into our hospital. She was my mentor and ally. She told me stories of her training and gave me valuable insight into the minds of my male colleagues.

When I first started training, I used to get upset about every little thing. She used to shake her head at me and said that I should toughen up, use my stiff upper lip, and basically grow a tough hide. But it wasn’t until she said to me ‘Take it like a Man’ that I realised to succeed and survive my training, I needed to be like my male colleagues. I needed to be one of them.

Behaviour

Short of wearing pants and ties, I started to observe my colleagues. They don’t cry when they get upset (well, maybe only when they were very very drunk), and they tell you as it is when they are. However, when I started to behave like one of the boys, people’s response to me was completely different. When one of my male colleagues started to rant and rave about something that had not been done for his patients, deathly silence ensued, and the nurses scrambled to do his bidding. When I mention that a certain instruction was not followed, nurses shrugged their shoulders at me and I was called a bitch behind my back.

Once, I watched one of my colleagues brush off a female patient’s concern as if it didn’t really matter. The patient reacted by shrugging her shoulders and put it down to ‘he’s a man, he doesn’t understand.’ Yet when I inferred a similar response to her complaint, she carried on about how that I was an unsympathetic doctor and should have been more understanding of her feelings.

So I learnt my lesson. I had to be tough like a male, but I needed to behave like a female, because my co-workers and my patients expected me, as a woman, to be more perceptive to their feeling, to be gentler, thoughtful, considerate and compassionate. All the qualities of their mothers.

Competency

And yet what did people expect of my abilities as a female?

There are several facets to this issue. Firstly, people make assumptions that you understand certain aspects of their lives, or have specific skills because you are female. Patients often tell me that they have specifically chosen me as their surgeon because I am female. That they know I will pay more attention to detail, that my work would be more delicate and that I have gentler hands. I have found these ideas vocalised more from female patients, although the back-handed sexist compliment makes an appearance now and then from the male patients: ‘Female hands are made to do fine embroidery, your sewing would be better.’ This is all inference without evidence. Some of the best microsurgeons I have had the privilege of learning from, are male surgeons with big clumsy-looking hands who couldn’t sew a hem to save their lives.

Some tell me that I would better understand what results they are after because I am female. One of my specialties is cosmetic and reconstructive breast surgery. Even my colleagues have presumptions and send their wives to me as a preference because I would know what beautiful breasts are supposed look like. I have my suspicious that it was more because they hesitate to have one of their male colleagues handling their wives’ bosoms. I often joked with them that beauty is in the eye of the beholder, and unless their wives are lesbians, what I thought would not really matter. Not to mention, as far as I was concerned, you are too big if you are bigger than me. Without fail, their gaze would lower to the A cup push-ups I wore hidden under my dress. The disappointment in their eyes when they come back up to my face is almost comical.

An interesting social survey that was done locally in my state by the Plastic Surgeons’ Society showed that majority of women preferred a male plastic surgeon for cosmetic procedures, but female plastic surgeons for reconstructive procedures (e.g. after cancer surgery, or for treatment of congenital deformities). I guess this may just be a reflection of the underlying reasons for these procedures. Most of the patients who have cosmetic procedures book in because they want to look attractive for the opposite sex, whilst those who have reconstructive procedures proceed for their own self-esteem.

But realistically, are male surgeons better than female surgeons? My personal experience is that overall, the common public perception is that male surgeons are more competent. It is not that unusual for my patients to ask for a second opinion specified to be from a male surgeon. It is also not uncommon that patient find it easier to accept an opinion (especially one that they do not agree with) from a male surgeon. Sometimes I would argue patients until I am blue in the face about my decision, and yet when my male colleague comes to the same conclusion, the answer is a meek ‘Yes, whatever you think is best, doctor.’ It is also not uncommon that when I am doing ward rounds with my junior male residents, the patients look to them to reassurance, assuming that they are the doctors in charge.

This perception is not just restricted to patients. I have had male colleagues who have volunteered to take difficult cases from me because they felt that it was stress I didn’t need or the procedure would be too long for me. I have had to stop myself being a ‘hypersensitive girl’ and ask them if they were questioning my competency; instead, I would often smile sweetly and tell them that ‘you are so thoughtful, but I really enjoy the challenge’. There is also no doubt that my male colleagues are particularly protective of me at times. Once I was bullied by a male colleague from another specialty, because he was not willing to accept that he made a mistake with my patient, an incident which I unfortunately had to bring up at the morbidity and mortality (M&M) meeting. The next thing I knew, two male surgeons from my department cornered the poor man in the tea room two days later. Ever since the incident, that particular surgeon seemed to be awfully fond of stairs when we bump into each other at the hospital lifts. The male protectiveness didn’t just come from senior staff either. When I have had to visit the secure unit (prison hospital) to see some patients with my junior residents, I have had male residents trying to protect me from seeing obnoxious abusive patients. Sweet, but totally unnecessary. I was more effective in getting the prisoners to comply with their therapy than any other surgeon. Apparently a pissed off female surgeon is a lot more terrifying than a male one.

Confidence & Self-Esteem

So with such behaviour surrounding female surgeons, you would think we have no confidence or self-esteem in ourselves. Yes and No. I believe these are two very different things.

Confidence is a projection, or a façade as I’d like to think. This is something a lot of female surgeon learn very quickly early on in their career, because a show of weakness or doubt, especially in front of our male colleagues or senior staff, was a sign we didn’t have what it took to be a good surgeon. Being decisive and making good clinical judgement is the crux of a good surgeon. Several times throughout my career it was emphasised to me that you could teach a monkey to operate, but you could never teach it to choose the right operation. Personally, I don’t think it is hard to project the illusion of confidence, because you see it around you constantly from all your colleagues. I don’t need to puff up my chest or spit at my feet, but when I announce my decision to the team, it is clear to all and sundry that it was my way or the highway.

Self-esteem, however, is another matter. It is no secret that females are more introspective than males. Looking at the gender difference in the psychology of cause and reason – females tend to blame themselves, and males tend to blame external factors. This is no different in surgery. How many times during an M&M have I had to listen to my male colleagues go on and on about how the surgical instruments they were using were old and unreliable, about how the patients were non-compliant, about how the disease was so advanced or that the patient’s anatomy was abnormal. Whereas I hear female surgeons lament about how they should have done this, thought about that, or even not have taken on the challenge in the first place. Whenever an unexpected problem occurs, the female will look inside themselves for reasons rather than recognise that sometimes the patient’s pathology defeats even the best surgeons.

This is something I constantly remind my female trainees (and myself from time to time). I tell them that there has never been any evidence that female surgeons are less competent than male surgeons. Yet, we have an innate inferior complex about ourselves. We tend to beat ourselves up when things go wrong. Then we are tempted to fall in a heap of self-pitying mess. I often tell them that we can’t ignore this female psyche we possess, if anything, it makes us a better surgeon because we are constantly evaluating ourselves. But we have to have the insight to understand that too much of it can be debilitating. Good surgeons should be able to move on from their complications, ‘failures’, and mistakes – to learn from it, and start the next case as a completely fresh problem. We shouldn’t be accumulating ‘baggage’ which erode our self-esteem, because our patients rely on us making the right decisions for them at every crucial moment – and the right decisions are never made when self-doubt takes over the decision making process.

Confidence and self-esteem does go hand in hand. The more self-esteem one possesses, the easier it is to project confidence. However, the biggest trick in the trade is to be able to take criticisms, scrutinies, mistakes and failures on the chin, and yet still project the same confidence so that both your colleagues and your patients will continue to have faith in your abilities. If being a female means you are more critical of yourself, this is not necessarily a bad thing, it just need to be moderated. Having good support from a sympathetic colleagues (male or female) can also go a long way.

Even though surgery is slowly being ‘infiltrated’(as one of my male colleagues like to put it), by females, it is still very much a male-dominant area of medicine; partly due to diminishing remnants of the ‘Old-boys’club’ attitude, but mostly due to its unrelenting hours and commitment. A career in surgery is unconducive for the stereotypical role of women – one of bearing babies, spending time with family, home making and baking cookies. Honestly, the only babies I see are those in the hospital, and the only baking I do is with a diathermy.

So until we have more female surgeons, and society start to see us as the norm, my belief is that we should Take it like a Man, but Give it like a Woman.

The Best Thing about Being a Surgeon III

Surgery is a very varied career and different people have different reasons for liking it. Here are some more things that people see as the best things about working in surgery:

“I think it’s the patients, definitely. Being able to diagnose somebody with a problem, take him to the theatre, fix it and come back and say ‘I fixed your problem’ or at least ‘I made it easier for you’ if it’s something that you can’t cure. But it’s definitely the communication with the patients.”

“On a day-to-day basis it is very varied. You never really know what you’re doing. You know your schedule but you don’t know the patients, you meet them for the first time sometimes and that is exciting.“

“It’s a fantastic job. It’s different from what people from the outside think. I don’t spend all my time operating. I operate four days a week, but often it’s only a half day rather than a full day. … I see people who are considered for an operation or who I’ve operated in the past to see how they are getting on and that sort of thing. So it’s not up to your elbows in muscles and guts all the time. It’s quite a balance and I like that.”

“It’s a very independent job. So if you don’t like to have a boss, people telling you what to do, then surgery in the UK is perfect because once you are consultant and you have the chance to work in a team that works with you rather than against you then if you need somebody to give you a hand, you can, and if you want to do things on your own and be completely independent, then you can do that, too.”

The Best Things about Being a Surgeon II

We have already talked about some of the things that make surgery a great career in a previous post. One of the major things that people cite as being great about surgery is the impact that you have on patients. Here are some quotes about the difference that you can make as a surgeon:

“I think the most rewarding aspect of my job is seeing patients satisfied with their treatment; patients thanking you for what you have done for them. This is my job, this is what I do, but to actually get a patient say ‘thank you’, getting a thank you card or a present is something so rewarding and very touching to come from a patient because this is what we’re trained to do.”

“I think there are quite a few moments in neurosurgery when you can stand at the bedside of someone who has just woken up from a major brain tumour operation. I can remember a twelve year old boy, just recently, had gone to his grandfather’s funeral and actually become unconscious at that funeral having been unwell for a few weeks. He had a big brain tumour, lots of pressure in his head and his parents, as you might imagine, were terrified. They had been told all sorts of things that might happen. I came in and told them what I was going to do during the surgery and I told them there was a risk of death and there was a risk of major neurological damage – but I was able to stand at the bedside, not only just after he had woken up after his operation and he was fine and I could tell them that he was fine and that I got all of the tumour out, but actually a few days later I could tell them that it was a benign tumour and because I had gotten it all out on the first operation he was cured, the problem was over. So they had gone in the space of a week from thinking their child was going to die to thinking ‘oh, he’s going to go back to school in a couple of weeks and everything is going to be just fine’. And I remember the father standing next to the bed and just extending his hand to me. He didn’t even know how to really shake it because he was so overcome with emotion. … He was speechless and motionless in his gratitude.”

“One day a lad came in, nineteen, with retention of urine, which is very unusual. Usually people are sixty or seventy. And in fact he had a very rare tumour at the prostate and I found out the best person in paediatric urology surgery in England and he said ‘well, he’ll be dead in six month but this is what you do to operate’ and so on, I wrote to Philadelphia and to Toronto children’s hospitals and they wrote back and said ‘there is surgery, chemotherapy and radiotherapy. If you use one of those three or two of those three you’ll have no survivors. But if you use all three according to our protocol you’ll get a survivor’. We did quite radical surgery on him, have him chemotherapy ourselves, he had radiotherapy then – and he lived into his 40s. He married, he had two children by AID, he had a wonderful life. And in the end, when he was dying in his 40s, in our hospital, I asked him ‘was it worth it?’ and he said ‘of course it was!’“

Why Surgery?

Surgery is a demanding career, but it is also very exciting and rewarding. But what attracts people to the career initially? Why do they choose surgery and not something else? Here are only a few examples of why people have chosen a surgical career:

“I have to admit that when I chose medical studies I was very young and maybe I wasn’t thinking about becoming a surgeon, not at the beginning. But I think what drove me there is the possibility to work with people, to talk to them, to support them and then over the years I realised that surgery was the best option to do that.”

“I knew from about the age of sixteen, when I first did anatomy in school, that I really liked this subject. So throughout medical school I was trying to see whether I did still enjoy that sort of thing on a day-to-day basis and actually in a hospital – which I did. But I guess a further moment that confirmed it was a medical student I was asked to participate in an operation and I really enjoyed the whole feel of my hands inside the warm abdominal cavity and I thought to myself ‘this is definitely what I want to do’.”

“When I got to medical school I sort of realised that I was surrounded by people who wanted to be doctors and wanted to help people and were very nice. And there was a bit of the feeling that I didn’t quite fit in. I mean, I do want to help people, but I wanted to actually fix something that needed fixing rather than just talk about it all the time. And when we went into the anatomy room which we did after first couple of weeks – it was the ability to open up, see that there is a problem and physically take it out or fix it or mend it and then sew the person back up again. It just fitted exactly with what I wanted to do.”

“I think I was inspired by a distant relative, to be honest. I’m from a very different background, I think. I think it’s changing now, that you have people from working class backgrounds. My mother was a single parent and I wasn’t connected to lots of family members but this distant family member was a cardiothoracic surgeon and I was really inspired by that – how do you transplant a heart and keep the body alive etc. And I think is persona inspired me more than anything.”

 

Some Advice for Future Surgeons

Just as any other career, surgery has its good and bad sides. While it is very rewarding, it can also be very challenging. Here is some advice from people working in surgery to those who might consider surgery as a career:

“I think surgery is a fantastic career if you love it. If you’ve done a bit of surgery or seen some of the ways that surgical patients are treated – it’s quite a quick process very often compared to medicine. If someone comes in and needs an emergency operation, everything happens very quickly. And I think if you love that, it’s a fantastic thing to do and worth spending the time, if that is something you love. If you were to do it because somebody else wanted you to, you’d be better of choosing something else because it takes a lot of effort. “

“Have a life plan. Where do you see yourself in 10-15 years? What kind of hours do you see yourself doing? Do you see yourself wanting to spend more time with friends and family? Are you willing to make the sacrifice, depending on specialty, when you just have to get up and go because you are on call, you can’t sit at home watching TV. You’ve got to have a clear idea of what you want in your life and how you would probably feel at that age. If still you are committed to performing surgery, wanting to be a surgeon and willing to make those sacrifices then absolutely do surgery. … for me, I think I made the right choice. … the fact that it makes such a difference in someone’s life fairly immediately is very satisfying.”

“Just think about the next step, what you need to do for that step to get forward, rather than being daunted by the whole long process, which actually, when you go through it, doesn’t seem all that daunting as long as you as long as you keep your horizon at a manageable scale.”

“I have no hesitation to say: If you love it, go for it. You have to keep your enthusiasm up. You have to be enthused about wanting to do this specialty and I think it’s probably the same with any career choice. You have to love it to continue because there are down times and great times and you have to take the down times, too. And it requires hard work – so you have to be motivated.”

Demanding Careers, Work-Life-Balance, Family Life and Happiness

Just like surgery, academia is a time consuming career to have and poses a challenge to a good work-life-balance. Radhika Nagpal, a professor for computer science at Harvard, is a woman who made it into a field that is – just like surgery – still very male dominated. In a recent guest blog post on Scientific American she talks about how she manages her life, her career, her family and her happiness. Although not all her points may apply to surgery, her article is certainly worth a read and contains some useful advice for managing a demanding career in general.

In her article she describes seven things she did to make sure to enjoy her life and her career despite its demands:

  • Pretending that her position was a seven year post-doc to take the pressure off her and rather enjoy being able to work with some amazing people in her field
  • Stopping to take advice and rather go her own way (such as focusing on her research instead of trying to network like crazy)
  • Creating a “feelgood” e-mail folder that contained her successes such as job offers and which she could read when things weren’t going as well
  • Working fixed hours in fixed amounts – both in her career and as a parent.
  • Trying to be the best “whole” person that she can. Realising that it is impossible to be the best, most dedicated academic who spends all her time working as well as the best parent who dedicates her entire life to her kids and the best partner who is there for her other half in every moment, supporting him always and unconditionally, she decided that it was a much more attainable goal to be neither of those but rather the best “whole” person who combines a little bit of all of this.
  • Finding real friends outside of her field who are not concerned with her career.
  • Having fun “now” rather than constantly working towards a future in which the fun is hopefully going to happen.

To read the full article (do it! It’s really inspiring!), click here: The awesomest 7 year postdoc or how I learned to stop worrying and love the tenure track faculty life

Changes in Surgery

We have alluded to a number of barriers that women still face in the workplace in general and in surgery in particular in a number of posts (e.g. here, here and here). Luckily, times are a-changing and many things are not as difficult as they used to be. Here is what some men and working in surgery have to say about that:

“I think things have changed quite a lot, partly because there are more women in all spheres of life whereas there weren’t 25 years ago. And that has had a bearing on what people expect women to do. They don’t expect you to stop working when you get married or stop working when you have children. And a lot of people are now married to men that earn less than they do. So again, you have a personal discussion around who is the one who collects the kid from school if the kid is ill and that sort of thing.”

“I think times will be changing. The NHS and the political climate change on a regular basis. The number of women coming through on a higher level of surgical training changes the gender ratio. There won’t be as many men to women as there have been and therefore female leaders will almost automatically be selected inevitably from the positions they’ve got to.”

“Things have changed over the last 20+ years that I’ve been a consultant, certainly. Prior to that, when I was a trainee, things were very different because we weren’t in the strange long hour culture that’s now being pretty much abolished, but it has changed. … I’ve seen more and more female graduates coming through and it is no longer unusual to see women in training in surgery – only today I’m interviewing for a consultant post in London and the two best candidates we have shortlisted are both women.”

“I think things are changing. I think these old style female surgeons have done a lot and maybe there is a new style female surgeon coming through who will try to multitask lots of different things like academia, clinical work and children. That makes life interesting. “

Jane Somerville on BBC Radio 4’s Desert Island Discs

This week Jane Somerville, a female cardiologist and Emeritus Professor at Imperial College London, was interviewed on BBC Radio 4. In this truly inspiring interview she talks among other things about her career, role models and being a woman in medicine in the 50s.

The episode is available online, so click here to listen.

Overcoming Barriers, Hurdles and Stumbling Blocks

Our last few posts have highlighted some of the barriers women in the workplace in general or in surgery in particular face. However, these barriers are by no means insurmountable. Here is the take of some women in surgery on overcoming these barriers:

“I know when I first started I was like ‘Oh my gosh, there are so many hurdles’, but they’re fun hurdles and they’re hurdles that you do with other people. So I’d say get some good work experience … speak to people who are doing that job day to day, find out what it entails. There have been loads of work experience people coming around recently and you just talk to them and say ‘this is what we do, are you interested in that? Okay, come and watch me do this’. And it gives them a bit of insight into what they are in for and hopefully it inspires a few people that it is not too difficult, that it is achievable.”

“I think WinS is absolutely fundamental to women centred issues around pursuing a surgical career. I’ve been at lots of conferences where we talked about maternity leave, breastfeeding, how do you operate when you’re pregnant… and answered a lot of questions and anxieties that women surgeons have that they just can’t ask in the workplace because there aren’t other women to ask. And also just the practicalities of how you manage pregnancy and how you manage childcare afterwards – there are hundreds of examples in the WinS organisation. They just need to come to our meetings or just tap into it and there is a wealth of information there. And then they go away having come with what seemed to be an insurmountable problem going ‘well, what was all that about? All these ladies made it seem really easy and if they can do it, there is no reason why I can’t do it.’.”

“Babies, pregnancy – how do you operate when you are quite far away from the table? But actually I noticed that some of my male colleagues were the same size already and they didn’t have a baby in them. So I thought ‘well, if they can do it, I can manage it as well’. I remember having a conversation with a male consultant about putting socks on at 35 weeks pregnant. I was having difficulties putting my socks on and he was like ‘yes, I have difficulties with that as well’ and it was a hilarious moment.“

“I think if you feel that things are getting compromised – either on your family side or on your job side then you have to reconsider. Work less and spend more time at home. Or the other way around – if you feel that you are missing out on things and progressions in your career then maybe you should organise more backup from home. In the end, everyone needs to be happy and stay happy – including yourself.”

“It’s a marathon rather than a sprint. It’s not glamorous on a day to day basis at all as it is portrayed on the TV. But it is doable and workable and if you are prepared to put in the hard work it is a very rewarding career to have.”