I attended the incredible FIX18 conference in New York earlier this year. One thing really stood out to me: the refrain “why are you here?” (or “why did you go to that?”)
For the most part, these questions came from a place of honest curiosity, but they still struck me as somewhat odd. This was an amazing conference. The speakers were world class. They were discussing incredibly important topics. And unlike many other medical conferences, the talks were all completely unique – nothing I had heard 20 times before. Why wouldn’t I want to be there?
However, I was distinctly in the minority. Men were few and far between. And as I reflected on the conference over the last month, I have realized that the ideals represented by this conference mean a lot more to me than I originally admitted. I think those ideals are incredibly important in medicine (and life), so I wanted to take a little time to expand upon them here. I thought that the best way to explain the importance of FIX to me was to share the outline of a talk that I wrote specifically for FIX (but never submitted) entitled “I am a skeptic because I am a feminist”.
I am a skeptic because I am a feminist
Like many people, I have to thank my mom for all my best attributes.
I took religion fairly seriously when I was growing up. I attended a Catholic school, and in preparation for confirmation in grade 8, I took an early bus every day to attend mass before school. I was dedicated.
But at the same time, I had my very first job. I was stuffing envelopes for an organization led by my mom: the Catholic Network for Women’s Equality. Every morning I would sit through a very conservative sermon. Every afternoon, I would read fliers asking relatively simple questions: Why didn’t the church treat women as equals? Why couldn’t women be priests?
I would have never considered these questions on my own, but once raised, they wouldn’t leave my mind. I was 13 years old and discovering, for the very first time, that the world might not be just. I was indignant.
So I had a series of meetings with my priest. They all followed a fairly similar pattern:
- So why can’t women be priests?
- That’s just is the way it is.
- But why?
- Because… Tradition.
- But why?
- Because I said so.
I grew frustrated. And I was 13 years old. So the last meeting ended with me yelling (and I am still sorry for this): “Well that is just F***ing stupid!” I was not welcome back in the church.
And although I handled the situation with all the maturity expected of a 13 year old, I had learned one of the most important lessons of my life: always ask why. Don’t accept the status quo. “That’s just how we do things” is not a good enough reason.
I learned to question authority. I learned to question my assumptions. I learned not to be satisfied with the easy questions: who, what, where, when. To get the answers that really matter, you have to ask “why”.
That lesson made me a nightmare for my teachers. My respect for authority was broken. My demands for rational explanations clashed with an expectation of thoughtless conformity.
But it also led to the most exciting period of my life. No longer trusting answers that were handed to me, I learned how to find answers for myself. Although I had one of the first modems on our street, it was so slow that most weekends I would take the subway downtown to spend hours in the reference library. I learned something about the scientific method and how to research. I learned to ask questions. I learned to love science.
I am a little ashamed to admit that, upon being accepted to medical school, these fundamental skills temporarily abandoned me. There was just so much to learn, and all of it coming from people who seemed to have so much knowledge, that I reverted back so simply accepting handed down wisdom. That was a mistake.
I rediscovered the importance of questioning everything early in residency. I had been following guidelines religiously. (Yes, that should have been a clue.) But then one day I read the background science on pediatric UTI, and I realized I had been hurting children unnecessarily. Then I read the science on home glucose monitoring in type 2 diabetes, and I realized I had been hurting more patients. Then came home blood pressure monitoring. Then came thrombolytics in stroke.
Time and time again, the best answers from science seemed to clash with what I had been taught, or what I read in guidelines. The lesson that I had learned as a child, thanks to my wonderful feminist mother, was as valuable as ever. Never accept the status quo. Always ask why.
So I was a skeptic because I was a feminist.
But I wasn’t a feminist
I have to admit, despite the incredible lessons feminism had taught me, I would not have considered myself a feminist in residency. It didn’t seem necessary. I believed inequality was a thing of the past.
There were as many women as men in my university classes. My medical school was more than half female. In my emergency medicine year, I was the only male in a class of 8. Obviously, there were still issues in positions of leadership, but it seemed like those were just vestiges of prior generations. That inequality seemed destined to disappear as my generation inherited the world.
I was wrong, and it took evidence based medicine (and some really smart women) to open my eyes.
In evidence based medicine, we spend all our time talking about bias. We understand that a test can appear fair on the surface, but be undermined by unseen bias or confounders. We understand that bias does not have to be intentional, but that even unintentional bias can have tremendous (and deleterious) effects. We learn to search for bias everywhere.
I have been writing about medical biases for years, but somehow I could not see the connection to the real world; to the way that women are treated. Luckily I have some really good friends who are more than willing to point out when I am wrong. (Yes, Nat May, I really appreciate your input.)
The best example of implicit bias that I have ever heard came in the form of one of the talks on the FIX stage this year. Dr. Nick Gorton transitioned from female to male after a few years of working as an attending in emergency medicine. He described that experience like playing a video game on the expert setting, and then all of a sudden being allowed to play on easy. Even if we can’t always point to exactly why, women have a harder time in medicine. Implicit bias is rampant.
It was feminism that originally opened my eyes to the importance of asking why. In return, evidence based medicine and skepticism have reminded me of the existence and power of bias in real life.
I am a skeptic because I am a feminist.
And I am a feminist because I am a skeptic.
Here is the talk by Dr. Nick Gorton:
Morgenstern, J. I am a skeptic because I am a feminist, First10EM, November 12, 2018. Available at:
5 thoughts on “I am a skeptic because I am a feminist”
Justin, (and everyone else who reads this)
Thank you for a thought provoking post. Thank you also for helping me clarify a few thoughts for me about this issue too.
Feminism for me makes me feel uncomfortable, principally because I don’t want it to exist. I don’t want the situation to be true that friends and colleagues and wives and daughters live in a world that isn’t fair, that is aggressive and downright dangerous and frankly wrong on too many levels. I don’t want that to be true and I don’t see it as true. I don’t understand, like you.
Because I’m not a woman.
It means I’m not exposed to it on a low level but constantly, day in day out. I’m not affected by it in my choice of clothes or route home late at night. It doesn’t negatively impact my career or career choices. It doesn’t affect my pay. It doesn’t force me to consider how I think or act. I don’t truly see it’s impact.
Because I’m not a woman.
Ignorance means not to know. I think too many men are ignorant in that we don’t know the impact and we don’t understand because we are not a woman. We need to learn.
I learned quite a bit by speaking at FIX17. I mean, Dara Kass says to you, “You are speaking at FIX,” so that’s a done deal. You speak. But an hour before I went on stage I was on the point of withdrawing from the line up. I had sat through a day and a half of women sharing their stories, their inspiration, their anger, their insights and their hopes. And I was ashamed at what I heard. I felt I had no place amongst them. I started to learn and to understand a little more about my life lived in ignorance. And I didn’t feel worthy because I was ashamed of not knowing, of being ignorant. (If you catch the start of my talk you may see me bumble and try to express that.)
Bias is a challenge. We all have biases. They are the result of our upbringing, education and experience. Or lack of those. I don’t fully understand mine but I’m working on it. I’m learning not to be ignorant. And I’m proud to wear the fabulous t-shirt I was given as a speaker. I’m a feminist.
Thanks for the very thoughtful comment Ross. I definitely understand that sense of being not worthy. It is the reason (or one of the reasons) that I wrote an entire talk for FIX but never submitted it to be considered. (I am jealous of the tee shirt though. Maybe I should have presented, just so I could have one.)
I think the message I would like to see repeated – that should be taught among medical students, residents, and all people – is that we all have biases. You can’t escape it. And you probably can’t see your own biases. That is easier to accept when discussing science, but far more important to accept when discussing life.
It isn’t easy – but I do hope my friends will continue to point out my biases, because without them, I would be lost.
Also – for anyone reading this far down – you absolutely should check out Ross’s FIX17 talk on being average. It is above average:
Thanks for sharing this, Justin. I do think you do yourself an injustice; you have a lot more wisdom than you realise and your constant reflection is commendable. When we met up in NY you told me you had planned a talk for FIX but decided not to submit it, because you “realised [you] should actually just come and listen.” Insight like that is rare and it means a huge amount to me (and others, I’m sure). We need more allies like you. Thanks for being #HeForShe.
Thanks Nat. It means a lot to me that I have people like you to keep learning from.
I’ll keep trying, and hopefully everyone at FeminEM can keep teaching, and we will all get better together.