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: