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“Setting: An impersonal, windowless conference room within a hospital
Characters: A nurse in charge (NIC), a department chair (DC) and me (ME)
NIC: Thank you for joining us to discuss the report you made of unprofessional behavior in the operating room. We’d like to start by letting you know that in this institution, we have a culture of informality. When I first got here, I found it unsettling that doctors were called by their first names in meetings.
DC: Yes, this culture was also surprising to me. At [Ivory tower institution 1], where I trained, no one would have ever called a physician by their first name! And at [Ivory tower institution 2] where I worked before moving here, no one would have dreamed of calling a doctor by their first name. Can you imagine someone calling Dr. [Worldfamous Surgeon at Ivory tower institution 2] Steve? It never would have happened! He would have been so angry! But here, I get called by my first name pretty regularly. I’ve gotten used to it, and now I don’t even mind.
ME: We’re not here because someone called me by my first name.
DC: What do you mean?”
Sarah M. Temkin is a gynecology-oncology physician.
She shares her story and discusses her KevinMD article, “A discussion about unprofessional behavior: a play in 1 act.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Sarah Temkin. She’s a gynecologic oncologist, and she wrote the KevinMD article “A discussion about unprofessional behavior: a play in 1 act.” Sarah, welcome to the show.
Sarah M. Temkin: Thank you so much for having me.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?
Sarah M. Temkin: Sure. You mentioned that I’m a gynecologic oncologist, and I think sometimes people don’t always know exactly what that is. I think it took me about 10 years of practice to be able to put it into one line, which is that I’m a cancer surgeon who prescribes chemotherapy.
You know, I originally went to medical school in the 1990s and wanted to be a surgeon, and I didn’t really see a lot of women in other surgical fields. And so I ultimately chose to be an OB/GYN, with the idea that I would ultimately pick the surgical end of the specialty. During my residency, actually, and fellowship, I really fell in love with cancer cure and taking care of cancer patients.
Kevin Pho: And how is the pandemic affecting both you and your practice?
Sarah M. Temkin: Oh, gosh. The pandemic is, I think, affecting everybody. We’ve really seen a lot of the impact on our cancer patients, and that some of them are so, so nervous. We’ve had delays to diagnosis. So some of the cancers that have been presented have been presenting at a later stage, with people being more symptomatic than usual.
Kevin Pho: So let’s get into your KevinMD article, “A discussion about unprofessional behavior: a play in 1 act.” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?
Sarah M. Temkin: Sure. I think for the last few years, I have really been trying to understand gender inequity in my field. I am a woman surgeon who takes care of women patients in a predominantly women, all-women environment. 58 percent of OB/GYNs are actually women today, and 84 percent of our trainees are women. And yet I think there’s still pervasive gender discrimination, including very subtle messaging that comes from our environment, saying that women aren’t as good as men, or women physicians don’t deserve as much money, or women surgeons aren’t as good as men and don’t deserve, don’t need the same amount of staff, for example.
I had been really wanting to have an example of how this happens in day-to-day practice. And so I did fictionalize this event somewhat, but I had a staff member, a woman in the operating room, I think, be a little frustrated with me and refer to me as “baby girl,” which I felt was unprofessional. I did report this to my supervisor and her supervisor, and ended up in a conference room discussing this. So this is a fictionalized version of a real event.
Kevin Pho: Now, in stories like these, what is the reaction of the other people in the room whenever you encounter behavior like this?
Sarah M. Temkin: So I think in this situation, what was so surprising and made this into what I thought of as a good story was that I was sitting in a room with two women, two women both with power, and both women agreed that the behavior had been unprofessional. However, they were really looking for ways to close the loop on this behavior without them having to go back and actually say anything had been done wrong. And so the only way to make that happen, actually, was to blame me for the events.
And so I think that happens a lot. We know from some reporting and data on women who report gender discrimination or sexual harassment in the workplace, even physicians, they’re quite often told that it’s their fault, and they’re actually very unlikely to report it, because they’re worried that there’s either going to be retaliation or they’ll be blamed as the target.
Kevin Pho: Saying that there is less accountability than you would like to see when these occasions arise?
Sarah M. Temkin: Oh, for sure. And you know, I think one of the biggest surprises to me in going back and looking into and trying to understand my own experience is how universal these experiences are among women physicians. I think, you know, when you start asking women to describe what’s happened in their workplace as physicians, there’s a remarkable number of women who’ve had these types of experiences.
Kevin Pho: Now, when these experiences are reported, what should administration do? What is the right thing to do?
Sarah M. Temkin: Well, I think it really depends on the incident that happened. There are obviously laws in place that can be enforced about sexual assault or sexual harassment, which are very infrequently enforced. There is also the opportunity, which I think is what was lost in this episode that I discussed in my piece, to have an unbiased approach where both sides of the story are investigated, rather than what I would call an institutional cover-up, where the institution decides what they want the outcome to be and creates a storyline that supports that.
Kevin Pho: So whenever a clinician, or another health care worker for that matter, experiences an incident of discrimination, should it be addressed right away? Should that person, the other person, be checked right away? Or should it be delayed and perhaps later on addressed with leadership or that person’s supervisor?
Sarah M. Temkin: So again, I really think it depends on the circumstance and the individuals involved. But what I think is missing in this is addressing both sides of the story. All too often, the complaints or the reports that women bring forward are just dismissed without an investigation.
Kevin Pho: What kind of advice do you give to other health care workers who experience discrimination?
Sarah M. Temkin: I am a mid-career surgeon and physician who spent most of my time in medicine in academics, and I’m incredibly privileged at this point in time that I have the ability to speak up and speak out. I have a supportive family. I have some degree of financial security. But not everybody has that. And so I think finding allies and finding people who are going to support you, and to understand the best way to approach your particular individual situation, is really crucial.
Kevin Pho: And what about those younger physicians, say junior attendings, interns, residents, or even medical students? When they experience these forms of discrimination, what can you say to them?
Sarah M. Temkin: I would say the same thing. You know, I think all too often women internalize these events and assume that something’s wrong with them or they did something wrong. However, having an outside perspective and having an outside advocate can really help women understand what is truly going on, and how to approach the situation, and ultimately how to decide whether the work environment is right for them or not, or whether they need to move on.
I mean, I think there are reports that, you know, women physicians, because of these types of incidents, are more likely to change jobs than male physicians, and that’s very sad for the workforce, and it’s terrible for patient care.
Kevin Pho: So we’re talking to Sarah Temkin. She’s a gynecologic oncologist, and she wrote the KevinMD article “A discussion about unprofessional behavior: a play in 1 act.” Sarah, what kind of resources are available if this happens to a particular health care worker? Is there anyone online, or is there anyone within that institution that they could turn to for support and guidance?
Sarah M. Temkin: This is actually one of the biggest problems that we have as physicians. The reporting structures are not uniform. In some academic centers, physicians may go to HR but be told that they have to report through the dean’s office. The dean’s office may not have the appropriate resources to deal with these types of workplace incidents.
And, you know, it’s important to remember, and this is what I hope that I brought out from this piece, that it’s not just men who have bias related to gender. It’s just as common among women. And so, you know, it’s very difficult sometimes to find the right place and the right person, and we as physicians don’t always have an internal advocate within our system.
Kevin Pho: So I normally end this interview with take-home messages, so I’m asking you take-home messages to two audiences. Do you have a take-home message to the administrators who may be listening to you? And finally, do you have a take-home message to the clinicians who may be listening to this interview?
Sarah M. Temkin: Yeah, I think for the administrators who are listening, I hope that they are able to take this story and think about their own actions and how to approach their workforce. You know, we have, in OB/GYN, for example, trained an entire generation of women to care for other women, and we should be really focused on retaining those women in the workforce and creating spaces where they can thrive and flourish. And I haven’t seen a lot of that during my career.
In terms of clinicians, I think it’s important that not just the target speaks up, but that the people in the environment feel empowered to speak up and be upstanders. “If you see something, say something,” like the TSA. And it’s only by normalizing these, you know, the reporting of these incidents, that we can make progress as a community to create workforces where everybody feels comfortable.
Kevin Pho: Sarah, thank you so much for sharing your story and insight, and thanks again for being on the show.
Sarah M. Temkin: Thanks so much for having me.
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