An excerpt from The DNA of a Doctor: How Upbringing, Culture, and Unbridled Ambition Curates Achievement.
Having the support of male colleagues and mentors was not new to me. I could not have gotten through plastic surgery residency without my male co-residents. Being the only woman in my class and the classes I was sandwiched between could be daunting. My male co-residents were a blessing, they looked after me, and I looked after them. I always felt respected and always had a seat at every table. I can truly say in retrospect that I was not treated differently, I did not have to work twice as hard as the guys, and in most cases was not just given a seat at the table, I was virtually forced to take it.
Gender was simply not a thing during residency. We did not have time for that. It was only about work, learning, and being the best plastic surgeon. Even back in medical school, my biggest supporter and mentor had been a minimally invasive male surgeon who helped me to forge the path to applying to a general surgery program. This was especially meaningful because I had had a hard time seeing myself as a surgeon since I did not know anyone that looked like me doing the same. He had encouraged me to follow my dreams and helped me as much as he could in those early years of navigating my career.
My mentors in general surgery and plastic surgery were all men. These guys were my biggest advocates and, to this day, I can turn to them for anything. I never had one moment of feeling “less than.” In fact, we used to joke that I was the only girl in the boy’s club, and I was proud of that. Other than a few female chief residents when I was a junior in general surgery and one or two attendings, every mentor that I had ever had in my career to that point had been male. I certainly had no female plastic surgery mentors. I was okay and good with that. This was simply my norm. I did not realize how helpful certain crucial female relationships would become later in my career.
It quickly became clear that “work” was a whole new territory. In residency, as much as you operate, study, learn, and cram, there is a whole lot about actually working as a surgeon you do not encounter. It had all been learning on the job in the hospital, managing patients with acute needs. There was very little exposure to administrative issues like insurance companies or billing or staffing or patient follow-up. This, I think, is a problem with medical training in general. For us surgeons, there is some exposure to clinics, usually an afternoon or morning a week depending on the rotation. But for all intents and purposes, our job was to learn how to operate. We rarely saw patients after they left the hospital, we did not have continuity of care, and we certainly did not learn about the business side of medicine. All these concerns and more I was confronted with, immediately. For many of these matters I would go through my immediate boss, my division chief. I was not sure the two of us were on the same page, though the chair and I certainly were.
It was a rude shock to find the Boston patient population so challenging compared to Dallas. The issue was not the disease process; that remained the same. Here in Boston, patient interactions were rougher. For the first time in my life, I was forcibly reminded just how young and female I really was. I would sit in a patient’s room and have 45-minute in-depth discussions on the surgery to come. I would detail everything the patient could possibly expect from the upcoming procedure. “This is where your incisions are going to be, this is how you can expect your recovery to proceed.” I never rushed these talks; I always took great pains to explain everything I could.
Several times patients would then say, “OK, so, when is the surgeon coming in to talk to me?” Certainly, I was taken aback, as I had introduced myself as their surgeon and had been sitting there in my white coat with Dr. Ramanadham stitched onto it the entire time.
It was in Boston that I first learned about saying “no” to patients. Sort of. In Dallas, patients were in the hospital or already on the OR schedule because they had urgent medical issues or had already been vetted in clinic by the attending surgeon. When we did say no, for instance, if another doctor had consulted us and surgery was not indicated, patients were usually relieved. That was not the case here.
I had several uncomfortable discussions where I had to tell someone, flat out, that no, I could not perform the surgery he or she desired. The reason might be because the person had a body mass index (BMI) of 45, or had uncontrolled cardiac or lung issues that needed to be optimized first. My sound medical reasons for refusing (for now) should have been quite evident, but some of these patients took the refusal badly. They would argue and some would scream and quite literally get in my face. On multiple occasions I had to step out of the room to grab whomever happened to be in the office and ask them to come in. If that staffer happened to be male, for example, our office manager, then I would get in trouble for bringing a man in the room with a female patient, even though technically the office manager was the next line of contact, as there was typically only one surgeon in clinic at a given time. After a few such encounters I felt I could not win this battle. If an irate patient was about to attack me, I needed someone in the room with me. Male or female. Period. End of story.
Smita Ramanadham is a plastic surgeon and author of The DNA of a Doctor: How Upbringing, Culture, and Unbridled Ambition Curates Achievement.
