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We read Ms. Manzoor and Dr. Redelmeier’s article on sexism in medical care with great interest. Their article tackles the important issue of gendered perceptions in medicine, which is a pressing issue in the medical profession and a topic of increasing interest to researchers. The article offers independent strategies that female physicians can employ when they are mistaken as nurses or other healthcare professionals in the clinical setting. While well thought out independent strategies can be useful tools for combatting socially constructed perceptions of gender and identity, we worry that the authors have missed the larger problems of sexism in medical care by focusing almost exclusively on physician-patient interactions. For example, while existing research(1,2) has shown that mischaracterizations (e.g. unequal naming practice) can feel frustrating and demeaning for female physicians when interacting with patients, research from our team and others(3,4) has also shown that it is the prevalence of gendered norms and subtle microaggressions between medical colleagues that principally reinforces the perception that women physicians are of a lower status than men and negatively impacts their careers and well-being. Ms. Manzoor and Dr. Redemeier appear to suggest that we hold patients to a higher standard of accountability than male clinicians given that the single paragraph that discusses clinician-clinician interactions is titled “collegial humor” and puts forth the assumption that when female clinicians are mistaken for something other than a physician by their male colleagues, it is an rare error that should be combatted with good humor. In contrast, research has demonstrated(5,6) that female physicians regularly experience both subtle and overt forms of discrimination in the context of their medical teams and we contend that these professional relationships should be the primary focus of efforts to improve equity in medicine.
References
(1) Wheeler M, de Bourmont S, Paul-Emile K, et al. Physician and Trainee Experiences With Patient Bias. JAMA Intern Med. 2019;179(12):1678–1685. doi:10.1001/jamainternmed.2019.4122
(2) DeFilippis EM. Putting the “She” in Doctor. JAMA Intern Med. 2018;178(3):323–324. doi:10.1001/jamainternmed.2017.8362
(3) Parsons Leigh, J., de Grood, C., Ahmed, SB., Ulrich, A., Fiest, KM., Straus, SE., Stelfox, HT. Towards Gender Equity in Critical Care Medicine: A Qualitative Study of Perceived Drivers, Implications and Strategies. Crit Care Med DOI: 10.1097/CCM.0000000000003625
(4) Liang R, Dornan T, Nestel D. Why do women leave surgical training? A qualitative and feminist study. Lancet. 2019. February 9;393(10171):541–9. 10.1016/S0140-6736(18)32612-6
(5) Ruzycki SM, Freeman G, Bharwani A, Brown A. Association of Physician Characteristics With Perceptions and Experiences of Gender Equity in an Academic Internal Medicine Department. JAMA Netw Open. 2019;2(11):e1915165. doi:10.1001/jamanetworkopen.2019.15165
(6) Lau ES, Wood MJ. How do we attract and retain women in cardiology?. Clin Cardiol. 2018;41(2):264–268. doi:10.1002/clc.22921