#MeToo

Over the past week, the systematic victimization of women in Hollywood by a serial sexual predator has caused many women to look at their own life experience and consider whether they have also been the victims of sexual harassment, or worse, in their workplace. Today I have been watching the intensity of the #MeToo campaign build and I have been thinking of the experience with sexual harassment of most women physicians and medical students, including myself.

The essence of the #MeToo campaign is that a woman who has been sexually harassed copies a prepared text onto their Facebook page, or Instagram, or Twitter with the hash tag #MeToo to indicate that she has also been a victim of sexual harassment. This is the screen shot from my Facebook page:

 

As a physician who trained in the 1970’s at McGill University in Quebec, I studied medicine in my late teens and early twenties. When I applied to medical school, I was asked by one interviewer, “Are you interested in getting married?” Having always been a little too smart-mouthed for my own good, I answered, “I’ve only just met you. Can I have some time to think about it?” But over the years of repeating that story, no one was ever surprised that someone (a man) asked me this question.

My women colleagues and I became used to professors and staff physicians and senior residents enquiring about our menstrual cycles, our marriage plans and commenting on our suitability for senior leadership roles. At the time, I suspect that most women medical trainees were like me. We took for granted that this treatment was typical in medicine. All trainees were subjected to humiliation, verbal abuse and a work load that was essentially equivalent to slavery. The sexual harassment that woman trainees experienced was influenced by a medical environment, but women were mistreated in all work environments. In fact, the term sexual harassment may have been coined at Cornell University in 1975, but that was not the literature medical professors considered valuable.

Over the past forty years, with both male and female colleagues, many of us are working to change this culture in medicine and we even have days when we believe we have been somewhat successful. We can say that there is now excellent evidence that respectful medical workplace behavior is still a problem and that every physician or medical student or resident should now be aware of the principles of medical professionalism and disruptive behavior. That’s it, however. That’s the extent of our progress: that we should know better. Medical students and residents continue to tell us that there is a problem and women doctors and medical students on Social Medial today are recording their #MeToo’s along with women in every other profession.
Many women in medicine will say that this misogynistic treatment occurred mainly when we were students and residents, but it is just not true. Women are still being passed over for academic promotion, hospital leadership roles, association leadership roles and even association awards. If you look through this list of winners of the Canadian Medical Association’s Frederic Newton Gisborne Starr Award, you will find the name of one woman. Even if you don’t count all the early years of the CMA when women couldn’t be doctors in Canada – not one of the best reasons for this low number of women award winners, mind you – it is still a sad statement about how women are regarded in the profession. Finally, and probably most telling, the specialties in medicine with the lowest fees are those dominated by women.

From the moment in an admission interview that I gave that sarcastic answer to an inappropriate question, I have been working for medicine to be a more positive profession for women. The number of women in medicine has grown, but we still work harder for recognition than our male colleagues. We still do not call out sexual harassment in medicine to the extent that we should. For all my women colleagues who think I am exaggerating, I suggest that you have a conversation with some work friends about your own experiences in Medicine.

This is what you’ll learn after thinking about most medical workplaces: #YouToo

 

Seria Una Cruz Verde?

I am watching the news from the Venezuelan election and wondering what I would do if I were a doctor in Venezuela today. The election is the most recent assault on the people of Venezuela by their President, Nicolas Maduro. By the end of the day, or within a few more days, he will become the dictator of Venezuela. The making of a dictator is the undoing of security in a country and many young Venezuelans have seen their country go from being the richest country in South America in the 1980’s to having an 86% poverty rate in 2017.
Since April, over 100 young people have died in protests in Venezuela. That total increased by 19 this weekend as protests over the election intensified. Venezuela’s neighbours, Brazil and Colombia are bracing for a refugee crisis. The country is experiencing a food security crisis and medicines are not at all available.
The scale of the humanitarian crisis was confirmed by Dr. Douglas Leon Natera, President of the Medical Federation of Venezuela. Natera is reaching out to colleagues in the region. This is a communication to Dr. Maite Sevillano, Vice President of the South American Region of Medical Women’s International Association:
“To the friends: The health sector being headed by the doctors is only attending emergencies, trying to continue to give priority to children, pregnant women and the elderly. These resolutions are being followed by 96% of doctors in public services and 85% in private.” (Personal Communication to dra Sevillano)
Venezuelan physicians are especially concerned about the impact on children, who have been most affected by the food insecurity. Also, youth have been the majority killed in protests against the Maduro regime, according to Dr. Natera.
In Venezuela, however, some of the heroes are also young. Medical students and recent graduates of the Central University of Venezuela have banded together as volunteers to provide first aid and whatever care they can to those injured in protests, on both sides. However, despite the group’s impartiality, government forces usually see them as part of the protest. As they help, some have been injured and one of the volunteers was killed. To identify themselves, the volunteers wear white helmets with a green medical cross and carry white flags bearing the same green cross. Cruz Verde (Green Cross) is what they are called and those injured in protests call out for them, and pray for them.
As most of the volunteers are in their twenties, they were born when their country was still wealthy. They have witnessed its disintegration. They are studying – and learning – the basics of public health, emergency medicine and the impact on health of a humanitarian crisis in the most unfortunate way. Their older colleagues, led by Dr. Natera, are also working to provide basic medical care to starving and desperate Venezuelans. When I read about their work and watch youtube videos of their working conditions, my own first world medical concerns dissolve into this philosophical question:
“Seria una Cruz Verde?”

(Photo credit: Christian Science Monitor)

Finale

In my last moments as Chair of the Ontario Medical Association Board, I thought of the five remarkable doctors, my former colleagues on the Executive Committee ,who have been my inspiration for the past six months. They embody the compassion, devotion and civility that epitomize physician leadership. I have learned so much from them.

Like my colleagues, despite having Council’s confidence to continue personally, I found the vote of nonconfidence in the Executive Committee in general to be extremely troubling.  As much as I want to assist in mending the divisions within the Ontario Medical Association, I believe that the best thing I can do is to assist as a Board member for a few more months.  The past six months have also taken a toll on those who care most about me and my clinical work so I feel it is important to attend to the interests of my family and my patients.

I am first and foremost a doctor and nothing is more satisfying to me than watching the life come back into a young person’s face as their depression lifts. I am inspired by the clinicians that I work with in my hospital and my community. The doctors and nurses, psychologists, social workers and other clinicians in my hospital keep me grounded in what is most important in medicine. They are amazing.

In ten years of medical politics, I have learned that I am not a politician. I can’t learn the lines or follow the cues. As too many people tell me, I cannot keep my facial expressions under control. If I have had any success, it is because I am persistent. It is because my efforts to be tolerant and gracious and kind have occasionally been successful. It is because, having always worked with youth, I have learned not to take my self too seriously.

The picture below is my favourite picture of me in OMA service. This was taken last November with Ontario’s medical student leaders. On the days when I have the most worries about where we are headed, I think about these doctors-in-training and I am reassured. If the work I have done for the Ontario Medical Student Bursary Fund and Physician Human Resources have had an impact for one young doctor, then my time at the OMA Board has been well spent and I leave with a light heart.

students4-002

(Photo credit: OMSBF)

Physician Activism: The Ontario Medical Student Bursary Fund

The average medical school tuition in Ontario is now over $23,000 annually. With the average overall pay for a woman in Ontario being approximately $40,000 annually, one can appreciate that studying medicine could easily be beyond the reach of most Ontario students. (Reference: http://www.payequity.gov.on.ca/en/pdf/wagegaps.pdf) This raises the question of what can be done to make access to a medical education more equitable. In 1999, the Ontario Medical Association decided to take action to help well-qualified but poor students become doctors. This decision recognized not only the reality of higher tuitions and living expenses but also that, as tuitions increased, the average income of a medical student’s family of origin also increased. For example, the average income today of a medical student’s family or origin is $140,000 annually – within the top10% of income earners. (Reference: http://www.cbc.ca/news/canada/who-are-canada-s-top-1-1.1703321) In 1999, led by then President-Elect Dr. Albert Schumacher and bolstered by the donation of Dr. George Yee, the Ontario Medical Association established the Ontario Medical Student Bursary Fund.

I have been the Chair of the Ontario Medical Student Bursary Fund (OMSBF) at the Ontario Medical Association since 2011. In that capacity, I have a unique opportunity to see physicians’ dedication to the future through their personal contributions to a fund dedicated to ensuring that medical school is affordable to youth from all walks of life.

Since its inception in 1999, the fund has raised more than $10 million. The fund is administered through the Ontario Medical Foundation with costs borne by the Ontario Medical Association. During the last academic year, the Bursary Fund distributed $400,000 worth of non-repayable bursaries to 133 medical students at Ontario’s six medical schools. Of the total bursaries, 108 students received a $3,000 bursary and 25 students each received $2,000 from one of our named bursary funds.

In the scheme of things, $2,000 – $3,000 may seem like very little money but most of the students who earn one of the OMA’s bursaries are also eligible for other financial aid as well as significant merit scholarships. As the Chair of the OMSBF, it is my hope that, over time, the fund will raise enough money to increase the size and importance of the bursary. At present, some of the most important bursaries are those provided by the OMA’s Branch Societies to support students from their own communities who are training in medicine. Since students often return to their own communities or regions to practice, funding a student bursary allows a community to invest in its own medical future.

Reviewing the applications for the named bursaries can be a very tiring task. This is not because it is arduous or time-consuming, but because it is emotional. As committee members read the letters provided by applicants, one becomes acutely aware of the stress students are under as they seek to finance their education. Also, many students have stressors beyond medical school and finances and I find myself hoping that there is good outreach to them about getting support. One of my predecessors on the Bursary Fund, Dr. Dennis Pitt, from Ottawa used to mention how compelling the stories were and this is still true.

This has been a difficult year for Ontario physicians with cutbacks, severe cutbacks in some cases but doctors are still contributing to the OMSBF. One doctor, Dr. David Berbrayer, has redirected all of his OMA honoraria to the fund. Others continue to contribute in large amounts. The Government of Ontario likes to imply that doctors are greedy but this fund proves in a very tangible way that this is not the case.

Hanukkah began on December 6 this year, incidentally St. Nicholas Day, each holiday one whose traditional gifts include small amounts of cash – symbolized in both cases by gold foil-wrapped coins. These tokens remind us of the benefits of giving, especially for the giver. As I reflect on this, and on another successful year for the Bursary Fund, I think of this wise quote from a girl whose faith in people made her a hero.

“No one has ever become poor by giving.”

Anne Frank

Reflection of a Life-Long Learner

One of the most appealing aspects of a medical career is that you are always learning. In my field of Psychiatry this has been especially true, although perhaps I say this in ignorance since I am not nearly as familiar with the developments and discoveries in specialties other than my own.

Ongoing self-education is so important to a medical career that all educational colleges require their members to be current in their chosen field. In the Royal College of Physicians and Surgeons of Canada, of which I am a Fellow, there is a five-year cycle of learning in which I must participate. I must also prove that I have completed the elements of the cycle on an annual basis. Over the 30 years that I have been a Fellow, this system of establishing that I continue to participate in Continuing Medical Education has developed and modernized. The Royal College strives to promote that Fellows must be current and knowledgeable.

This is not even a new concept in medicine. Sir William Osler told medical students: The greater the ignorance, the greater the dogmatism.” Osler’s love of learning was reflected in the vast library he accumulated. His original library of 8,000 volumes of medical and other books was donated by Osler to McGill University, in gratitude for his medical education. That collection formed the original collection of the Osler Library of the History of Medicine at McGill University. (http://www.mcgill.ca/library/branches/osler) The collection has grown to over 100,000 volumes. When I was a medical student, I spent a great deal of time in the Osler Library. When anatomy and physiology seemed incomprehensible to my English-honours trained brain, Osler’s library was a wonderful reminder that I had years, a whole lifetime, to learn my craft. Osler loved teaching medical students and residents ( albeit only male medical students and residents) and he certainly instilled the idea that medicine was a career of life-long learning.

I am committed to the principle that a doctor must continue to study, observe and learn. Because of this, I am very much troubled by the current fashion to call medical students and residents “learners”. It seems to exclude the rest of us from the category when, in fact, we likely all want doctors to continue to be “learners” throughout their career. I have looked through the websites of the educational colleges to have an idea of when this practice began. It seems to be one of those trends that just snuck up on us, but it does seem to be sticking. In general, I hate to mention my dislike of this usage for fear of insulting both residents and students since this is the term that all student and resident leaders use to describe the collective of medical students and residents. I never use “learner” when I mean a resident or a medical student, for the reason I have set out. I do not want to be excluded from those who must continue to study.

I would also never want to give the impression that learning in medicine (or any worthwhile career, for that matter) stops. My life-long effort to learn medicine is ongoing. This was proven to me very definitively about three years ago when I found myself describing exactly where the hypothalamus is located in the brain – something I could never have done as a medical student. There is still hope that I will learn the physiology of the Loop of Henle.