Anne Marie Slaughter and Women at Work

A female Princeton professor writes an article in the Atlantic magazine about what needs to happen in the American workplace to allow women to fully realize their potential and to take their rightful places at the top echelons of the professions. On The News Hour she says when she was growing up she knew only one female doctor and one female lawyer, but now that's changed. She says we have to get past the idea of the person who spends the most time at work is the most valuable worker.  She says we have to achieve a new frame of mind to allow women to work from home and still be leaders at work.  She has a nifty phrase which, sadly, I could not keep in mind but it is something along the lines of jettisoning the macho manhour syndrome which has to do with proving you are valuable by getting to work earlier and staying later than everyone else.

Of course, the Japanese are famous for staying at their desks until the boss leaves, getting nothing accomplished but being tough about putting in the hours. And, having a wife who telecommuted to her Washington, DC job from New Hampshire for four years, I can well understand the dynamics of certain jobs, which can be better done from a room at home.  When she flew down to Washington for a few days at the office she came home complaining she could not get anything done, with coworkers stopping by to chat, people wanting to go out for lunch and all the other distractions. 

Having said all this, I have to see this line of thought from the worm's eye view of seeing women physicians perform over the years.  Of course, there have been stellar women physicians who inspired me, who were simply better than the men around them: Even the chief of neurology at Cornell, a man who said he would never name a woman to his faculty because women could simply not be as committed to their job as men because they will always put their children before medicine.  But even he had to name a woman chief resident, a mother of two, because she was so obviously better than any other candidate, male or female. But she came in at 6 AM to do teaching rounds with medical students and she stayed as long as necessary to round on every patient from the emergency room to the wards. She was more relentless than any man. She put in the hours, and they were all quality hours.

But she proved to be the exception who proved the rule. And the rule is, most women doctors do not in fact commit themselves to their clinical practices the way at least some men do. They tend to strictly limit what they are willing to do for patients, for their practices, at the hospital, in the office. They tend to justify this limiting behavior in  two ways: 1. They invoke their duty to their children, which others must accept as having a higher claim in life than duty to patient  2. They tend to make a virtue of their drawing tight lines around their duty. So an endocrinologist who is seeing a patient for a thyroid problem may elicit a history from that patient symptoms which suggest possible heart disease, but rather than investigating that possible heart ailment as she has been trained to do, she says she has to refer this patient to a cardiologist, even if that means a delay in diagnosis and treatment. She says it's not her job. She says it's better for the patient to be seen by someone who is more comfortable with heart disease. And she is comfortable with only a very limited number of medical things. It means female surgeons refer difficult cases to male colleagues at other centers. These women "skim the cream" meaning they restrict themselves to the easy cases which will allow them to schedule elective cases and not run over schedule. 

Of course, as women in medicine have demanded predictable hours and shift work, men have jumped on the bandwagon. Men want to go home on time, too. So there has been a race to the bottom in terms of walking out of work on time, the thing which always disrupted lives for doctors when most of them were men, and felt ashamed if they bailed out to go home when things were happening on the ward. 


The shift mentality is not all bad. But the old phrase about a good doctor putting the patient first is not a value shared by most of the women doctors I have seen. Putting the patient first means inconveniencing yourself in most cases--it means putting yourself behind when a patient presents a problem which will make your day more difficult. It means not punting the evaluation of a patient to another physician or another time, in the interest of getting the patient squared away as expeditiously as possible. 


When people insist on just doing the minimal require and on walking out of the office on time no matter what is going on in that office, you begin to ask yourself: What does it mean to be a professional?

Women did a lot of good things when they arrived on the wards, in terms of civilizing the locker room atmosphere.  But they also had the effect of changing the ethos of dedication, which used to mean you stayed with the patient as long as he needed you, and that meant coming home late, and if you had kids, somebody had to take care of the kids, not you.

There is no turning back. Women in medicine has happened and will never unhappen.  But, at some point, we ought to think, over a beer, in a setting like a bar where you can speak the truth without being politically correct, and we ought to talk about the bad with the good part of that.

Show Me Your Papers

I grew up in the immediate aftermath of World War II, and in those days my favorite movies, and there were many of them, were horror shows about Nazi Germany, where the dreaded, slimy, lethal Gestapo hyena would stop the underground resistance fighter at the checkpoint. The resistance fighter  was helping the American flyer to escape and the Gestapo goon would ask her, in the most sinister tones, "Und vear are your papers?"  or sometimes, if he was really creepy, he would be all polite, "Und, may I please zee yoah papers?" And your blood would run cold.  You just knew the jig was up, unless the forgers were really good. Then the pretty resistance fighter would try to work her feminine wiles on him, while he was examining the all important papers, trying to distract him, and you were sitting there watching, hoping he would not look too closely.


I have never been clear exactly what constitutes fascism, but, on an emotional level, for me, this was one of its necessary if not sufficient component of a nightmare state, the state where you had to carry your "papers."


Apparently, in Nazi Germany, you had to carry with you an identity card, (like a driver's license), even if you were in your own village or close to it, and to travel on a railroad or any significant distance from your village, you needed special "papers" which had to be "in order." So the government controlled where you could be and defined who was legitimate and anyone discovered to not have proper government papers was likely to wind up in some jail, prison or concentration camp, at least for a while.


I shuddered to think what it must be like to live in such a dystopia, such a menacing society--which was a special nightmare for me because I was always losing things, forgetting homework, or a textbook or some object. I knew I could never keep track of the all important "papers."  That's one reason I still hate traveling outside the USA--when you go to Europe you better have your passport, your papers. And in Italy once, the hotel people collected our passports to hand over to the local police, in Rome. Made me very nervous.


Now we have it here, courtesy of the Supreme Court's ruling today on the Arizona law.  And, of course, if you are arrested for not having your papers to prove you are a legitimate US citizen, you can get hauled off to jail and stripped searched.


So how has this happened in the land of the free and the home of the brave?


I suppose it's just that everyone believes this will never happen to me, only to them.


And we don't care much about "them" any more.


Thanks Justices Scalia, Thomas, Roberts, Alito and Kennedy. Thanks for making dreams come true.  Was there ever a star chamber court in the Spanish Inquistion which had more power or more willfulness to impose discipline on a nation?

L'enfer, c'est les autres

"Hell is other people" 
                    Jean Paul Sartre, Huis Clos (No Exit)

Gail Collins recently observed that right wingers, Tea Party types, now most Republicans, are people from Empty Spaces. Anyone looking at an election map with all that red across the vast empty middle of the country and the blue states clustered along the coasts can see what she is talking about.  In those big, empty states, Arizona, Oklahoma, Montana, Wyoming, Texas, Kansas, Idaho, Utah, they don't like government because they don't much like other people, have no faith in other people, have had bad experiences in the company of other people, and are generally anti social. They can come in from the farm on a Sunday and sit in a church for some social time, but that's quite enough for the company of others.


When I left New York City after 8 years, I moved to a rural area of southern Rhode Island and I met a lot of people who lived on farms, or who  worked on farms or who drifted around farms and I thought, "These people are here for a reason."  They could not have lasted long in New York City. They'd get in fights, get arrested, be most unhappy.


I loved Thoreau in high school, that whole idea of man living by his own efforts, off the grid, in a shack he built himself on a pond. Thoreau is often quoted by Tea Party types.


But then my sister in law, who is a very smart woman, observed wryly over a martini glass, "Sure, Thoreau's okay, until you need to accomplish something that needs other people."


And that's the rub. 


If you don't care for automobiles or roads or healthcare or communications, phones, computers, electricity, sewers, plumbing, restaurants, movies, art, theater, ballet, pediatric wards, virtually all the things which have raised modern American life above the subsistence existence of farm life in the mid eighteenth century, you really don't need government or other people.


But the Tea Party and the off the grid people live in a fantasy about how sweet life  would be without other people.


Not even the Amish, who reject life with most other people, who wall themselves off and who do not ask much from other people, not even the Amish live like that.  The Amish believe in community. And community means governance of some sort. 


And that is the basic difference between Romney, the Republicans and people who actually believe in some government--The Republicans, Rush Limbaugh and the right wing sell a fantasy of un regulated life, which, were it ever achieved,  would return us very quickly and directly to the eighteenth century, or at least to a time in American life when life was hard and bitter and tedious and if any of those Tea Party people actually had to live that life, they would be the first people mewling and screaming for all the luxuries which community, government and other people provide.


I mean, can you imagine that soft, porcine Carl Rove hauling water up from the creek with his own arms? 


Now, of course, what Satre was really talking about is how hell would be finding yourself locked up with people you really hate. He was not saying just having to live with other people in general is hell; living with certain other people would be hell. But the Tea Party loonies, for them, it's simply everyone else, except maybe for a few like minded other misanthropes.


For me, it might well be the Tea Party loonies themselves. Imagine yourself in a locked room with Rush Limbaugh and Carl Rove. 

Blogosphere Mysteries

A bumper sticker caught my eye the other day: We are not alone. 

I presume this was saying there is intelligent life out there in the universe, and we ought to feel better about that, for some reason.

Actually, it did make me feel momentarily better to consider there may be some other sentient being out there.

But what difference does it make if there are intelligent beings out there, if we can never hear from them? They live in their world and we in ours.

Which is why, my fondest hope in starting this blog and its companion political blog was I might hear from intelligent life elsewhere in the universe.

And, once or twice, a year or two ago, I did. I got replies from Australia.

Australia! Somebody out there, down under, read something I said, and responded. 

How very cool.

But I've had no responses since then to anything I've written. 

I assumed this is because I have nothing much interesting to say, but it turns out, there may be another explanation. 

My brother, who is the only other human being in the solar system who knows for sure the identity of the author of this blog phones me regularly to comment, because he has tried to comment by clicking on the opinion key provided and the blog mechanism will allow him to type in a response but then gives him one of those panels where you are supposed to type in the letters, but when he does, he simply gets rejected and told to type in some more letters.

So my respondent in Australia may be having or may have long ago had the same problem.

I wanted, of course, to ring up the masters of this blog, but there is no way to do this.

I have no idea who created this blog, or who controls it. 

I can guess it's someone in Google, but there is no way to talk to whoever the creator is, at least there is no way to get a response.

In this, it's a little like trying to talk to God. You can beam out your message into space, but you know you will not get an answer.

It's not precisely like trying to talk to God, because there is a sidebar which says "Post Settings"  and in it there is a tab for "options" which brings you to a Readers comments place and you can punch in Allow but that does not solve the problem of allowing your brother to comment have it appear on your blog.

Which makes you realize--here is this gift of a universe, where you can choose your colors and you and import your pictures and create a life, but you never know who provided it, who made the rules or what the rules really are. 

It's an existence place, with a creator (unknown, silent, but, presumably, present, or once present) , a sentient being (me) and no communication between the two.

So, if there is a voice in the woods but no ear to hear it, is there really a voice at all?

Inchoate

I am the master of the inchoate thought.  Today at an otherwise routine staff meeting in our clinic,  someone mentioned the need for a closet in which to store coupons left by drug salesmen  for the unconscionably overpriced drugs they push. 


I hadn't thought this out, but something about our taking the little coupons from those pretty, smiling,  drug reps and handing them out, smiling, to our patients felt, on some gut level really obscene. 


Something just boiled over in me, and, sitting next to one of my favorite colleagues, who is a wonderful doctor but a deeply conservative Republican, I could not restrain myself, although a better angel kept dancing around my shoulders whispering, "Shut up." Couldn't do it. Couldn't restrain myself. 


And I blurted out, "I don't think we should have any closet for any coupons. I think we should not be in the business of playing shill for the drug companies. We should not be handing out coupons for the drug companies in our clinic."


Cries arose around the room, "But it's for the patients."  And, "I have a little old lady who needs them." And another of my colleagues, a woman,  said, "We are going to write for Androgel anyway, and the rep leaves the coupons, so why not make it easier on the patient who needs to fill that prescription?"


My favorite colleague said, "Well, I'm going to hand out those coupons and I'm glad to do it."


And all I could say, not having thought out my position in sufficient detail,  was it felt wrong: We are participating in a deception. 


Drugs in this country are shamefully overpriced and the company, having charged ten times what it ought to, comes by and plays the hero by offering a few coupons to reduce the price for some lucky few patients who are our patients. So we seduce the patient to pay our fees and come to our office by handing out coupons to reduce the price of an overpriced drug and we become complicit in the drug company's crime. 


Whenever I'm looking through the window at the drug rep in the waiting room, that well scrubbed, perfectly groomed saleswoman, who offers me coupons, I say in a loud and clear voice, so everyone in the waiting room can hear, "No. I do not want your coupons. I want you to go back to your bosses and tell them we do not want coupons. We want your company to lower the price on this drug for everyone . We want you to charge a reasonable price, which you are currently not doing. Don't play all magnanimous with a handful of coupons."


European drug companies spend more on Research and Development than American drug companies and yet they sell their drugs for about 60% of what American drug companies charge for the same drugs.


A drug with costs the company 50 cents to produce is sold for $10 a pill, and the company claims that's to cover the cost of "Research and Development." Somehow, European drug companies seem to do more R&D without over burdening their customers with outlandish prices at the pharmacy.


Drug companies lobby Congress for complete protection from foreign competition, from Indian companies which can make bio identical drugs for a quarter of the price our companies charge,  under the guise of "intellectual property rights."  American government agencies, like the National Institutes of Health develop and supervise testing of drugs for which American companies then claim patents. Congress passes laws to outlaw Canadian pharmacies from selling the same high quality but lower cost drugs to American consumers. American pharmacies, like Express Scripts require doctors to choose a brand like Humulin insulin and refuse to fill prescriptions unless a brand is specified. 


One filthy hand grasps another. Vulture capitalism has become predator capitalism. 


The oil companies don't hold a candle to the drug companies when it comes to raping the system.


And we participate, in our small way, in the office, by saying, "Oh, what's wrong with that?"


What was that great line from Apocalypse Now? We cut them in half with  machine gun fire, and then we throw a Band Aide at them and feel all virtuous.


I felt today the way I used to feel in suburban Maryland in the fifties when everyone around me, all those nice people, were saying, "But those Negroes don't want to go to school with white kids. They are more comfortable with their own kind." Everyone was so earnest and well meaning and part of the problem of simply not wanting to see the evil, and convinced the system is benign and good for everyone, so what is the basis for the protest?

Academic Elitism

Listening to Car Talk this morning I was once again reminded why I love the Click and Clack brothers, who are ending their 35 year reign as one of the most bracing radio shows which is social criticism masquerading as a car advice show. 


Ray is the younger, more focused, stolid of the brothers, but I love Tommy, the irascible, more free wheeling spirit, who tends to fly off into regions of truth and philosophy from the most tangential remarks from callers--everything from the pernicious development by which adults have usurped the sandlot from their children, who no longer go out to a ball field by themselves, without adult supervision, to his rant this morning provoked by a sweet caller, who, Tommy discovered taught math at a South Carolina college, and when he probed, it turned out one of the the courses she taught most often was calculus.  "And what can your students do with calculus?" Tommy pressed her. "Well, they can calculate the area under a curve and calculate the instant velocity of things, and the average velocity."


"And, how many times in their lives, after they finish your calculus course will they ever do this, will they ever need to do any of these things?" Tommy persisted.


"Well, I don't know."


"Oh, but I know," Tommy honed in. "Zero. Never. Zilch. You are teaching a totally worthless course, with no value other than intimidating students and making them think they are no good at math." And remember, Tommy graduated from MIT, and is presumably a good math student. So this is  not likely sour grapes, but simply a cry of outrage.


And, of course, he is not only correct, but he is more correct than he knows. Without a good grade in calculus you cannot hope to get into medical school in the United States. Harvard will not even consider your application if your physics course is not one which is calculus rich.


Every physician I have asked has said they never once used calculus, once they had taken their final exam in calculus in college. Calculus is about as important to learning medicine or surgery as Greek and Latin. 


Organic chemistry, a course I did quite well in myself, is similarly ridiculous. The sort of learning you do to learn organic chemistry resembles what you do in some medical school courses--there is a big volume of material which you have to organize to remember--so it's been thought to be sort of a predictor of how well you'll do in medical school. But if you want to predict which students will succeed in medical school, why not simply teach them physiology and anatomy and microbiology and genetics in college, the courses they will need to master in medical school?  You may ask what medical school would be for, if the students already had these courses in college, but the fact is, as anyone who has every tried to master them in the single year you get in medical school, these fields are so vast and complex, a second visit in medical school would be a welcome experience.


So, the selection process for medical schools, i.e. the schools granting MD degrees is very flawed, so irrational and obnoxious and ill conceived it can reliably tell you only one thing about the students you are selecting for the glittering prize of a medical school place: How much do they want it?  How hard are you willing to work? Are you willing to sit in a library and study while all your friends are out partying, having sex, having adventures, studying really cool stuff like philosophy, anthropology and literature?  


I once mentioned to my father, who had spent a career in what is now called Human Resources a study showing the SAT exam predicted only the first half of the first semester in college. And he responded, to my surprise, "Well, then it's a decent test. What you want to know is how is going to wash out that first year."  He laughed at the idea there could be any test which would predict who would do well throughout a four year college career, who would be Phi Beta Kappa or Summa Cum Laude.  


Elite schools like Harvard, Yale and Princeton promulgate a very useful idea of ultra meritocracy--they say they can recognize the geniuses, and they can point to Bill Gates and Mark Zuckerberg as proof of their discernment. 


But I wonder if they are the exceptions which prove the rule. In general, I wonder what exactly Harvard classes have harvested.  I wonder if they are very like what medical school classes look like--people who have demonstrated they are willing to work very hard, doing even worthless things, jumping meaningless hurdles to compete.


There is nothing wrong with people who are willing to work hard and repress their own gratification to gain a future goal. On the other hand, there is a worry for a nation which structures its reward system to put these worker ants in its most important institutions. 


I read those New York Times wedding advertisements--I know, they are "announcements," but what they really are is people bragging on themselves. These people have degree upon degree, from Harvard, Oxford and the London School of economics. These are people who pursue one academic merit badge after another, apparently because they can, and because they have nothing better to do in life, and nothing to contribute to the world beyond keeping Oxford dons in full employment.  


I say all this on the occasion of the graduation of a son from one of the most elite institutions, who has years of surgical training ahead of him, which will require persistence and which will require him to do many things he really does not want to do, to jump over hurdles. He has been carefully selected. 


But I think he was identified despite, not because of all those professors and deans who threw obstacles in his path.


I think we can do better for our nation, for the generations rising to meet the needs of the twenty-first century.

What's the Matter with Wisconsin?

I did not understand Wisconsin's vote to keep Walker until this morning. A woman at work remarking about a coworker who had recently been told to pack up his things in a cardboard box and marched off the premises by security--fired--and she was saying what an excellent worker he had been and probably possessed the highest level of sheer talent of anyone at work. But he had obviously offended somebody in administration and he was gone. We all have contracts which say we can be fired at any time for no reason at all. We work at the pleasure of the bosses and the bosses have no mercy. 

She then commented how different our position is from that of the teachers in her town who are public employees, have tenure, recycle the same old lessons year after year and nobody can march any of them out of their offices with their things in cardboard boxes.

What she was saying is: 1. Some of these teachers ought to be fired but cannot be 2. Keeping these particular protected workers injures the rest of us 3. We should have no sympathy for public service employees because they abuse their privileges. She went on to talk about all the policemen and firemen who worked overtime the last few years of their 20 or 30 years because their pensions get inflated by doing so  and they retire at age 50 with an $80,000-150,000 pension and can go out and find another job. And they never went to college--became police or firemen right out of high school at 18 to 20 and after 30 years, they are still only 50. 4. In her town, they cannot fix pot holes because the town is financially strapped paying out 60% of its budget on these inflated pensions for these guys who don't really deserve it.

It reminded me of my father's reaction during a players' strike of the National Football League. "I'm all for the workers," he said. "But these guys are not workers. They are millionaires fighting with billionaires."  

This is the sort of thing the labor unions in Wisconsin were up against: Most citizens have not been able to wrangle such good benefits for themselves and they feel the unions have extracted these sweet deals at our expense. If the unions wrangled sweet deals out of Boeing or Walmart, okay. If the unions wrangle deals that sink the government or General Motors, not so good.

The labor movement has a delicate balancing act here. Traditionally, the only people they had to please was their own membership and their greatest threat and opponents were the bosses with the money, the dogs, the police and the government on their side. Now, the unions have to face the envy, resentment and animosity of the citizen who goes to work every day at the mercy of his boss, who has to watch his step and watch his back and has little to no security and says,  "Why should I pay for such a sweet deal for someone else, when I have to prove my own worth every day?

Of course, it never occurs to the worker to ask why he should have to put up with a contract that says he can be fired without cause.

Margin Call: Winners and Losers

Just watched Margin Call the 2011 film about the Wall Street fiasco that resulted in the collapse of Lehman Brothers and Bear Stearns and which revealed Goldman Sachs as a ruthless company which swindled its own customers to maximize profits for itself.


And this morning, I read in the New York Times wedding announcements about the wedding of one of the kids from our old neighborhood, who had grown up and gone to medical school.


Yesterday, I watched that superb documentary: Stronger, Faster, Higher which is nominally about the use of androgens by professional athletes, competitive weight lifters and run of the mill gym rates. But saying Stronger, Faster, Higher is about androgen abuse is like saying Huck Finn is a book about a kid on a raft.


You will ask: What could connect these three experiences? 


I myself have pondered the connection and come up with this: They are all about the idea of what it means to be successful, of winning, in American life.


In the case of the Margin Call, you get very quickly caught up in the culture of this Wall Street trading firm, as employees are escorted out of the offices by security guards, carrying personal effects from their offices in cardboard boxes, as their fellow employees watch, knowing  they may be next.  if they do not meet their sales goals. And you have a sense of the disgrace and economic peril visited upon the fired employees. Those fired employees of this Goldman Sachs like place have likely been stars all their lives, have graduated from Princeton and Yale and even MIT, and now have been booted out, prospects uncertain.  In the end, one of the senior employees tells us about how he built a bridge when he was an engineer, before he started his career on Wall Street, and how wonderful that solid accomplishment felt: He had saved the people who used that bridged years of time which would otherwise have been spent in cars commuting longer distances. And you see what he got for leaving his career as an engineer--his beautiful home in Brooklyn Heights.


In Stronger Faster, Higher, you see the fantasies which make life livable for so many Americans in different circumstances and subcultures, the idea of success and value which is so plain and pathetic. The father of a boy who was a star baseball player in a Texas high school tells the camera his son's death has meaning because he's set up a foundation to fight androgen abuse, and it was androgen abuse which killed his son. Well, it turns out his son: A/  Had depression  B/ Was being treated with Lexapro and either of these, or something else entirely, might have been more important to his decision to hang himself in his own room. But for the father, "All I have to know is my son is dead and he used Androgens. I don't need to know anything else."  That is, he doesn't want to know anything else. He prefers faith and his own version of the truth. His son was a success in that Texas town, but apparently not in his own mind. And now something successful, some win has to emerge for the father--the foundation, testifying before Congress, keeping his son's room as a shrine.


The neighborhood kid in the Times, left his home town a success. He had his share of disappointment and loss in high school--he didn't make the high school soccer team after having been a star in club soccer teams before high school, but this high school is super competitive and most of the starters were kids from Brazil and Europe and the local kids who grew up playing teams coached by their parents were not going to win positions on that team. But  he got  into Penn, an Ivy League school, and emerged a winner. Except competing against all his Ivy League classmates, he could not get the grades to get into an American medical school and had to go to St. George's in Grenada, offshore. There he met a woman who had had a similar experience, from Georgetown to Grenada. But persistence is very important to anyone who wants to succeed in medicine, and they clawed their way back to the States and both got residencies in fields which are very competitive--orthopedics and plastic surgery. True, they are doing these residencies at a state school, but once they are trained and pass their boards, they will be winners again, and they will get paid the same fees graduates of Harvard medical schools get paid.


So what is success, in this country?  


It is, ultimately, what Thoreau described:  It is a man's own opinion of himself.


One of the weight lifters talks about his dream of becoming a star professional wrestler, and his  frustration that he has never been chosen to be one of the actors on the circuit. His hero, growing up, had been Hulk Hogan, but that career would never happen for this loser. "But I know I was born to greatness. I'm out here and California now. One day, I may be walking down the street and someone may pull me over and say, 'Can I talk to you for a moment?' And that could never happen in Poughkeepsie."


So what is success? In America, it's money; it's finding the right mate; it's getting into the competitive school; it's getting the competitive position at the competitive institution. Until you get all that and discover, not really.


America is about pointless competitiveness, about style over substance and about emotion gaining ascendance over rationality. It is a place which is so big, so diverse, there is no core. New York City is the essence of America.  Shaker Heights, Scarsdale, Bethesda, Chapel Hill, Plano, Chevy Chase, Gross Point, Winetka, Darien, none of the rich suburbs or small towns, where people share a core set of values is the real America. They are all versions of Fantasyland.