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.