Patients Want Empathic Doctors. So Why Is It Seen As A Weakness To Show Emotion?

Women represent just 12% of surgeons in Australia. In certain surgical sub-specialties, this percentage is even lower. Being a woman in surgery is hard, not just because of this lack of visibility and representation, but because of sexist attitudes within the profession.

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“Emotional female” was something I was called when I was working as a plastic surgery registrar in 2018. At the time, I was working an unfair on-call roster, which put me on a 24-hour on-call shift 10 days every fortnight. My co-worker did the other four. I was increasingly fatigued and sleep deprived. That night, I was on call for emergencies, and got rung at 3am about something that was not urgent at all – an appointment booking. The male registrar working in the emergency department tried to argue back to justify his phone call, but I wasn’t having any of it. Eventually he told me to stop being an emotional female.

That prompted me to think about the experiences of women in the workplace. I was certain that if my male colleague had said the same thing, he would not have been called emotional. Why is it an insult almost exclusively aimed at women? And why is it an insult in the first place? Being emotional is something I’ve always considered a good thing. I’ve read the works of Daniel Goleman on emotional intelligence. I know that patients want doctors who are empathic. It makes us human. However, in the workplace, it’s seen as a weakness to show emotion, even though being emotionally self-aware leads to personal and professional success. It’s such a socialised thing – misogyny and toxic masculinity put women down for being emotional, and stop men from showing their emotions.

The long hours and sexism weren’t the only problems I faced. Being a woman of colour made it just that little bit worse. Both of my parents are Japanese. I came to Australia when I was 15, and graduated from medical school in Sydney. As an “overseas” student, I was made to feel second-class, and I was constantly trying to prove myself. There was one occasion when a patient requested she get an “Aussie” doctor instead of me. I also felt that career progression was getting increasingly difficult as more years passed. Was I experiencing the bamboo ceiling? The higher we climbed, the fewer positions there were. Medicine valued qualities such as leadership, which Asians traditionally do worse in. There’s this trope of the submissive, timid Asian who doesn’t aspire to lead. This docility myth hurts Asian women even more. I wondered whether this may have unconsciously been a barrier to succeeding in surgery.

These microaggressions added up over time. We often talk about physical exhaustion, but I was emotionally tired by 2018. I was burning out from the physical hours, yes, but the hostile and unpleasant work environment was a silent contributor. Eventually I quit on 1 June 2018. There was a point when I realised my conditions were not going to change despite many desperate emails and conversations with my bosses to distribute the workload more evenly between my co-worker and I. In fact, an updated roster showed that I would be working even more hours. When I left, my body and mind were in a terrible state. I became clinically depressed and found myself facing an identity crisis – what was I without surgery? When you dedicate so much of your life to your profession, your job becomes your identity.

I was so mentally unwell it took me a long time – nearly two years – to start feeling better. I suffered from insomnia and other symptoms of depression. The medical profession is one of the most at-risk in terms of mental illness. We know from a national survey by Beyond Blue in 2013 that one in five doctors have had a diagnosis of depression or received treatment for it. Both doctors and medical students have higher rates of psychological distress and suicidal thoughts compared to the general population, and the rates are even higher among female doctors aged 30 or younger. Young female doctors scored the highest in all three domains of burnout that were assessed: emotional exhaustion, cynicism and feeling a lack of professional achievement. Troublingly, 40% of doctors felt that their peers with psychiatric diagnoses were perceived as less competent; and nearly half felt that doctors were less likely to be appointed if they had a history of mental illness. It’s clear that there is still some de-stigmatising to do.

Both doctors and medical students have higher rates of psychological distress and suicidal thoughts compared to the general population

However, there have been some changes to the way in which we talk about burnout, which are promising. Whereas in the past we spoke about things like individual resilience, we are now examining systems. Although burnout is not a medical diagnosis, the 11th revision of the International Classification of Diseases now includes burnout as an “occupational phenomenon”. I welcome the change in shifting the blame from the individual and looking at systemic factors. The canary in the coalmine. The solution is not to make stronger canaries. I’d like to think that I was a pretty strong canary to start with. In fact, most doctors are already very resilient. We have to be, to survive working in what is often a traumatic environment, where we confront cancers and terminal illnesses, as well as horrific injuries. The nature of our job can already be difficult as it is.

Overwork. Sexism. Bullying and harassment. These are all things that are affecting the mental health of our doctors. It took a lot of time (and therapy) for me to recover and live my happy life now. While I have no intention of ever returning to a public hospital, I know it will get better for others. I can see some small changes starting to improve the culture. It won’t happen any time soon, but I’m optimistic that future generations of doctors will work in a safer, and more pleasant environment so that they are better able to care for their patients.

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