When female physicians talk about maintaining boundaries in our practice, some people go straight to "that place." The one that has to do with amorous patients or colleagues. The one that deals with inappropriate advances. And that absolutely is an important topic. But for another day. What I'd like to discuss here is the more global boundaries that we deal with in our encounters with patients, support staff, and colleagues. There have been important studies about how nurses and doctors react differently in acute situations and how they perceive their roles and their priorities differently. In an article written in 2016 (not 1916, as one might expect) titled "Why Women Should Be Nurses and Not Doctors," historian Anne Crowther reviews the inherent conflicts in the training of women nurses and women physicians. For the female readers in the audience, I'm sure you can all relate to the common occurrence of receiving more after-hours pages or obtuse questions from nursing staff and from patients than our male counterparts tend to receive. When I was in my internship in a large county hospital, I witnessed daily -- if not hourly -- discrepancies in how the nursing staff treated male and female interns. As we were trying to learn procedures such as starting IVs, putting in an arterial line, or other challenges, my colleagues and I would look to the seasoned nursing staff (who were mostly female) for guidance. A funny thing happened on the way to learning: the nursing staff seemed to be ready, willing, and able to help our male interns and provide assistance and instruction. Yet, when I or one of my female colleagues would ask for help, we were met with shrugged shoulders, rolling eyes of indifference, or worse. Granted, this was in the '80s and one would hope times have changed since the days of arguments between the Florence Nightingale supporters versus the physician Jex-Blake supporters. But, sadly, similar discrepancies happen on a daily basis in 2019. It seems like patients are more apt to demand additional information, page physicians more often during off hours, and question treatment plans when the physician is female. This is reflected in some reports of a higher percentage of burnout, and more frustration, in women physicians than men. Although as women physicians, we should be pleased by the report that our patients actually do better than the patients of our male counterparts, it's small compensation when we feel overwhelmed and overburdened. This is especially troubling when data supports that our male counterparts make more money than we do, even when controlling for hours worked and productivity. So what is the answer? It's a problem when it feels like patients, support staff, and even colleagues who determine physician salaries reflect a "less than" attitude toward some female physicians. I think it's important to take some lessons from female business leaders who advise us how to set boundaries without receiving a negative label. In order to keep our own expectations and stress levels on an even course, having more concrete boundaries on a daily basis can help. Reminding ourselves -- and each other -- that "no" is a complete sentence can help. And these lessons need to start at the top. As many of us move into mentorship and leadership roles ourselves, we need to set examples for our students and residents by remembering that we teach people how to treat us. Every boundary kept can be a building block for future resilience. We know that as women we have the upper hand, typically, when it comes to being empathetic. And the good news is that increased empathy leads to not only better physician-patient encounters but fewer medical errors. Perhaps if we align ourselves with other female healthcare workers in a show of solidarity, we can come together for the common good of ourselves and our patients. Don't get me wrong. I'm not saying that we need to start male-bashing our medical colleagues because of gender. But I am saying that we need to be more aware of the discrepancies and look to common ground, rather than increasing the divide. Source
