Racism, Sexism, Other Forms of Discrimination Persist in Ob/Gyn

Nancy A. Melville

September 25, 2018

Despite years of medical school training, residencies, and clinical experience, many ob/gyns report being judged not on their experience and expertise, but on lingering racial, gender, and cultural biases that should have no place in the modern-day medical setting.

"Our work as ob/gyns requires that we build a trusting relationship with our patients, but if some characteristic we have prevents a patient from accepting us as a healthcare provider, the delivery of healthcare breaks down," write Nancy C. Chescheir, MD, of the University of North Carolina at Chapel Hill School of Medicine, and Rebecca S. Benner, MPS, of the American College of Obstetricians and Gynecologists (ACOG), Washington, DC, in one of three articles that delve into the topic published in the October issue of Obstetrics & Gynecology.

"Our work is hard enough without feeling dismissed and disrespected by patients, coworkers, and peers," they add.

They cite a recent case involving ob/gyn Tamika Cross, MD, a young African American woman who described in a Facebook post how she was turned down by a flight attendant to provide urgently needed medical assistance to a passenger mid-flight. The Facebook posting went viral and consequently brought much needed national attention to the situation.

"Whether this was race, age, gender discrimination, it's not right," Cross wrote in her post.

The Workplace Can Be Cruel: First-Hand Accounts of Bias in Ob/Gyn

The first article by Chescheir and Benner also details a variety of other cases of discrimination, with eight first-hand accounts of experiences with discrimination and bias. The stories include:

  • An Asian woman told by a white male superior during a family medicine rotation that she was taking up a spot that a white man deserved because she would "end up leaving medicine to make babies."

  • A physician trained in India who faced discrimination throughout medical school in the United States and even in full-time practice, with one patient's Yelp review criticizing her medical school training in India, writing "she is just not of the caliber of doctors I expect to see."

  • An ob/gyn who chose to take time off after several years as an academic generalist to spend time with her young child and who, when she was ready to return to full-time practice, was told by a supervisor that "there was no interest in hiring a faculty member full-time who essentially needed to be retrained."

  • An ob/gyn who reported that when a group practice found its female physicians' schedules overbooked because of patient preference — while the male physicians had plenty of availability — the company's chief executive pronounced the solution: simply that "the company will never hire another male ob/gyn again."

  • A residency program that was over-achieving in terms of diversity recruitment, but upon reports of perceived harsher feedback for under-represented residents, conducted an analysis and found nearly half of under-represented residents had their performance characterized as "concerning" compared with just 10% of nonunder-represented residents. In response, various strategies were enacted, including more mentoring, dinner clubs for the residents, and the inclusion of nursing staff in formal "unconscious bias" workshops.

"These stories of our colleagues' lived experiences as a student, a resident, and as practicing ob/gyns show us that the workplace can be cruel," say Chescheir and Benner.

"We have a duty to care for our patients and to commit to learning to practice our profession."

Don't Do Nothing...Build a "Ladder of Responsibility"

In the series' second article, Ashish Premkumar, MD, of the Department of Obstetrics and Gynecology at the Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and colleagues present a specific example of discrimination in the workplace: an intern who faced racism when treating a patient and reported the case to her senior resident only to receive a brief response of "sorry that happened to you," followed by silence on the matter.

The authors underscore the need to take such reports more seriously — even if the recipients are not comfortable doing so.

"Witnessing discrimination and discussing racism can be stressful for health professional educators," they write. "However, the discomfort experienced by educators pales in comparison with the trauma of discrimination that trainees experience. Educators have an obligation to create an environment that allows trainees to thrive even when acts of discrimination occur."

In the series' third article, Kacey Y. Eichelberger, MD, of the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Carolina School of Medicine Greenville/Greenville Health System, and colleagues look at strategies on a broader institutional level.

They suggest that efforts begin with an assessment of a unit's risk for discriminatory events before they occur; that a diverse and inclusive team is built and a "ladder of responsibility" established for when discrimination is reported.

"Ask to be graded," Eichelberger and coauthors recommend. "Consider conducting periodic surveys, focus groups, or exit interviews with team members who are historically at higher risk for experiencing discrimination (for example, women; under-represented minorities; gay, lesbian, and transgender staff; and people with disabilities)."

"Ask the important questions: What are our institutional blind spots? What can we do to create a healthier work environment?"

True Inclusion Requires Work

Chescheir, who is professor of Maternal-Fetal Medicine and assistant dean of Academic Affairs for Special Projects, University of North Carolina, a co-author on the first and third articles, and editor-in-chief of Obstetrics & Gynecology, notes that the case of the residency program over-achieving in diversity recruitment but falling short in preventing discrimination within the program isn't unusual and sums up some of the key challenges institutions face.

"I do believe that in many cases the idea of diversity is a numbers project for organizations: X number of this group, Y number of that group — the spreadsheet looks great, and then [people think] the work is done," she told Medscape Medical News.

"However, more than simple numeric equity, the idea of inclusion and a truly equitable position requires much more work," stressed Chescheir.

"Being included in an organization means being present for conversations that are appropriate for one's level in the organization and having an opportunity to contribute to those conversations and be heard at the same level as those with the majority status."

"It means having the organization embrace the diversity by requesting and including the input of all members of the group."

As referenced in the trilogy of articles in Obstetrics & Gynecology, a recent WebMD/Medscape comprehensive report takes an in-depth look at the issue of patient prejudice in the medical setting.

Chescheir is editor-in-chief of Obstetrics & Gynecology. Benner is an employee of the American College of Obstetricians and Gynecologists. The authors have reported no relevant financial relationships.

Obstet Gynecol. 2018;132:813-819, 820-827, 828-832.

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