COMMENTARY

Time to Eliminate Ageism and Sexism in Medicine

Melissa Walton-Shirley, MD

Disclosures

January 22, 2019

Years ago, I was contacted by a department chair to testify as a character witness for  a young physician accused of sexual harassment. The accused was driven, new to his job, hungry for new publications,  and brimming with confidence. He never crossed personal boundaries with me, so I agreed to testify. But the evening before the deposition, I received a call from a male trainee who related that for over a year, he had personally walked several female employees to their cars because they were afraid of this guy. That was all I needed to hear. I cancelled the deposition, but, looking back, I regret not coming forward with what I categorized as merely annoying incidents over the years.

Small Hands

A year earlier I had accepted an offer for a training position in the "accused's"  department. While rounding on an infectious disease rotation,  we ran into him at the nurses' station. I had hoped for a celebratory "hello," but instead, he grabbed my hands and turned them over to inspect my palms, then turned them again to inspect the back. I stood there awkwardly anticipating some sort of a joke. Instead he loudly announced, "Your hands are too small. You will never learn to do procedures" as he threw  my hands aside like a used sandwich wrapper and brushed past me as if I had offended him in some way.

The wonderful support  and comradery I enjoyed during my years of training diluted that negative experience to near-nonexistence. But what I initially considered mere aggravation I now see as blatant sexism—the hands of male trainees were never inspected to see if they were "too small to learn to perform procedures." My failure to report it did a disservice to the women who would follow me. 

Ageism: The Older Sister of Sexism

Another common form of work place harassment is awaiting its #MeToo movement. In most work places it has neither been defined nor understood. My basic definition of ageism is the failure to provide a nurturing work environment despite changes in personal responsibility and physical capabilities associated with ageing. To be clear, terminating someone who is a threat to patient well-being at any age is appropriate and should not be considered an ageist stance.

For some, ageism is experienced surprisingly early in their careers. In a powerful internet-based chat room called the PMG (Physician Moms Group), one member stated, "I started my own practice at 39 years of age because I was told that I was too old and experienced to hire. For real." I had a friend who was dealt a difficult blow when her partner developed a chronic illness and resisted bringing outside help into the home. She found herself having to leave work to pick up the children and to pick up household chores. During that period of adjustment she was given no latitude for the requirements of caring for an ailing older partner, so she had to seek other employment.

I think ageism is far more insidious than sexism. Ageism fails to respect those with great clinical skills who are less adept with the keyboard and can never become the scribes that modern productivity demands. It is the unwillingness to make accommodations for clinicians who suffer age-related illness and require less call, a more forgiving schedule, or a leave of absence. Ageism is the exclusion of mature individuals in key decision-making processes when the wealth of their experience and skills would be a bonus. In the worst-case scenarios, ageism and sexism are demonstrated simultaneously. They are not mutually exclusive. 

Equality for All Is Difficult

We must also take care to understand that the advances we have made in the treatment of women in no way should allow for the biased treatment of men. At times, it's  difficult to separate fact from generalization. Assigning the inability to multitask to the entire male species, for instance, is a slippery slope  There should be equality for all.  

That said, it's time for medicine to admit that sexism and ageism are cowardly cancers that blight creativity and stifle the upward mobility that hard work deserves. It is saddening that those who work in the business of healing can be guilty of bias, but bias is everywhere in medicine, from gender-pay disparities to the lack of objectivity regarding the job performance of older individuals. 

We would do well to acknowledge the quote from bestselling young-adult author Rick Riordan, in his novel The Red Pyramid, that "Fairness does not mean everyone gets the same. Fairness means everyone gets what they need." Women, men, young and old should be seen, heard, respected, and nurtured. To ablate the biases in medicine that stem from our views on gender and age, casting the bright light of fairness will be the only solution because the shadow of bias will never thrive in the light. 

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