Almost half of female doctors (47.7%) report having been the targets of gender-based harassment and one-third (36.9%) report direct sexual harassment, according to a new study.

Although 42% of today's medical students are women, medical schools top the list of sites where harassment occurs, according to Dr. Erica Frank, who led a team of Emory University GA researchers publishing the report in the February 23 issue of the Archives of Internal Medicine.

"Present thought characterizes sexual harassment as primarily a manifestation of power, rather than sexual attraction. The profession of medicine, particularly in academic settings, may be especially prone to harassment because of the importance of hierarchy," researchers said.

The 1993-1994 nationwide survey found younger doctors report more harassment than older ones, especially those in surgery and emergency medicine, fields that especially value hierarchy and authority.

"This is the first study of the harassment of women physicians in a large national sample," said Janet Bickel, VP for institutional planning and development at the Association of American Medical Colleges. She had hoped the increase in female medical students and in school policies against harassment would have decreased the problem, but clearly that isn't the case.

Remedies would be for medical school deans to take strong action against faculty harassing students, and to teach female doctors how to deal with patients who harass them.

"It's learning how to re-direct the conversation or the exam in such a way that it doesn't insult the patient but re-establishes the doctor's authority in the patient-physician relationship," she said.

(excerpted from Women in Higher Education, April 1998)

Probably every major newspaper reported on the Tamoxifen Prevention Trial: "A new study of 13,388 women shows that the drug tamoxifen may prevent breast cancer in women who are at high risk." (New York Times, April 7, 1998). However, the National Women's Health Network responded to the NCI announcement of "good news" with "What about prevention for the rest of us?" "This trial provides only limited information about the use of tamoxifen to prevent disease. There are crucial questions that have not yet been answered: Will there be additional risks in the long run? Will there be fewer deaths in the long run? What are the implications for women in the general population? Is disease substitution rather than disease prevention a worthy public health goal? While the Network is cautiously optimistic that tamoxifen may benefit women with the BRCA gene and other women at high risk of breast cancer, the benefits of tamoxifen as a preventive remain very questionable . . . Attempting to prevent cancer in the general population with a known carcinogen is of questionable public health benefit."

And, the National Breast Cancer Coalition responded to news of the trial: "This is exciting in that it is the first time a drug has been shown to have preventative aspects to it. However, there are many issues. First, tamoxifen has serious side effects. Also, we do not know how long women should be on this drug--remember these are healthy women. Questions follow, such as, if women should take tamoxifen for prevention, should they take it for more than 5 years? Does the benefit continue once a woman is off the drug? If a woman takes the drug for more than 5 years, will there be increased adverse side effects? What is the long term effect in healthy women who take the drug for 5 years or less?"

Major newspapers also reported on the JAMA article, "Incidence of adverse drug reactions in hospitalized patients. A meta-analysis of prospective studies" (April 15, 1998). The Associated Press reported that "Adverse drug reactions appear to be a major cause of death among hospital patients in the U.S." What is not known--and should be (in this writer's opinion), is what drugs were tested and if they were ever tested on women. This report is clearly a call for more information--a gender analysis!!!!

There has been very little Congressional activity regarding women's health in the first session of Congress. Senator Frist, Representative of Tennessee, who chairs the Labor and Human Resources Committee in the Senate, introduced legislation (S. 1722, March 6, 1998) reauthorizing many women's health programs. This proposed legislation would extend women's health research at NIH and at CDC. While many senators have signed on to sponsor this bill, neither of our Missouri senators have.

"More than 3 million people suffer from panic disorder. Women are affected twice as often as men. Anorexia has the highest mortality rate-7 to 24%--of any psychiatric disorder. Eating disorders occur in 10 times as many women as men. Each year nearly 5,000 teenagers commit suicide. Although the ratio of male to female suicides is 4 to 1, young women attempt suicides twice as often as young men." The Society for the Advancement of Women's Health Research reported this is their spring newsletter and in briefings to Congress. The briefings also included a discussion of how pending and future legislation and public policies could affect the large numbers of people who have these disorders. Another area of concern is the issue of the inclusion of women in clinical trials. "While women use the majority of psychotropic drugs and benzodiazepine tranquilizers, they are often excluded from early clinical trials. Broader inclusion of women in clinical drug studies would improve knowledge of the nuances of pharmacologic action in female patients," the Society also reported.

The Medical Marriage: A Couple's Survival Guide by Wayne M. and Mary O. Sotile

The Sotile are co-directors of Sotile Psychological Associates, and since 1979, Wayne Sotile has served as Director of Psychological Services at the Wake Forest University Cardiac Rehabilitation Program.

This is an excellent book for all doctors to read, married or not. It reveals much about our personalities, our work ethics, and our ability to interact with our patients, colleagues, spouses, and children. Did you know that while the average woman lives ten years longer than the average man, the average female physician lives ten years less than the average male physician?

Many physicians misuse their talents when it comes to dealing with stress and emotion. They tend to acclimate to toxic environments, rather than trying to make life more self-nurturing. With effective emotional management, which they deal with in detail with many examples, the Sotiles teach us to think differently. They stress that the most fundamental way to examine the stress of life is to question, "Is the territory of my life more toxic or nurturing to me?"

Many couples get caught in the "waiting until" habit. This dangerous habit may place their relationship lower and lower in their priorities. This may result in a disconnected relationship, with loss of intimacy and friendship. In a study of parenting stress, involving thousands of male residents and staff, 75% expected parenting stress to decrease after residency. The follow-up showed that 50% found that stress increased after residency.

High-powered couples can introduce a "conspiracy of silence" into their relationship. We tend not to identify the role we play in generating our own stress. We tend not to discuss the stresses of our medical practice or even acknowledge their existence. This may lead to emotional withdrawal, inability to share feelings and social isolation. Moodiness, fatigue, increased work, and loneliness may be the end result.

There are stresses that couples hold each other accountable for. These may drain our collective energies, fuel resentment, and contribute to power struggles that can ruin medical marriages. These include the following:

-excessive ambitiousness

-excessive materialism

-competitiveness

-refusal to relax and enjoy life

-needing to control others

-hostility and cynicism

-constantly rushing

Sound familiar? The book can be ordered by phone at 910-765-3030 or by fax at 910-760-6977.

(excerpted from the Newsletter of the Women's Dermatologic Society, October, 1997, the President's Message by Gloria Graham)

Survival Guide for Women Radiologists: The AAWR Pocket Mentor (Mosby, 1997)

The American Association of Women Radiologists (AAWR) recently published this survival guide modeled after the Pocket Mentor written by the Association of Women Surgeons (AWS). This easily readable, 120-page Pocket Mentor is designed to enhance the personal and professional life of a woman radiologist, and is particularly geared to women in training. Sections of general applicability for women in medicine include chapters on mentors, suggestions for being efficient, politics, gender issues including sexual harassment and discrimination, interviewing, contracts, and professional behavior.

Talking 9-to-5 by Deborah Tannen

This book discusses communication differences between men and women in the workplace. Like her previous books (You Just Don't Understand; That's Not What I Meant), Dr. Tannen's thesis is that differences in conversation style between men and women lead to misinterpretation, or misunderstanding. Specific chapters relevant for us are: Women in the workplace; "She's the boss": women and authority; Who gets heard? Talking at meetings. Dr. Tannen also discusses the doctor-patient relationship and points out that women physicians get better marks in listening to their patients.

Women are becoming increasingly visible at leadership levels in science. M.R.C. Greenwood, the former associate director in the Office of Science and Technology Policy likes to point out that in recent years, women have headed the two most important Cabinet departments related to science-the department of Energy and Health and Human Services. Additionally, she notes, women have held leadership roles at the National Institutes of Health, the National Science Foundations, and many scientific societies, including the American Association for the Advancement of Science, the American Chemical Society, and the American Society for Cell Biology.

But does this mean that the glass ceiling-the barrier that lets women see the upper levels of scientific leadership while preventing them from actually attaining these levels-has been shattered forever? While some women policymakers believe there are large cracks, other observers of women in science point out that significant barriers to advancement still exist and that this is no time for complacency.

"I certainly never imagined when I was younger that I would see many of these very powerful science policy positions held by women," states Greenwood. And the fact that that has happened means that as a consequence people more easily think of women doing these jobs than they used to. I just happen to be an optimist. I don't think it means that there are no problems. But I do think that things have gotten better."

Catherine J. Didion, executive director of the Washington, D.C.-based Association for Women in Science is concerned that "people are going to somehow think the problem has been solved and more on to other issues. While the glass is in many ways more than half full, the gains could evaporate."

But Edna Mitchel, a professor of education and director of the Women's Leadership Institute at Mills College in Oakland, CA notes "One way is to be glad that women are in top positions and that progress is being made. But they don't compare with the numbers of men who are in similar positions. It's not 50/50 at the top. It's not 50/50 midway. The glass ceiling still exists for women in science and there are more women who are bumping into it than ever before. There is still a condition of almost tragic waste for women who are capable of advancing and not able to advance when men are going right past them because of the culture, the work environment and their own history and life circumstances."

The sociological causes of women scientists' failure to advance as fast and as far as men were examined in Project Access, a study conducted by sociologist Gerhard Sonnert and physicist Gerald Holton, both from Harvard. They found that while outright institutional discrimination used to be the primary factor keeping women from rising in science, these days many other factors come into play.

For example, in the Project Access study, 62% of the married women, but only 19% of the married men, had a spouse with a doctorate. Often it is difficult for dual-career couples to find equivalent positions, and since the women tended to marry men who were older and more established in their careers, the women's careers tended to take a back seat. Additionally, a woman may run into the "three-clock problem: attempting to synchronize her biological clock, her career clock, and her partner's career clock."

Greenwood noted that almost 50% of the graduate students in the biological sciences are women, and that's a dramatic shift from 25 to 30 years ago. However, Mitchell argues "it's not the numbers of women who go into science, it is what happens to them once they get there."

In 1993, women accounted for 22% of the science and engineering labor force, which was an increase of 13% since 1980. But many of these women do not pursue scientific careers. Notes Rep. Constance A. Morella (R-MD) We are doing more training. But we have to get them to stay there and to begin to expand and to demonstrate leadership.?

Things may be worse for women in academia. "In federal agencies I think it is changing rapidly. In academia things have moved a little more slowly says Ruth Kirschstein, deputy director of NIH. "In government, high-level positions do not have to be held by individuals who have made their mark as outstanding researchers. In universities, on the other hand, moving into high-level administrative academic positions requires you generally to be one of the outstanding tenured faculty members."

Then there are the cultural stereotypes. "The general culture rule that women are not competent as managers unless they are very, very tough, or very masculine, still prevails. And there is still a mind set that it's the man in the shop who really is capable of making the decisions, of managing the resources and the budget decisions. It's a male culture in almost every field of science."

And that male culture-primarily a white male culture䴊tends to be se-perpetuating. The problem is not so much that the men aren't good, it's just that they tend to think of people like themselves when asked to suggest others for positions of honor or status. Says Ann Peterson of the Kellogg Foundation "One of the reasons I decided to stay in administration was that I realized that women of accomplishment weren't going to be noticed without at least some women in a position to bring their accomplishments to the attention of others.

(excerpted from The Scientist, November 1997)

In its 1995 report, the Mills College Women in Science Summit developed the following list of "key recommendations" to promote equal opportunity for women to advance in scientific leadership:

If you think society still harbors different stereotypes of married women depending on whether or not they retain their birth names, or use a Ms., you're right . . . at least for 10,000 Midwesterners surveyed.

Thomas Murray, professor of English at Kansas State University, asked them about attributing 20 characteristics to women, depending on how they called themselves.

Married women who retain their birth names instead of taking their husbands' names, and those who use Ms., were seen as more independent, feminist, educated, likely to work outside the home, outspoken and self-confident than those who took their husband's names or called themselves Miss or Mrs.

They were also perceived to be less attractive, less likely to make good wives and mothers, less likely to enjoy cooking or to attend church.

More likely to buy into these stereotypes are males, blacks and older people.

Part of society is slow to accept women making a name choice that goes against tradition, Murray said, noting that Ms. Entered the language almost 50 years ago, and the number of women who use it has risen significantly in the last generation.

(excerpted from Women in Higher Education, April 1998)

To facilitate collaboration, promote career growth, and improve recruitment into clinical studies being conducted by AWN members, AWNings has begun a column that will feature descriptions by members of their ongoing research projects. In this quarter's column, studies of the following AWN members will be featured: Anne Goldberg, MD, Division of Endocrinology and Metabolism, Department of Internal Medicine; Victoria Fraser, MD, Division of Infectious Diseases, Department of Internal Medicine; Rumi Kato Price, PhD, MPE, Department of Psychiatry; and Linda Peterson, MD, Cardiovascular Division, Department of Internal Medicine.

Dr. Goldberg is an Associate Professor who has participated in clinical trials involving the use of lipid-lowering medications. Her current studies include:

1) Several studies on the effects of a number of medications which lower LDL cholesterol

2) A study of the effects of an estrogen compound versus the effects of simvastatin in postmenopausal women with high cholesterol levels.

3) A study of cholesterol lowering and secondary prevention of cardiac events.

Dr. Fraser is an Assistant Professor who has conducted studies in the area of hospital epidemiology. She is presently involved in:

1) The development of the Helena Hatch Center, which is a 5 year demonstration project designed to develop an ideal service delivery model for women with HIV. Thus far, this center has decreased the vertical transmission rate of HIV from 44% to 0%.

2) Development of strategies to minimize the risk of tuberculosis among health care workers.

3) Exploration of methods for decreasing the risk of transmission of blood-borne pathogens to health care workers.

4) Determination of the risk factors for infection in intensive care unit patients and to design interventions that decrease the risk of such infections.

Dr. Price is a core member of the Department of Psychiatry's Epidemiology and Genetics Research Units. She is now conducting:

1) A longitudinal investigation of the long-term psychological effects of the Vietnam War, substance abuse, psychiatric disorders, and life events on veterans.

2) A migration/intergenerational study of drug, alcohol, and cigarette use and risk and protective factors. This involves the use of international epidemiological datasets, such as results of surveys of junior high school students on inhalant, alcohol, and cigarette use.

Dr. Peterson has performed studies on primary and secondary prevention of coronary artery disease (CAD), with a special focus on prevention of CAD in women. Her studies concern:

1) The effects of estrogen replacement therapy on myocardial perfusion as assessed by positron emission tomography (PET).

2) The effects of different antihypertensive agents on vascular function.

3) Comparison of the effects of t-PA versus angioplasty in patients who have had coronary artery bypass surgery.

4) Examination of the utility of vein graft markers in these patients.

If you are interested in being featured in this column in the future, please contact Linda Peterson at 362-1297 or by e-mail at .

Studies comparing the advancement of men and women in academic medicine continue to find that, even when credentials and time commitment are equal, a lower percentage of women progress to the top ranks. The two contributing factors that seem to come up most often are that women receive less adequate institutional support for their research and a poorer quality of mentorship.

The glass ceiling metaphor is not helpful in enlarging our understanding of these complex phenomena. "Cumulative career disadvantages" is better, and many of these disadvantages are quite subtle. For instance, men have company as they enjoy career success, whereas women become greater rarities, living in "glass houses" where there is no room for error and no place to practice. This kind of "surplus visibility" is a stress for minorities of any kind. Another downside of isolation is a lack of "social capital," frequently resulting in politically naïve assumptions and decisions.

In most cultures, women are allowed a narrower band of assertive behavior than men-that is, while it is necessary to be adequately aggressive to achieve one's goals, women walk a very fine line between "tough enough" and "too tough". The same behavior that is considered laudably "goal-oriented" or "competitive" on the part of a man may well be labeled "harsh" or "confrontational" in a woman, because women are expected to smile and defer. Both men and women retain these perceptual biases in part because as a culture we have so much less experience with women as idea-generators and leaders.

These stereotypes continue to interfere with the hiring of women into top positions. If an organization's leadership is predominantly male, highly qualified women may be viewed as "risky" simply because they do not look or sound like the traditional executive. This "comfort syndrome" is illustrated by the results of a study by Catalyst, a New York-based firm devoted to maximizing the potential of women professionals. A mailed survey to women executives at Fortune 1000 companies asked about attributes related to their career success. After "consistently exceeding performance expectations," the second most critical factor they identified was "developing a style with which male managers are comfortable."

While some women may need to "tone down" their styles to be maximally effective, at the other end of the spectrum are those who need to strengthen their self-presentation skills because they are too soft-spoken or indirect to win serious consideration. A related skill area is conflict management. Since all the inherent sources of conflict in academic medicine are becoming more intense, the tendency to avoid conflict or to immediately accommodate the other person interferes with effectiveness. Other conflict-management skills-competing, collaborating, and compromising-need to be acquired.

Because of the shortage of amenable mentors, women who wish to maximize their professional development options must seek Mentor Replacement Therapy (MRT). Every professional needs a mentor. However, because society has not overcome its traditional tendency to undervalue women's careers and because women tend to downplay their strengths, they experience a greater need for mentorship to help them think positively and strategically and to garner resources.

MRT can take a number of forms. Specific management and leadership skill-development seminars should be sought. Also, rather than seeking one mentor, it's helpful to think in terms of a spectrum of individuals-coach, guide, counselor-who can contribute different kinds of assistance. It is most important to build networks by participating in organizations external to one's own institution. Such participation also provides new perspectives so that individuals can see the extent of their expertise.

Academic medicine cannot afford to waste the leadership talent of any of its members, but gender stereotypes continue to detract from the optimal professional development of women-and, by extension, men. Outdated stereotypes also detract from the collegiality of the academic environment and interfere with men and women working together, and ultimately detract from the quality of patient care and science. In addition to individual efforts to overcome gender-related stereotypes, maximizing the potential of women requires institutions and societies to offer skill-development opportunities; excellent topics include team building, conflict management, systems redesign, academic financial management, presentation skills, overcoming resistance to change and time management. Some of these efforts might be targeted specifically at women, but most should be open to men as well-not only because men and women faculty mostly share the same needs, but also because mixed sessions facilitate bridge building, especially when gender-related concerns are an overt part of the agenda.

(excerpted from The Scientist, May 12, 1997)

AWNings wants to know.

Name _______________________________

Department___________________________

Promotion or Award____________________

____________________________________

____________________________________

Send to:

Linda Pike

Box 8231 (or pike@biochem.wustl.edu)

Last modified: August 18, 2003