March 30, 2017 | Jenine John, MD
Career Development

Female cardiologists may not face as many challenges in the workplace as in the past, but progress is stagnating, and we still have a ways to go. As FITs, both male and female, we are the future of cardiology. Consequently, it is up to us to  “own this [inequality] and fix it.” The first step in doing this is to understand our biases.

Everyone has biases. They arise from the shortcuts that our brains use to assess situations. The book, Blindspot: Hidden Biases of Good People, explains that biases are difficult to overcome because the person is often completely unaware of even having them. Although we may not consciously think or act in biased ways, ideas that society and our scattered experiences have taught us linger in our brains. They then unconsciously affect our decisions, sometimes even in self-defeating ways.

Denial that such biases exist is in itself a danger, because those who consider themselves unbiased may in fact tend to act in more biased ways than those who are aware of their biases. One explanation for this is that if someone believes that their instincts can be trusted, they become more susceptible to unchecked subtle biases.

Unconscious biases can actually run counter to our beliefs and identities. For example, society has deeply entrenched gender-biased beliefs of both men and women. On an Implicit Association Test, 75 percent of males associated the concepts of male with work and female with family. Of the female subjects, 80 percent did the same. I took the test, and try as I may, I could not help but make the same stereotypical associations. You can give it a try here.

How can both men and women avoid acting in a biased manner? A large part of the solution lies in simply being aware that we all have unconscious biases. You can watch this Google talk on unconscious bias in the workplace and encourage others to do the same.

Often a bias against women in leadership roles manifests as a description of her as “aggressive” or “cold.” Our unconscious minds have certain expectations for how women should behave. When a woman does not meet these expectations, it seems that this creates an uncomfortable experience for the mind, and the woman is ascribed negative qualities.

We challenge our minds regularly in cardiology. We form a gut reaction about a patient, but then we carefully assess them and fine-tune or scrap our initial impression. This critical thinking can be applied to gender biases. The next time you are tempted to describe a woman negatively, don’t let your brain be lazy. Take a moment to assess your thought process. If she were a man, would you have the same response?

Actively overcoming our biases regarding women in this way not only helps with gender parity, but also equips us with skills that can be used in other arenas. Learning how to monitor our thought processes and objectively assess situations can improve our medical skills and help us be perceptive and effective leaders. It can also be applied to help us address biases affecting men.

Here are some other ways to avoid acting in a gender-biased manner:

• Be mindful of any judgments made based on masculinity, femininity, voice, attire, attractiveness or childbearing decisions.
• When listening to a report on someone’s reputation, keep in mind that the report may be the result of an amplified bias.
• When you find yourself saying, “I can’t put my finger on it, I just don’t like her,” dig deeper.
• When assessing women, be careful to apply the same standards that you apply to men.
• When writing evaluations, ensure that women are not described with more words that express agreeableness while men are described with more words that express competence.
• Be aware of assumptions you have about someone’s values and experiences. In a recent ESC study, there were large discrepancies between women’s reasons for not pursuing interventional cardiology and the reasons that men perceived to be most important for women.
• Point out biased behavior, preferably without accusation. Chances are that the person did not realize the bias. Accusations often lead people to double down and more strongly assert that they are not biased, which is counterproductive.

Opportunities to show leadership in eliminating gender-biased behavior are not as infrequent as you may think. As a first-year cardiology fellow, I was in a cath case where the left radial artery was accessed. The male interventionalist turned to me and said, “Reaching across the patient will be tricky for you because of your height – do you think you can do it?” I responded yes. I strained a bit to keep my balance as I leaned forward over the table. A well-meaning female cath lab nurse said, “Doc, are you really going to make her do this? She’s just a little girl!” As a petite woman who appears younger than I am, it was a perception that I was no stranger to. Still focused on the task, I started thinking distractedly, “Oh right, I am just a little girl.”

I waited for the “There’s a reason why there aren’t more women in interventional,” the “Well, let’s let her try,” or the “She’s not like other girls.” The interventionalist, however, turned to the nurse without missing a beat and stated simply but assertively, “She’s fine the way she is.”

This article was authored by Jenine John, MD, a Fellow in Training (FIT) at Stony Brooke Hospital.