DocWire News recently covered a study published in JAMA Network Open, “Women Surgeons’ Experiences of Interprofessional Workplace Conflict.” The study has garnered attention on social media. Women have continued sharing their experiences at work using the hashtag #WhyIWasWrittenUp.
DocWire spoke with study author Dana A. Dossett, MD, MPH, of the University of Michigan Medical School, Ann Arbor, about the paper.
What prompted you to undertake this study?
Dr. Telem: It’s interesting as we think about wellness and development and how we exist in this world, I think sometimes we get lost in the microcosm of what our surrounding is. And one of the things that we’ve noticed is that sometimes many of the things that can impact who we are and how our days go have nothing to do with the culture of our own homes. So you could do all this work to fix the culture of the department of surgery, but then the second you walk out our doors and you interface with the entire world, sometimes things can be a little bit different. Also, anecdotally, you hear about this double standard all the time, and we see Facebook posts and Twitter posts, and it’s kind of whispered along in the halls about how there are differences or agentic expectations of how women have to behave versus how men have to behave.
But all of it is whispers. And so we wanted to put some rigorous methodology behind it to understand, is this just noise that is the perception of a couple of people, or what are the real experiences that women are having? How is it impacting them? And more importantly, conflicts are going to arise. How do you want to fix them? And how do you want to take care of them? What’s the best way to deal with these things when they come up? So we really just wanted to spotlight a problem that we’ve heard anecdotally has been going on for a really long time, to better understand how we can create better community across departments and across interprofessional colleagues.
What are some of the key takeaways from the study?
Dr. Telem: The key takeaway is, real or perceived, there is a perceived double standard for women in surgery. Women in particular feel like they have to modify their behavior in order to be treated in an equitable fashion. And I think that comes in two flavors. One, if people do misbehave—and no one should misbehave—but if somebody does misbehave, it’s treated very differently. And two, in order to be perceived as not misbehaving, there’s all these extra steps that one has to take in the day that eat up different areas of the brain.
One of the researchers I’ve worked with here talks about this concept of vigilance, which is when you wake up in the morning, how much baggage do you have attached to you, how does that impact your day and your interactions, and how does that set up disparity around you? So when I wake up in the morning and I’m worried about, How do I sound and what clothes am I wearing and how is this going to be perceived?, that eats up many minutes and many hours of things that I need to worry about, whereas perhaps my male colleagues just get up in the morning and go to work and don’t have to worry about all of those extra things.
What we found is it really takes a toll on people—and not just in terms of burnout in surgery, but many of the women talked about the physical toll it took, anxiety, nausea, etc., and we talk about, how do you reduce the glass ceiling and get people through? There comes a point where you’re just like, “Forget it. I don’t want to deal with this anymore.”
The other thing we learned is that what people want is to not weaponize patient safety reporting mechanisms. People just want to be able to have a conversation and talk about things in real time and be in an environment where that’s expected and celebrated, versus finding out three days later that you’ve been written up or you’ve committed some egregious crime that you don’t even know about, where you’re always assumed wrong, and you’ve never actually had a chance to, one, communicate with the other person, or two, really adequately defend yourself.
Broadly, it speaks to the need for systems-level change in how we deal with conflict. What can we do to divorce this from patient safety and other mechanisms, and create a space that we all need in this world right now, to have people with different opinions and have a conversation, versus escalating it when “sorry” or “this was a miscommunication” would’ve sufficed? And that will have real significance, not just on professional satisfaction and perhaps even achievement and accomplishment, but on personal wellbeing.
Were you surprised by any of the study’s findings?
Dr. Telem: Unfortunately not. It just meant the whispers are true. When you hear this noise, you want to think that it’s the experience of a few disgruntled persons and not the truth, because you want to be endlessly optimistic. But I think confirmation of what we know, and every time I hear people’s stories and can relate to them from my own personal experience, it’s not surprising, but it’s still disheartening. And it’s still the confirmation of what you believed you knew was true, but you didn’t want to be true, but actually it turned out to be a fact.
But I always think that it’s important to put it out there because once you start having conversations, that’s when you can lead to real change. When it’s an anecdote, or “I feel like I’m being treated differently,” it’s much different than saying, “Here are papers and JAMA Network Open and in Annals of Surgery characterizing the experience of diverse women saying that this isn’t an anecdote. This is something, and this is how it impacts, and here are ways to address it.” That’s a much more powerful argument when you go and deal with systems-level leadership.
What roles do men and women play in adjusting interprofessional conflict in the workplace?
Dr. Telem: I think everybody’s responsible, and this responsibility lies at the top. It lies in the institutional or organizational leadership, the head nurse on the floor, the chief operating officer, all the leads in an operating room, all the leads in the department of surgery, to set the systems and policies, to assure that they’re fair practices and there are systems in place for when different things happen. And if you have a set system, then it’s hard to treat people differently within that system. So if you had a system that said, “If there’s a conflict at the end of the case, it’s your responsibility to report it, and you’ll sit down and have a mediated conversation, do not put this in the patient safety reporting mechanism, then you’re going to deal, and if it can’t get resolved with a mediated conversation, these are the next steps for escalation, ” that’s a very different path than somebody getting mad and writing you up behind your back and putting it through some anonymous reporting mechanism. Then you’re sitting in the room and the person’s not there, and you don’t even understand why they were mad at you. And you get into this whole circuitous thing, when that person could have just approached whoever the mediator is and said, “I had a conflict today,” and everybody could’ve just sat down and it would’ve been done. And when that becomes the expectation and that becomes the culture, then that leads to conversations and people learning how to have healthy and productive conflicts. Conflicts are going to happen. It’s high stress environments. No one is perfect. Not every day is the best day of somebody’s life. It’s what you do with that and how you resolve that, that makes the difference.
Do you believe the study has any implications for recruiting women into surgery?
Dr. Telem: I hope it has a positive implication saying, “Hey, we’ve asked you, we’re looking into this, we’re going to fix it. Things are going to be better, even better for you than they are for us, which is even better than it was for the generation ahead of me. ” And so I hope it has the positive implication of people knowing that we want to make sure that surgery is a place where all people can succeed.
What limitations did the study have?
Dr. Telem: One of the main limitations that I’d like to see rectified in the future is it doesn’t capture intersectionality and intersectional burden, things like race or ethnicity or sexual orientation, those things that make us, us. It kind of treats women as kind of a homogeneous group versus understanding that the experience of a woman of color is probably different than a White woman or somebody who’s LGBTQ+ is probably different than not, or different religions are different… And kind of getting at, does it impact one group more than another? What are the other subtle differences so that, when you go to strategize and come up with an intervention, you’re not inadvertently missing out on other groups that the intervention may not be as ideal for?
Any final comments?
Dr. Telem: Every system gets the exact results it was designed to get. So if you don’t take a step back and fix our system, we can recruit as many diverse people and we can invite as many people into our house, we can do all of the things we can do—but if we have policies that are inadvertently inequitable, if we have systems and strategies that leave people out, we’re never going to achieve what we’ve set out to do. That’s the message I would want to get out there, is we need systems and organization level change, not just for this, but for most things.
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