Nikki Nabavi: Too girly to be a doctor?

“Professionalism” is a word that is thrown around a lot in medical education, but what does it really mean? Defined in the Cambridge Dictionary as “the combination of all the qualities that are connected with trained and skilled people”, there seems to be no official indication of what these “qualities” should encompass. Then why, when you search the word “professional” in Google images, are you met with an array of photos of tall, masculine figures in dark and boxy suits? Do we still hold a historical perception of professionalism as a less feminine quality?

On Episode 42 of Sharp Scratch, our BMJ Student podcast, our expert guest Kate Lovett, consultant psychiatrist and dean of the Royal College of Psychiatrists, joined me and some of our regular panelists Laura Nunez-Mulder and Olukayode Oki, as we explored ideas of “professionalism” and discussed whether our concept of this as a society is more “masculine.” We often like to discuss professionalism on Sharp Scratch, as it is a vital part of the “hidden curriculum” and the culture of medical school.

The initial inspiration for this topic was after I received feedback from a consultant that I was “too girly”, in the context of “what I might improve on.” I couldn’t imagine either of the boys in my group were told that they were “too boyish”, or “too manly”. What may have just been a poorly phrased piece of verbal feedback (as it was just verbal, and did not make its way onto my official end-of-block sign-off form), sparked a lot of reflection around why I might have received that comment – and whether, should it have been true, it even belonged in a “to be improved” section of my review.

After hearing my anecdote on the episode, the panel expressed regret that “clearly sexist” comments were still being used as professional feedback. “It’s a shame that nonsense like that is still being peddled in 2020. I’m aware of other examples, and over time, it has felt like they’ve got fewer and fewer.” Kate said as she reflected on sexism in medicine, and went on to talk about “anticipatory limitation of ambition”, recalling a surgeon she came across at medical school, who had asked her mixed tutor group what specialty they wanted to do, before dismissing the girls and saying that they would all be GPs – “girls don’t do surgery were his exact words.”

Kate went on to share that when she was first elected as dean at the Royal College of Psychiatrists, a common question she was asked was, “how is your husband coping?” “I knew for a fact that nobody was asking my other male honorary officers at the college how their wives were coping.”

The episode sparked conversation about how society might critique the appearance of professional women in a very different manner to that of men. This is perhaps best demonstrated by looking at women in power in the media. “I really admire Angela Merkel”, said Kate, “Because she, I think, has a deliberate policy of just wearing the same thing so that it’s not a distraction…But you shouldn’t have to.” She went on to criticise an article she had picked up in The Telegraph titled, “Why Kamala Harris is the modern beauty icon the world needs”, for bringing attention to her appearance, instead of “what she has to say.”

Going back to my own experience on placement – my instinctive reaction was also to reflect on my own appearance, particularly scrutinising what I had worn over the last few weeks to see if I had deserved the “too girly” label. While I might be partial to a cute hairband and I own a baby pink stethoscope – I had been wearing the same cycle of outfits I had always worn on placement; I had stuck to hospital dress codes. Perhaps the comment is not just reflective of appearance, but character traits as well. But again we are faced with a familiar question – which character traits are “too girly”?

Laura mentioned how she finds it helpful to separate the two types of professionalism we might hear about. “There is a difference between the professionalism that we as doctors aspire to so that we can take better care of our patients, and the other meaning which is a group of customs that you learn which help you be taken seriously by other people.” Laura went on to say how there are a lot of qualities that “are regarded as feminine, though are by no means exclusive to women, such as nurturing, or diplomacy”, or a general softness of character. “A lot of the things that might mean you are taken less seriously with your colleagues, are also the same things that might really benefit your patients.”

“The advice I was given by my fantastic role model surgeon when I was a medical school was look after your patients and your career takes care of itself,,” added Kate.

“So much of this is about being able to bring our authentic selves to work”, added Kate,

and questioned why we may feel the need to manipulate things such as our clothes or our accents to fit in. After listening to the episode, a listener wrote in, saying “I have noticed similar prejudice in myself. I have almost felt that girly women let the side down and stop us being taken seriously by men and patients. I now realise that this was the wrong way to look at things, but perhaps [the consultant who gave the feedback] felt similarly to me. When you’ve had to fight to be taken seriously by men, perhaps you start to judge other women much more unfairly.” Our discussions and reflection took place in the hope that moving forward, professionals in medicine, or any other career path, do not feel the need to suppress their more feminine qualities or imitate masculinity in order to fit in or be perceived as professional.

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The Sharp Scratch Panel:

Nikki Nabavi, The BMJ, University of Manchester

Laura Nunez-Mulder, Final year medical student, Cambridge University, and past editorial scholar, The BMJ

Olukayode Oki, Fourth year medical student, University of Dundee

Episode guests:

Kate Lovett, Dean of Royal College of Psychiatrists and Consultant Psychiatrist for North and West Plymouth

Listen to the episode on Spotify or Apple pods

Panel: @nikkixnabavi @teekayoki @lnm_rugby

Guest: @DrKateLovett

Brought to you by: @bmj_latest, @BMJStudent