CanMEDS Roles addressed: Expert, Leader An 83 year old female presents for follow-up after completing 3 months of oral anticoagulant therapy with Rivaroxaban for her unprovoked deep vein thrombosis. She did some research online and heard about a link between venous thrombosis and cancer, and asks why you are not getting a CT scan to rule out malignancy. Should you screen her for cancer? If so, which tests are necessary? What is the ...
The post Blood and Clots Series: My patient has a pulmonary embolism. Should I screen them for cancer? appeared first on CanadiEM and was written by Eric Tseng.
As a female doctor over the years I have gone to a lot of sessions that, if you cut to the chase, are focused on helping women be more effective in their professional interactions with men. You know the-be-direct-use-less-words-stay-on-subject-ask-for-raises sort of stuff. The idea was that if we could develop skills to seamlessly integrate into a hierarchical male work environment then we could create real pipelines into power positions. Obviously, things didn’t quite work out the way the overly enthusiastic workshop teachers had promised. There are likely a thousand reasons for this ranging from residual discrimination and implicit bias to the gradual recognition that perhaps maybe it was actually the workplace and not necessarily the women that needed a make-over in the first place. What I have noticed, however, is that one topic is conspicuously absent from most of these discussions and that is the impact of other women on our professional life. Where is the literature on the best practices for women to work together? Spoiler alert — it’s pretty skimpy, fortunately I was able to track down Dr. Anne Litwin of Litwin Associates who has recently written a book called New Rules for Women.
Dr. Litwin has a PhD in organizational behavior and for her dissertation she interviewed professional women around the globe about their perceived challenges of working with other women. What she came up with was a set of expected “Friendship Rules”. The five main rules are: equality, loyalty, listening, sharing of confidences and the big one — as the rules are implicitly expected— it’s taboo to actually talk about the rules. Dr. Litwin believes that we usually develop understanding of these rules as very young girls. This is why you likely reserved your top pick in gym class for your terribly uncoordinated best friend even though she was a total klutz. And why your daughter responds to your question about whether she has actually spoken to the girl who has apparently so seriously wronged her with a, “Of course not, she knows exactly what she did”. Importantly, however, these rules have followed us into the competitive and hierarchical modern-day work force and unchecked they are setting us up against each other. As Dr. Litwin states, “These friendship rules themselves have some internal contradictions, so there is no way that someone is not going to feel disappointed or betrayed.”
Let’s take an example, say Ellen and Brittany are both floor nurses applying for a charge nurse position. They have worked well together for years and have, thus far, easily followed their expected “friendship rules.” When Ellen gets the position over Brittany, however, the rules will be predictably strained. If Ellen tries to interact with Brittany the same way as she did before her promotion, she will fall short on the “equal” and “sharing of confidences” rules, as her new position will likely require annual reviews and keeping certain departmental information confidential. Unrecognized, this could leave Brittany confused or even feeling backstabbed, ok we were just talking about potential preschools for our kids and then she slipped in that if I’m late again she’s putting me on probation, what the heck??!! Conversely, Ellen might actually recognize some of the potential difficulties of maintaining her previous relationships and decide to consciously distance herself from them to avoid a perception of favoritism. Unfortunately, this too comes with potential consequences as she will inadvertently violate the “loyalty” rule and now risks the reputation of being unapproachable or “too good for us.” Either way, Ellen is in a Catch-22. Although this is an example between two nurses, it’s pretty easy to extrapolate how the inevitable breaking of the friendship rules might complicate relationships between female nurses and female physicians.
Fortunately, there are some solutions. Dr. Litwin suggests that the first step is to break the implicit silence surrounding the old rules and to begin a series of frank discussions about the realities of the new workplace including the challenges around competition, disagreement and hierarchy. If you are in a leadership role, she would coach you to speak with your team to create a new mission statement that aligns shared goals and expected behavior. This would include a commitment that women would agree to address intrapersonal conflict in a timely professional fashion via a direct (versus indirect) approach. She would also encourage you as a leader to be very transparent about situations in which you need to play a specific role. “I’m going to need to put on my professional hat right now because we have to have a difficult discussion about some concerning issues that have recently come up.”
So let’s see how we might apply these strategies in medicine.
You are a young female attending working with a bunch of female nurses and realize that it has been somewhat difficult for you to shift into a more declarative style of leadership during codes because you are concerned about potential passive aggressive backlash by some of the nurses after the resuscitation.
Suggestion: Speak with the team as you are setting up the room. Possible wordsmithing might be “Our goal during this code is to provide excellent patient care. To do that it is essential that we all optimize our roles within the team. I ask you that if issues come up during the code or you notice something we could do better in the future that we debrief afterwards because it is really important that we all work together and support each other.”
You are applying for the position of medical student clerkship director and you just found out that one of your close female colleagues is also applying.
Suggestion: First go out for coffee and celebrate that you are both bravely putting your names in the hat for a promotion. Next, acknowledge that it is going to be a little awkward for your relationship if one of you gets the job and commit upfront to work through it and to find opportunities to continue to support each other.
You are one of two women on a high-powered testosterone charged committee. You know that the other woman is bringing up a proposal that although you don’t actually agree with, you’re pretty sure she is expecting you to back her up on.
Suggestion: If at all possible talk to her before the meeting and be honest so she is not blindsided. Consider ensuring that her idea still gets adequate airtime at the meeting (even if you don’t agree with it) so that other members can come up with their own conclusions.
Ladies, let’s face it, it is 2018 and we still have some major work to do in the positive societal tipping point department. To do this successfully we need to finally acknowledge the real difficulties that women often face when working together and learn new skills to mitigate them. It’s time that we all commit to an updated and more realistic version of the workplace “friendship rules”.
Ways Women Can Support Each Other—
- Amplify good suggestions at meetings
- Ensure that ideas are appropriately credited
- Recognize, validate and broadcast good work
- Support organizational policies that are good for humans in stressful jobs
- Ensure objective recruiting policies
- Try and get at least 30% of women on key committees
- Bring in diverse speakers
- Share your networks
- Mentor and sponsor junior women
- Expand leadership opportunities
Watch the full FIX17 talk below!
For more on this topic please see Dr. Wolfe’s podcast with Dr. Litwin http://www.sexandwhy.com/episode-6-new-rules-for-women/.
For more discussions on how sex and gender influence our behavior please see Dr. Wolfe’s website http://www.sexandwhy.com.
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