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A father and son are in a car crash and are rushed to the hospital. The father dies. The boy is taken to the operating room and the surgeon says, “I can’t operate on this boy, because he’s my son.”
HOW is this possible?
Apparently, most of people can’t solve this riddle because they’re unable to imagine the surgeon is a woman. The surgeon is the boy’s mother. This is an example of the unconscious bias that can exist in the minds of people when it comes to women in medicine.
As a father of three daughters, my dream is for them to be able to grow up in a world where they can have the opportunity to fulfil their full potential and be whomever, and whatever, they want to be. We are lucky we live in a Western democratic society, where the rights of women in general have progressed much further, so they have a better chance than the majority of girls growing up in other societies. Australia and New Zealand lead the way in this regard, with New Zealand the first country in the world to give women the right to vote on a national level in 1893, and Australia not far behind in 1902.
However, the truth of the matter is that humanity as a whole still as a long way to go in recognising women as having equal rights and status. There are still countries in the world where women cannot vote, go to school or even drive. We should note that in Australia, it was as recently as 1966 that the marriage bar which restricted the employment of married women was removed. There are currently women in the world who have subordinate legal status, leading to a lack of access to education and other opportunities that we may take for granted here.
Nevertheless, Australia still has a way to go when it comes to gender equity in career opportunities. According to recent news reports, Australia will not be hitting its target of having 30% of women on company boards by 2018. And apparently, there are fewer women in top management roles in Australian companies than there are men named John, Peter or David. This is despite evidence that having women in leadership roles leads to better performance. Let’s be honest though, the issue is to do with our current culture and society. Today, we still celebrate beauty pageants where women are rated on how they look in a swimsuit; where the media still focuses on what a female political leader is wearing rather than on her substance.
But the focus of my article today is specifically about women in medicine. Dr Constance Stone was the first woman to be registered to practice medicine in Australia in 1890, and Dr Dagmar Berne, the first Australian medical student to be enrolled in 1886, registered to practice in 1895. It took Australia over 100 years to reach gender parity in 2000, with now just over 50% of medical students being female.
Despite this, there are still less women in certain medical specialties, and there is a definite under-representation of women in medical leadership roles in hospitals, specialty medical colleges, and other health organisations. A study I was involved in – “Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia”– identified a range of potential barriers for women across three broad domains: perceptions of capability, capacity and credibility.
With the barrier of the perception of capability, organisations need to ensure that their female doctors are being given opportunities for leadership training. At Monash Health, we recognised the lack of female representation at our highest medical leadership roles, and we have decided to address this by implementing our Monash Doctors Women in Medicine program, which was launched by the Hon Jill Hennessy, Victorian Minister of Health, in 2015. Since then we have had four cohorts of female doctors, totalling an alumni group of 70, who have undergone leadership training and development. I had the privilege of meeting them last week, one of the reasons why I decided to pen this article. As Marie Curie, the twice Nobel Prize winner, once said: “Life is not easy for any of us. But what of that? We must have perseverance and above all confidence in ourselves. We must believe that we are gifted for something and that this thing must be attained.”
The second barrier is the perception of capacity. I recall the decision my wife made to defer having children until she finished her specialty medical college training, because she was very aware that part-time training was difficult and meant a delay in embarking on her career of choice. When she became a mother, she was fortunate to be able to take sufficient time off on maternity leave.
There are two points to make here. First, there is still work to be done by both employing health services and the training medical specialty colleges, on creating better maternity leave frameworks to support female doctors. Second, we cannot underestimate the impact of maternity leave on a female doctor’s career progression.
Many female doctors make the conscious decision to be the main carer for their children if they choose to have any, and this again affects their capacity to spend more time in their clinical practice, which influences their opportunities to progress into medical leadership roles, as well as their ability to attend leadership development programs. But it should not be a complete barrier. Carol Greider, the molecular biologist who won the 2009 Nobel Prize for Medicine pointed out: “In the newspapers, there’s a picture of me and my kids right there. How many men have won the Nobel [Prize] in the last few years, and they have kids the same age as mine, and their kids aren’t in the picture? That’s a big difference, right? And that makes a statement.”
The last barrier is one of credibility. I started off this article with a riddle demonstrating the potential for unconscious bias that may exist in all of us. Female doctors today, are still called “doctors” less than their male counterparts. We need more women in leadership roles in medicine so that they can be role models for others, provide better representation of our medical community and allow us to have a more diverse leadership group. I really believe that although we have come a long way, we still have a long way to go. An old Chinese proverb says: “Women hold up half the sky.”
Let’s work together to make this a world where all of us, no matter our gender, race or faith, can be truly equal in both rights, opportunities and roles.
Professor Erwin Loh is chief medical officer at Monash Health, and clinical professor at Monash University.
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Thanks Gabrielle.
Wasn’t sure if your reference was in the Vancouver, Chicago or MLA citation style.
It is well documented in many studies that women get better outcomes in medicine. They are less interventional, more holistic and more careful about procedures……just google it. There is NO vacuum.
Men love having children when it is convenient and when it is not….they leave. That leaves a woman in the position of either getting an abortion or spending a life time caring for another human being.
Odd, 26. Anonymous: “There is an invalid and old fashioned assumption that the choice to bear children …. is solely a woman’s.” Review of current abortion rulings would seem to suggest that is exactly the case: hadn’t realized that was regarded as old-fashioned or invalid.
And 28. Kate Stewart: “considering the enormous advantage you all have in that you don’t have the capacity to conceive and bear children”. Sad indeed that you see children as such a burden and the offer of a choice (which men don’t have) to have children, a disadvantage.
And females get better outcomes??: statement in a vacuum.
My husband (Dr Martin) and I (Dr Moore) are both doctors. When we got married I kept my surname and he kept his. In 15 years of marriage we have had mail addressed to us as Dr and Mrs Martin, (mostly) Dr Martin and Ms Moore, (sometimes) and Dr Martin and Dr Moore, (rarely). We have never once in all those years had a letter addressed to Dr Moore and Mr Martin. This is unconscious bias written on an envelope.
The assumption still remains that male=doctor, female=wife/appendage.
We have much-loved children but their arrival has impacted my career in ways that have simply not affected my husband. As has been pointed out multiple times above, there is no good reason why the bulk of child-rearing (as opposed to child-bearing) should be done by women. My expectations of equality in society generally and medicine particularly have been disappointed so many times that I begin to despair of what lies ahead for my daughters – and my sons.
I highly recommend ”The Wife Drought – Why women need wives and men need lives’ by Annabel Crabbe, which eruditely summarises all the research in this area and should be compulsory reading for our students.
I’m a female doctor, but if I were male I’d just hate for people to think that I got to my position because of affirmative action! Isn’t it … well… embarrassing for you doctor men? I mean, considering the enormous advantage you all have in that you don’t have the capacity to conceive and bear children, and you can outsource that to your partners if any, it’s amazing to me that the power imbalance and gender gap in medicine isn’t larger than it already is. We already know that female doctors get better patient outcomes, and we do this working fewer hours on average, enduring systemic sexism, and oh, also earning a whole lot less!
Women doctors don’t want special treatment; we just want to put an end to affirmative action for men doctors, because it’s unfair.
My husband was lucky enough to take paternity leave for 6 months while I worked full time with a small baby and sat the FRACP exams. He had to go back to work full time and full time daycare was too costly for us so now I’ve slowed down my career, tolerated snide comments about my ‘commitment’ to the job, all because his work would never ever offer him part time work (which he would happily do). Having children is not a ‘woman’s choice’ – it is a family choice, and the children of this country become its future workforce and taxpayers. Saying doctors should not contribute to this population is ridiculous. Where are the men in the profession advocating for other men to do the child rearing? Why is it not a man’s choice also. The inconvenient truth is that men have had it far too easy with a wife at home ensuring their ‘commitment’ is intact. Women have no such safety net at this point in time. This is not a women in medicine issue, this is a medicine stuck in a long gone past issue.
I am confused by some of the comments made by some male colleagues. There is an invalid and old fashioned assumption that the choice to bear children and care of children is solely a woman’s. Mostly the decision to have children is a joint decision between a man and a woman (excluding gender diverse couples). However it seems that many of you see the responsibility of that decision weighing mostly on women and their careers.
It is heartwarming that so many males see the value in caring for children, seemingly even more important than practicing medicine. So how many of my male colleagues who have had children took parental leave, became stay at home dads, or pursued genuine part time work? If not, why not?
Some would call this hypocrisy. I will be generous and call it cognitive dissonance.
We live in a world that is made by men, in men’s image, through men’s eyes. For a long time. We do not even have the right words, or language to discuss these issues. This is how deep, and entrenched the ideas and concepts are. Everything that women have fought for and won are tenuous because fundamentally the world has not changed the way it sees itself, and we lack the self awareness to realise this. Everything is about men, compared to men, assessed by men and decided ultimately by men. Whether a view point is valid is ultimately seen through a male perspective. To even question whether we all deserve equal rights, or to deny there is a lack of equal rights between different genders requires a deep seeded denial, delusional thinking and fear.
I see the vehemence and anger displayed by some people above as a clear reflection of fear. Fear in a lot men not wanting to lose their inherent power. There is no greater “silver spoon” in this world, than to be a white male born in a western developed country. Men fear because when men take power, they often destroy and they cannot imagine that others who seek to share in their power might do it in a different way.
As a woman, I seek to share in this power, but not the power to decide upon others’ fate (I don’t want to reverse the hierarchy to have men at the bottom), but simply the power to decide my own fate. And in the end, I seek to essentially subvert the very idea of gendered power so we do not see people’s abilities as inherently tied to their gender, but to their… drum roll… ABILITIES.
But first we must recognise that we’re all playing a rigged game, we all have blinkers on, men and women and all other genders in the spectrum. We live in a male world, in a male perspective. This is why the riddle is so important. Holding a mirror to one’s own biases and unquestioned prejudices is scary. Some people react with self-examination and humility and others respond with fear, anger and more prejudice. I hope there are more people of the former kind than the latter. However, I would like to see more change in my lifetime, meaning that I feel we do not have all the time in the world to stop and help those who only respond with anger. If you are one of those people, don’t be surprised if you wake up one day in the future, and the world has moved on without you.
Caroline de Costa nailed it when she said “The pelvic floor is a long way from the glass ceiling”. After 40 years, as a male, I’m also tired of the egos, the figjams and the silver spoons who are in it for occupational therapy rather than professional calling.
We have already spent ‘hundreds of years’. Women have had the vote in Australia since 1902 and we have had only ONE female Prime Minister and ONE female Governor General in that time.
There have been qualified, registered women medical practitioners since 1890 (the Victorian Medical Women’s Society was founded in 1896 by Dr Constance Stone) yet I was told in 1972, as I started my medical training, that ‘it is a waste of time training females in Medicine – they only go off and get married’.
In the 40 years since graduation I have been working in a profession which undervalues women, stifles career progress and generates anger and frustration in its female members.
Ironically my Citation as a Fellow of the AMA states that this election was ‘in recognition of outstanding services to the Association and as a mark of the high esteem in which HE is held by Fellow Members.
I rest my case.
Some of the above comments are making me quite nauseous. Especially the ones making light of the 72 women who were killed at the hands of their partners. This is the kind of importance society places on women in general, that the fact that women are either beaten or put into the ground by their male partners is something to have a little joke about. But don’t worry, their partners were acting out of character. He was a good bloke, really, hard working, salt of the earth kind of guy. Gentle. Loved his family, really he did. Just under a bit of stress, is all. Wouldn’t hurt a fly.
I do not understand how many of you can think the issue does not exist when it does not exist FOR YOU. But I have experienced gendered discrimination, violence and harassment.
You have not stood there asking for genuine advice from a senior colleague about how to hone your skills to make yourself more employable as a consultant, only to be told that your large breasts would probably get the job done anyway, as most directors are male. You haven’t had to explain to a family that their parent is never coming home, sort out goals of patient care, only to be asked what the doctor thought about all of this. You haven’t had to sit through countless meetings where you and your female colleagues were talked over by overconfident alpha males. You haven’t had to work through the crap that is assumed incompetence, while watching your male colleagues get praised for just showing up. You haven’t had a nurse override your decision and call in the other senior registrar, who is male, only for him to make the exact same decision as you. You haven’t had to shift in discomfort as a surgeon leered at you, that familiar look that you experienced over two decades ago, when an old man propositioned your 14 year old self for sex and then chased you down the street when you said no.
And you haven’t had to sit here, justifying your position, justifying your arguments because as usual, women just need to stop being so hysterical, it’s not a big deal anyway and it’s all in your head. Meritocracy is how it should work anyway, there’s no nepotism in medicine at all. If you work hard you should get a seat at the table.
And how has that worked out so far?
Thanks, Prof Marcus. Medicine is just one part of wider society. If people are judged for valid parenting choices – whether they take the role as carer or as professional, or, indeed, both, then that’s a problem for all of society.
Dear Professor Ieraci,
Who stays home to raise the kids is a problem for the couple, not for medicine.
If they are too concerned what people will think, that’s their problem too.
If you want to have it all, there will always be compromises.
Despite having been a senior consultant for many years, Head of Department for many years, federal Vice-President of my College, on every committee known to man at hospital, state and federal levels, I can’t count how many times I’ve been introduced to others, among a group, as “This is Prof X, Dr Y, and Sue.”
I worked full-time for many years, displayed appropriate ambition, made appropriate achievements, put my hand up for all sorts of roles – but I remain, simply ‘Sue’.
Those commenting who have never experienced this phenomenon may be a bit like Anglo-Australians who have never perceived subtle racism: just because you don’t perceive it, that doesn’t mean it isn’t there.
We are still in the very early stages of reversing hundreds of years of gender bias. Until the last few decades, men didn’t get positions because they were better than women at the task – they got them because society accorded them privilege. Do others here really think we should wait hundreds of years for equity?
Yes – women are biologically required to BEAR children – but not necessarily to raise them. In village life, where everyone’s labour is esential to survival, there was little – if any – one-on-one parenting – raising children was a group endeavour. For the extremely privileged, it was handed over to the nanny.
There is no intrinsic reason why parenting has to be the main task of a mother – the other parent, the extended family, the employees and the village can contribute.
When we have male trainees and consultants being encouraged to go home in the evening with “don’t you need to get home to the kids?”, we will know we are getting somewhere.
If you have children and stay home to look after them, you ARE less career focussed. There is no judgement in that, just a fact.
You are never compelled to have children.
If a woman doesn’t have children to distract from her career, is equally capable, and still doesn’t get promoted, then a case for sexism may be made.
I used to believe we live in a fair society where if you work hard you will get promoted. Experience has taught me that it is WHO you know that gets you promoted – not your experience or hard work.
Women are judged when they have children- as less career focused OR worse that it is their job to stay home and mind the child/children.
One male manager told me “don’t you want to stay home and be with your kids” when I requested extra hours at work to finish projects. “Would he have said this to a male colleague?” Did I report this to HR? Well no as I knew he would deny the comment.
Sexism is entrenched in the workplace, in particular the health care industry.
It is amusing that so few people (including perhaps the author of the original article) think that the prospect of a gay male surgeon is realistic. [Whimsical emoticon required.]
Our society values jobs according to income, so that a truck driver has lower status than an aeroplane driver, even though the need for constant watchfulness is greater in the truckie than the pilot, and the risk of death in a crash much higher. Therefore the completely unpaid job of caring for your own children is regarded as ‘not a proper job’. And even when it is paid, it is relatively poorly paid, and often devolves as so-called “women’s work”. I do not know any doctors who have insisted that their children only be cared for by males, in order to break the cycle of poorly paid women’s employment.
Breaking the patriarchal hegemony would be greatly aided if every doctor insisted on a male nanny for his or her children, and insisted on an hourly rate no less than $50. Then childcare, like Nobel prize winning, would be seen as a valuable pursuit.
But this devaluing of child care applies to our entire society, not just to females who care for children. In a song from his final album, the late John Lennon writes of how his presumably artistic and sensitive friends felt that he was wasting his life, by being a stay-at-home dad. Having missed out on Julian’s childhood because he was touring, he chose to stay at home and bake bread for Sean, and play together with toy trains, taking joy in just watching the wheels go round and round.
Carol Greider got photographed with her children, but there are not many photos of John with young Julian–it certainly does make a statement.
Perhaps the saddest part of an article on unconscious bias, is that so many of us have an unconscious bias that being a Chief Medical Officer and Clinical Professor is better than playing with trains with your child.
Watching the Wheels – John Lennon
People say I’m crazy
Doing what I’m doing
Well, they give me all kinds of warnings
To save me from ruin
When I say that I’m okay, well they look at me kinda strange
“Surely, you’re not happy now, you no longer play the game”
People say I’m lazy
Dreaming my life away
Well they give me all kinds of advice
Designed to enlighten me
When I tell them that I’m doing fine watching shadows on the wall
“Don’t you miss the big time boy, you’re no longer on the ball?”
I’m just sitting here watching the wheels go round and round
I really love to watch them roll
No longer riding on the merry-go-round
I just had to let it go
Ah, people ask me questions
Lost in confusion
Well, I tell them there’s no problem
Only solutions
Well, they shake their heads and they look at me, as if I’ve lost my mind
I tell them there’s no hurry, I’m just sitting here doing time
I’m just sitting here watching the wheels go round and round
I really love to watch them roll
No longer riding on the merry-go-round
I just had to let it go
I just had to let it go
I just had to let it go
I could not solve the riddle because I cannot picture a parent regardless of gender not treating their own children in times of need. Gender didn’t even ocur to me.
As a proud father of a daughter in her last year of medicine and another daughter keen to study medicine too I am worried though about a family hostile workplace – not a woman hostile one, but a work environment that disregards and disrespects the needs of young families and especially young children.
“72 women were murdered by their partners in 2016”.
And none of the murderers could solve The Loh Riddle??
Case closed!
Yes Dr Loh- get into 2017! The boy could have several biological or adopted parents, of “any” gender!
But seriously- none of my male colleagues do much at home, and most of their wives do little paid work to give them time to support all the things which need to be done at home. Many male colleagues would likely not actually know the first thing of what to do with most home tasks- most cultures still strongly encourage gender roles (especially the cultures younger Drs are from). So they can work 60 hrs plus, and relax that everything else is happening smoothly at home. Us ladies can’t- even if we delegate some work a network of people are there to judge us for not doing “our job” by putting it onto our man, relatives or paid help, and constant guilt if anything is not perfect, thinking if only I’d worked less I could have done this… If you’re not a super high achiever (i.e. Winning Australian of the year) who needs that?? Stay sane and set low goals, at least for getting into management, while working part time is my motto now! And maybe ladies- find men without huge career goals who want to be a househusband (and telll you so enthusiastically!) I’m sure some are out there…
From a female surgeon: stop arguing about the riddle and men please stop telling women they “prefer” to shoulder a disproportionate share of child care and domestic duties. My mother had no choice when she was dismissed from her role as a paediatric nurse when she married my father, as the legislation at the time dictated. At the time of my birth it was still legal to discriminate on the basis of gender. 72 women were murdered by their partners in 2016. We have a serious problem with sexism in Australia.
I assumed it was another father in another car that died. Not sure I even got to making the other incorrect assumption about the surgeons gender.
It always amuses me when people trot out the ‘argument’ about no quotas and merit-only appointments! Men don’t seem to notice how 100% male appointments (regardless of relative merit) and systems of the past have privileged them.
The riddle is flawed. Surely no one would conceive of a surgeon, male or female, operating ion an acutely injured patient when their partner/spouse has just been killed in a motor vehicle accident. I agree with the comments of Marcus and Randal; appointments should be made on merit, with part-time positions and parental leave available to both female and male medical practitioners. It is then up to each individual to decide their priorities and their work-life balance. I write as a physician who has supervised female advanced trainees for many years.
Women may make the conscious choice to look after the kids – but would they so often if the man had any opportunity to work part time? My husband took 8 months paternity leave and I was happy to work full time knowing our daughter was at home with him, far more comfortable than with full time daycare. If my husband had the opportunity to work part time or even stay home, I would happily go full time but it just isn’t happening for men. Not in corporate Australia and certainly not in medicine. I cannot even begin to imagine the reaction if a man were to request part time work for child-rearing from the medical community. I work part time (and consider myself lucky my department and training program are supportive) so that one of us gets those precious early years with our daughter – but mainly because we have no choice, and I know that my husband is sorely missing that time.
In my opinion the medical profession in Australia has been at the forefront in female equality, and I reckon Dr Loh is misguided in trying to suggest otherwise. Women doctors have the same opportunities to progress in their fields, but some make the choice to take time off to have children, to work part time or to avoid after hours work . This may limit their options , but the opportunities are none the less there for those that wish to avail themselves. Until biology allows men to have the babies this won’t change.
I dont subscribe to affirmative action policies or quotas–when you start appointing on other than merit you are on a slippery slope. Tokenistic appointments to reach arbitrary gender quotas help no one.
I also have to say, re “30%…” Women have children, and women are less ambitious/aggressive than men (or, testosterone has no effect).
If I had to choose between having children and having a career, I would choose the children any time. So, if women are not on boards, it is because they have had more important things to do. Certainly, parenting is very low-prestige, very boring and very stressful, with insufficient warm, gooey, in-love feelings as compensation. When I see something that a woman has done before she had children and her career stops, I think how it is history’s loss, but the children’s gain, and the children might have been more important to the woman than history, or shareholders.
Germaine Greer thinks/thought that women could have it all. She didn’t have it all. Women can’t really, not on an equal footing. I think that it is nice that you acknowledge the practicable barriers that women face. But nowhere is there any acknowledgement of which is the more important job. This is offensive to women, and, I believe, offensive to children. We were all children. My mother was stay-at-home. I would not like to have been viewed as a career problem.
You don’t know the mechanism of the riddle. I suggest that you change the riddle to “A girl and her mother… this is my daughter”. It might work and it might not. If it still works, it will be because the brain is primed to view THE dead person as THE parent, and it will not be to do with sex.
Stated differently: “Dude, test your hypothesis before you write 1147 words. Please”.
Implementing training such as ‘leadership development for women’ is another indication that the systemic causes of gender inequity are not being adequately examined or addressed. Men have been the beneficiaries of unearned privilege for centuries – where is the training for men to recognize and remedy this and to take only their fair share of society’s benefits based on actual (not perceived) merit?
Systems of training, education and professional practice should cater to a range of human life experiences (including parenthood and other caring roles) and not only to the ‘traditional’ male breadwinner model. We all benefit from systems whereby everyone’s talents are valued, recognized and adequately remunerated.
Oh Erwin, and round and round we go. There is no riddle.
I, like you, want a world where women have full equality of opportunity and status.
I also want them to have choices. Unfashionable as it is to militant feminists and the Lean-In brigade, some choose to take a nurturing role at home and to care for their own children, knowing that in the first 3 years of the life of a child, this represents the very best care available in their social demographic. This should not be discouraged, nor should the state or bureaucracies try to mandate an alternative approach: this is a decision she (most often with her partner) will come to.
But that decision very often means stepping off what would otherwise have been her career trajectory. Indeed, most people find it very difficult to be in 2 places at once. Their choice.
So the percentage representation of women in senior positions?: it’s not just about (unconscious) bias in the workplace.
P.S. Citing the Harvard Business Review is like citing The Monthly as an academic reference. As the cheerleader journal for Diversity and Inclusion in business, it is hardly an unbiased source in its own right.
And the evidence that companies with women in leadership roles do better is confounded by reverse causation: companies that are doing well feel more able to engage in tokenistic virtue signalling.
Women who are in leadership roles should be there because they are capable, not because they are women.
Has Professor Loh considered resigning his position as Chief Medical Officer so a female doctor can take over this prestigious position?
If he genuinely believes in advancing gender equality — and does not want to appear a hypocrite — why has he not done so?
As a (female) emergency physician, I was mortified a few months ago when my two daughters couldn’t solve this “riddle” even though I changed the story to “boy taken to ED and emergency physician said…” I was further deflated when my husband took a while to solve it also! We still have strides to make 🙂 Thank you for your commentary.