Book Review

Walking Out on the Boys

N Engl J Med 1998; 339:1402November 5, 1998

Article

Walking Out on the Boys
By Frances K. Conley. 245 pp. New York, Farrar, Straus, and Giroux, 1998. $24. ISBN: 0-374-28621-3

Few topics in the 1990s have generated as much interest or controversy as sex bias and sexual harassment. Frances K. Conley's book, Walking Out on the Boys, is likely to do both. A few months before the Senate hearing on Clarence Thomas's nomination to the Supreme Court, Conley resigned from her position as a professor at Stanford University to protest what is described on the jacket of her book as “long-ingrained overt gender discrimination.”

Conley's highly personal perspective provides one woman's view of academic medicine, of sexual harassment, and of institutional reactions to sexual harassment. It may make some readers uncomfortable. There are few heroes in this book. This book names people, describes relatively personal aspects of their lives, and concludes on this critical, even negative, note: “I have learned that universities, in general, no longer function as agents of societal change . . . [that their] liberal environment is a masquerade.”

It seems clear to me from talking with colleagues that there are many perspectives about what happened at Stanford. Some readers will see Conley's book as a realistic description of events that could happen at any medical center, whereas others will see her account as one-dimensional, inaccurate, or not relevant to their own institutions. Nevertheless, her account serves a very important role in emphasizing that even at a time when women are entering medicine and science in greater numbers, sex discrimination and sexual harassment are still taking their toll.

Social change is not easy. Those at the forefront pay a price, and Conley's saga illustrates this. She was a trailblazer. She finished medical school when tradition favored a career for women in pediatrics, psychiatry, pathology, or family practice. Conley chose neurosurgery. After serving as the first female surgical intern at Stanford University Hospital, she joined the faculty and was elected chair of the Faculty Senate, the first nontenured faculty member and the first woman to serve in that position.

Conley's account should remind us of several points. It is not unusual, in complaints of sexual harassment, for there to be divergent views, both of what happened and of its significance. One person's comment, intended as humorous, may be another person's insult and cause pain. A second point is that sexual harassment is largely an issue of power, not sex. It occurs when one person has more power than the other and uses that power inappropriately, to intimidate.

Conley's comments about her own participation in ritual harassment in the operating room (“I, too, could be insulting, using our dirty language to turn their faces red”) bespeaks an important principle: trainees learn harassment from their professional culture and their role models; very few of them are immune. And they pass it on. Alternatively, I would like to think that trainees can also learn positive aspects of behavior, and that these, too, can be passed on from generation to generation.

Conley's book raises questions for all of us, both men and women. Would the outcome of this story have been different if, at the time, Stanford had had a mechanism through which her grievances might have been aired? I believe that thoughtful, comprehensive institutional policies and programs can avert at least some of the pitfalls mentioned in Conley's book.

What else can we do to change the culture of medicine and science so that all the players can grow to their full professional potential? What policies and procedures should institutions put in place to encourage positive behavior and to discourage negative behavior? How can we encourage creativity and the free expression of ideas while building a society that does not condone the belittling or exploitation of others? At a minimum, Conley's book puts these questions squarely on the table.

Although I share Conley's deep concern about equity for women in medicine and science and empathize with her impatience, I suspect that, like a nearly victorious but weary warrior, she cannot now see that the battle is going well. We have recruited a new generation of energetic, sensitive, and collegial people, members of both sexes, to our profession. I believe that universities and academic medical centers are in fact agents of social change. I know that prejudices and barriers are dissolving. Conley's book serves an important purpose in reminding us that we cannot have it any other way.

Merle Waxman
Yale University School of Medicine, New Haven, CT 06405-2657