Book Review

When the Personal Was Political: Five Women Doctors Look Back

N Engl J Med 2009; 360:198-199January 8, 2009

Article

When the Personal Was Political: Five Women Doctors Look Back
By Toni Martin. 165 pp. New York, iUniverse, 2008. $15.95 (paper); $6 (e-book). ISBN: 978-0-595-48726-4 (paper); 978-0-595-60822-5 (e-book).

This concise, lively, and sometimes humorous history will interest women and men of all ages. Author Toni Martin includes the experiences of herself and four others in her book — all from the class of 1977 of the medical school of the University of California, San Francisco. Despite the small sample size, a multidimensional portrait emerges of a groundbreaking generation of women physicians who came after the pioneers but before today's students, who often take access to education for granted. As Martin explains, “Today's young women travel to medical school on a passport of achievement, just like the men [but] we were seen as an invading force so we could never let down our guard.”

Gender equity in medicine is elusive, despite the large number of women who are entering the field and although most men assume that it has been achieved. Thus the question Martin poses, “What does it mean to be a woman in medicine?” remains relevant. Her account is a lens through which to examine what has changed and the disadvantages that women continue to face. Although young women no longer hear, “You don't look like a doctor,” nor do they have to “construct a woman doctor identity from scratch,” they still must try to “squeeze into the standard model,” and they then tend to ruminate over what is wrong with themselves when they do not fit. For example, similar behavior is perceived differently in men and women: he is confident, she is conceited; he pays attention to detail, she is picky. With ambition in women still considered by many to be unseemly, women tend to underestimate their own abilities, creating a kind of personal glass ceiling. Martin documents how, among herself and the classmates she profiles, “none of us recognized what we were worth.” Even though three of the five had been chief resident, it never occurred to them to use this honor as a negotiating point. Such modesty and naiveté remain characteristic of many women today and are liabilities in competitive environments.

Naturally, another of Martin's themes is parenting, and this book is replete with examples of women doctors being “the most organized people on earth.” While Martin describes how “older women distanced themselves from us when they saw we wanted lives as well as careers,” today's young people have many more role models. However, supportive institutional practices and good sources of advice about how to weave family and work together are still lacking. And the double standard remains in this area, too, “cutting men a lot of slack in the fatherhood department” — that is, “a good daddy is busy, don't bother him; a good mommy is always available.”

Martin also explores other phenomena that have not been sufficiently addressed elsewhere. Because they did not consider themselves to be “empathy specialists,” Martin and her colleagues were unprepared for patients “feeling freer to vent their feelings” to them than to male physicians, and for the psychosocially complex patients “triaging themselves and being triaged” to them. Similarly, these women did not expect their orientation toward teamwork to work against them, but in the career sweepstakes, “men were always jockeying for position, lobbying the coach to be in the starting lineup and to get more playing time.”

So how are we to assess progress? Martin is rightfully proud of the progress that women physicians of her generation made toward achieving gender equity. She also points out that they gained recognition that “intimidation is not the best way to teach critical thinking,” and influenced how communication skills are taught in medical school. But a cautionary look at the challenges that remain would have strengthened the book. Women are still much less likely than men to translate their enormous intellectual capital into career capital. This is not a “women's issue.” The future of medicine is inextricably linked to women physicians' realizing their potential as leaders.

Janet Bickel, M.A.
Janet Bickel & Associates, Falls Church, VA 22043
janetbickel@cox.net