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"I wanted my dignity back'

I have just resigned my position as a full, tenured professor of neurosurgery at Stanford University Medical School. I did so because I was tired of being treated as less than an equal person. I was tired of being condescendingly called "Hon" by my peers, of having my honest differences of opinion put down as a manifestation of premenstrual syndrome, of having my ideas treated less seriously than those of the men with whom I work. I wanted my dignity back.

Those who administer my work environment at the present time have never been able to accept me as a peer, not because I lack professional competence, but because I use a different bathroom. I lack the appropriate gender identification that permits full membership in the club.

I resigned because of a subtle sexism that, while not physically harmful, is extremely pervasive and debilitating. It is, I suspect, the kind of unequal treatment professional women around the country put up with all too often to get ahead, just as I did. It's 1991, and it's time to put a stop to that.

Most medical school classes today across the United States are composed of at least 35 percent women; in many, the percentage is higher. Just a few weeks ago, the medical students at my institution _ both men and women, in approximately equal and impressive numbers _ attended a meeting of the Faculty Senate to share their concerns. Even today, they told us, faculty are using slides of Playboy centerfolds to spice up lectures; sexist comments are frequent and those who are offended are told to be less sensitive; unsolicited touching and fondling occur between house staff and students, with the latter having little recourse to object. To complain might affect a performance evaluation or career paths.

In an operating room encounter with a surgical resident, a female medical student was asked if she were interested in a particular surgical subspecialty as a career choice: "If so" she was told, "you'll need the genes of a man." Sexual discrimination can go both ways; a male student cited a clerkship in which the training experience was qualitatively different for the two sexes, with women getting the better training. Students pleaded for change in the present environment to one where one gender can respect the other.

It is probably true that, at least in the past, medicine has tended to attract men most comfortable in a society where males dominate subservient females. This society of men is most developed in surgery where there is a defined hierarchy.

A few summers ago I invited a friend who is a professor of organizational behavior to examine power relationships within an operating room environment. My contention was that I used power and my position as "the surgeon" quite differently from my male counterparts. He found female surgeons tend to manage their operating rooms with a team approach; male surgeons remain "captains of the ship." Of significance, both methods can provide good patient outcome.

When working with surgeons who are women, the nursing staff (predominantly women but also a few men) stated they felt more valued as fellow professionals _ male surgeons were far less inclined to thank or praise their team at the successful completion of a case. Women surgeons used humor much more frequently to achieve their goals. An operating room is a confined unit, and women have been successful in adapting this environment to their special managerial style.

Unfortunately, there is the world in academic medicine outside of the operating theater _ one composed of clinics, teaching, insurance forms, lawyers, research, administration and politics, all governed by deans and department chairs. The administrative structure of American medicine today remains dominated by men, many of whom were raised by doting parents who considered them superior beings.

In the distant past, when I was the only woman training in surgery at my institution, a fellow resident surgeon (married, as was I) used to delight in asking me to go to bed with him. The invitation was offered a number of times, always in jest and always in the company of others _ always men. The purpose? Perhaps he was playing a game of "mine is bigger than yours," but I doubt it.

To this surgeon, women were created to feed him, clean up after him and provide sexual gratification. Period. He had not even considered that I was his equal as a person _ despite very similar educational backgrounds, intellect and professional ability. The only way he could relate was to reduce our relationship to a level where there were clearly defined roles for a man and a woman.

Surgical training reinforces the concept of male superiority. It is so focused and demanding that, for some men, personality growth is truncated, leaving them in a time warp of persistent delusions about their superiority. Such a person lacks the capacity to adjust to societal changes. The danger for the future of medicine (and, I suspect, business and law) comes when one of these stunted individuals, who may be very gifted technically, is assigned a position with authority over the professional lives of others.

In my letter of resignation I described my work environment of the past 24 months as "hostile." Two years ago, the man who hired me 23 years ago retired. Over the years, we disagreed about many things but his pride in my professional development and support of me as a person created a workplace where others mirrored his respect. Under new leadership, life has not been the same. Looking ahead, I decided, at 50, that I didn't need to continue hearing myself described as "difficult."

I felt I had the right to express an honest difference of opinion but found any deviation on my part from the majority view often was prominently announced as being a manifestation of either PMS syndrome or being "on the rag." Until recently, I was precluded from joining the rest of the faculty in interviewing resident candidates to our training program; my return to the fold occurred only at the urging of a younger, sympathetic male faculty member.

Repeatedly over the past two years I have been invited to "talk out our differences." The invitation always has strings attached _ it can only take place over lunch or a drink, again establishing a situation where society assumes male dominance. My closing the office door and inviting the discussion then and there in a neutral environment is rarely accepted.

Will anything be gained by my leaving a truly fine academic position? Many will view the move as a defeat, a loss of will to survive in a dog-eat-dog world. I hope, though, that the answer to my question is "yes"; that the future encompasses the rebuilding of my self-esteem and personal dignity. I also hope that the media fascination with what I have done will help open the way for true dialogue on this issue at medical schools throughout the country.

But I have no illusions that my leaving will benefit the present classes of medical students. Instead, I leave in place a validated legacy of sexism, a role model for all men, that women are, indeed, inferior and expected to remain so.

Dr. Frances K. Conley will be a professor of neurosurgery at Stanford University Medical Center until September. She wrote this commentary for the Los Angeles Times.

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