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May 30, 2017

'You are not a fraud': A Mass General doc's open letter to young female physicians

Daily Briefing

    Inspired by notes new interns wrote to their future selves at an orientation session last June, physician Suzanne Koven wrote an open letter to young doctors everywhere, filled with the advice she wished she'd received as an intern—and as a woman entering the field of medicine. 

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    "I'd be worried if you weren't at least a little worried" at the start of your internships, Koven, an assistant professor at Harvard Medical School and primary care physician at Massachusetts General Hospital, writes. "The hours you will work, the body of knowledge you must master, and the responsibility you will bear for people's lives and well-being are daunting"—and "as a woman, you face an additional set of challenges."

    Koven touches on some of the sexism she experienced over the course of her 30-year career, ranging from the "merely annoying" to "serious and damaging discrimination." She writes, "It pains me to tell you that in 2017, as I'm nearing the end of my career, female physicians earn on average $20,000 less than our male counterparts ...; are still underrepresented in leadership positions, even in specialties such as OB-GYN in which we are a majority; and are subjected to sexual harassment ranging from unwelcome 'bro' humor in operating rooms and on hospital rounds to abuse so severe it causes some women to leave medicine altogether."

    But while these obstacles are formidable, "one of the greatest hurdles you confront may be one largely of your own making," Koven writes: The fear that you are a fraud.

    Koven explains that "this fear, sometimes called 'imposter syndrome,' is not unique to women"—male physicians also have to tackle this form of self-doubt. But while "women's fear of fraudulence is similar to men's, [it has] an added feature: not only do we tend to perseverate over our inadequacies, we also often denigrate our strengths," she writes.

    For instance, Koven cites a study suggesting "that patients of female physicians have superior outcomes," noting that the findings spurred speculation as to "why it might be so: perhaps women are more intuitive, more empathic, more attentive to detail, better listeners, or even kinder?" While she doesn't claim to know whether any of those generalizations are valid, Koven points out that "when women do possess these positive traits, we tend to discount their significance and may even consider them liabilities."

    Reflecting on her own experience as a physician, Koven recounts how she "wasted much time and energy" trying to convince herself that she "was not a fraud and ... had more to offer my patients than the qualities they seemed to value most."

    Now, however, "late in my clinical career, I understand that I've been neither so weak nor so powerful," she writes, and "I should have spent less time worrying about being a fraud and more time appreciating about myself some of the things my patients appreciate most about me: my large inventory of jokes, my knack for knowing when to butt in and when to shut up, my hugs." As Koven puts it, "Every clinician has her or his own personal armamentarium, as therapeutic as any drug."

    Koven writes, "My dear young colleague, you are not a fraud. You are a flawed and unique human being, with excellent training and an admirable sense of purpose." And while "your training and sense of purpose will serve you well," it's "your humanity will serve your patients even better," she concludes (Rosin, Becker's Hospital Review, 5/23; Koven, New England Journal of Medicine, 5/18).

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