S1E19: Women in Medicine

Harjit: She knows where the mic goes.

Chloe: She does. Oh, yeah. She's been in here hundreds of times.

Dr. Jones: Literally. I think literally now, yeah.

Chloe: Literally. Maybe probably even more.

Harjit: Perfect. Welcome to the "Bundle of Hers." This is Harjit, and in the studio we have Margaux. Bushra and Leen are taking a break today. We're really lucky because we have Dr. Kirtly Jones in the studio with us, and she also has a podcast with The Scope called the "7 Domains of Women's Health." So we're really excited that you're in the studio with us, Dr. Jones. Thank you for coming.

Dr. Jones: I'm pleased to be here.

Margaux: I think today we really were interested in talking to you about women in medical school, because that's something we feel the pressures of every day. And so we were curious on your perspective of what it was like going through medical school as a woman, and maybe even in your practice.

Dr. Jones: Oh, okay. Well, first of all, I graduated from medical school 40 years ago this year. You have to remember that we're working on my memory, which is usually pretty good, but not perfect, and my background, which isn't necessarily yours.

So thinking back, I graduated from the University of Colorado, and I went to the University of Colorado as an undergrad. So it was my medical school. I never thought about being a pre-med until the summer between my junior and senior year. So I happily took the MCATs in September, interviews in October, and was accepted early decision in November.

Margaux: Wow.

Harjit:Wow.

Dr. Jones: So a lot of the concerns that people have about getting into medical school, and women about putting their lives together and putting their lives on hold, I didn't really experience because there I was. There were some difficulties in my family that moved my direction from developmental and molecular biology to medicine. My father had died that summer, and so I was ready to make a move. I don't know that I knew what I was getting into.

So in terms of women in medical school, things have changed, I would say. So I've been an educator here at the University of Utah for the past 34 years, and the things I've seen, it's certainly more women. And that's terrific because you add a gentle flavor to the medical school class. That doesn't mean you're not competitive, but it just is nicer. And the fact that you guys get together, I think that's great.

I think one of the differences for women in medicine is that we were expected just to know the unwritten curriculum. So we didn't touch a patient until our third year, and we were expected to have the social skills to walk into a clinic and touch someone.

Now, as women, I think it's comfortable for us touching. So I think that actually doing a physical exam and being on a level with patients wasn't hard for us, but we didn't have any experience before our third year. So I think that that was a little bit different. There weren't that many of us.

Margaux: May I ask how many women were in your medical school class?

Dr. Jones: Well, this is going back in my memory. I think we had about 20 out of a little over 100. So that was pretty progressive at the time, and it was enough that we had an impact.

Now I would say that you probably have some women in your medical class who are pregnant even now, perhaps, or who have children. Is that true?

Harjit: Right. We have mothers.

Margaux: I'm glad you brought that point up because it's something that has been on my mind as a "nontraditional applicant." I just turned 29 this year, and as they call it, geriatric maternal age is approaching me. I feel kind of . . .

Dr. Jones: No, no, no. Thirty-five. You've got a ways. Just hurry.

Margaux: I'm also interested in surgery, which is one of the more competitive residencies, and so I'm kind of finding myself in this balance of, "Well, do I have children in medical . . ." And I want a family, so do I start having my family in medical school and/or in residency, and when is the right time? There is no right time, but I feel like it's such a big barrier for women to have to think about family planning and their paths in medicine.

Dr. Jones: Right. Well, having come from a generation where there were very few, if any, of my classmates who had children, that would not have been thought of. And having a baby during a residency was also unheard of unless you had a very special partner. So having children in whatever your career might be is totally dependent on your partner.

If you have a partner who's in there full-on, ready to pick up the pieces any time of day, or you have a partner and a third person, you need someone who is there that you trust to be there to pick up pieces because you won't always be there. So you can do it any time if you have that support.

If you don't have that support, then you will constantly be judging yourself to be inadequate. You won't be a good enough surgeon. You won't be a good enough mother. You won't be a good enough wife.

Now, that's not that you will be those things, but you'll see yourself as that. So it's a matter of how you build your team. And I'd say my whole career has been built with women at my side. I have a male partner, husband, a partner for over 40 years now, but it's the women who've been at my side, my nannies, my housekeepers.

Margaux: Supporting you.

Dr. Jones: Yeah, they are the ones who've supported me. My secretaries.

Harjit: I love that you say that because I think that's something that I always feel like, even now, what's been holding me together is I'm really good friends with the people that I do this podcast with, Margaux, Bushra, and Leen, and we really hold each other and support each other through this.

And I guess my question is, was there ever a time where you felt support with your classmates, especially your female classmates, when you were in medical school?

Dr. Jones: No, but that may have more to do with me, in that I was a pretty serious student. I took medicine, because of this thing that happened in my family, as a calling. So for me, I wasn't terribly social.

It was an experience that I remembered vividly when I was thinking of coming here today. When we were in our first year doing anatomy, you had the option of either doing the entire anatomy dissection with a small team, or you could do just part and you could teach your part to a larger team. I think that was actually an experiment.

Margaux: Interesting.

Dr. Jones: So there was a group of women whose consciousness about women's issues was much more elevated than mine. I tended to sit, do my stuff. I was kind of a Teflon girl. If someone either whistled at me or whatever, I just didn't really notice it, or it was their problem.

But one of the faculty, an orthopedic male faculty, in his lecture put up a scantily clad woman, and these women walked out. I went, "They are so brave." And I didn't know them that well. They were kind of a tough group, and I was kind of a scaredy-cat. So they walked out, and I should have been friends with them.

Another thing happened that year. They grouped together to make a group where their body part was going to be the female pelvis that they were going to dissect. And during their dissection, someone at night came and destroyed their pelvis prosection. Mutilated it.

Margaux: That's just terrible.

Dr. Jones: And it was awful. It tore up the medical school class. We had no idea who had done it, whether it was someone in the lab, or it was one of the medical students. And that also should have pulled me closer to these women. I knew something awful had happened to women, and unfortunately, my head was in the clouds.

So I think you guys are much more aware than I was, and much more than the rest of my class. This was a group of women who really supported each other and stuck together. Not that they didn't have male friends and colleagues.

Harjit: Right. I love that you say that.

Dr. Jones: In fact, I had some male colleagues who are still my friends from medical school, the few that I do have, a couple of women and a couple of men, but I missed out on the richness of these friendships.

Margaux: Do you feel like the male peers in your class respected you or the group of women as women students?

Dr. Jones: Well, I think they respected me because I was a smart girl, and I think they were in awe and a little fear. This group of women were fearsome. They were warriors.

Margaux: That's good.

Dr. Jones: They were warriors for women. So I don't know the word . . . Respect is partly a term . . . somewhat of respect. Some didn't get it. Some guys really didn't get it, but some did and we were right there with them.

Actually, again, I guess it was my second year during physical diagnosis, you know how you have program patients you have to be your . . .

Harjit:Yes.

Dr. Jones:Well, we did not, so we did physical exams on each other. And we were supposed to pair up with women, and guys who didn't . . .I don't know how guys actually did a female pelvic exam, but I chose with a guy, a friend of mine. We chose to be physical diagnosis partners so that we could see what it felt like to be examined by either someone we knew . . . And this was not someone I was emotionally close to. He had just been a partner in my lab.

So we examined each other. It freaked out the colonel at the Air Force Academy who was our doctor mentor that we were taking clothes off. He really was uncomfortable with me taking my clothes off in front of my medical student male partner who was going to do my exam, but I said, "I am comfortable with this because I trust this man." So there were some amazing guys in my class, amazing guys.

Margaux: That's good.

Harjit: I think even in our class, we have some people that if they've not been through the experience, they try to take the time to understand it, which I really appreciate. I think that, like you said, we add something different to every class.

Dr. Jones: You do.

Harjit: And I think that it's people like you who started from the beginning that have changed the way that medicine or medical school is. So do you see that shift how women are treated in medicine?

Dr. Jones: Well, I'd say so. I mean, it just happens to be when you have more women in the room, women are less likely to be disrespected. Now, it's not good to have a whole bunch of women because when they get together, you know who they diss?

Margaux: Each other.

Dr. Jones: No, they diss the guys. So we are not gentle to men when we get together with a group of women. And if you have a big group of men, they are not always gentle with women. So the more you mix it up, the healthier, I think, that it is.

Also, I was substituting for Layers of Medicine, which is your curriculum's effort to teach the unwritten curriculum.

Harjit: Right.

Margaux: In humanities.

Dr. Jones: In the humanities. And we never had that. Oh, no. And as I was there, they did this thing called check-in. So each time the small group meets, and they've been meeting together for now a year and a half, they do check-in where they talk about how they are with each other.

Harjit: That's great.

Dr. Jones: Which I thought was fabulous. They were unceasingly anxious, which I thought was too sad, but at least they were willing to articulate that. So that's been a difference.

And I think having more women both as educators, because the directors of that course are both women, helps put the flavor of community, of caring. Not that guys don't care, because they do, but they're less likely to articulate their caring and be comfortable with squishy things, and I really like that in your class.

Harjit: Did you see a shift in the way you, or women in general, were treated during the first two years where you were just getting the education, like lectures, versus when you started rotations? Was there a difference? Was it more noticeable that you were a female?

Dr. Jones: Yeah, although, once again, that's more my personality. If things came my way from some attending, I would listen and absorb, but it never got to me. It's like, "Wow, that guy is really a jerk. Too bad for him."

There was a time when I was on my surgery rotation. I was actually doing a surgery sub-I, so it was a fourth-year. And the head of surgery at this hospital was a former army general, and he was letting me do an appendectomy, which I thought was cool as a medical student, but he called me "kitten."

I was processing this as I was operating, and I should have been just operating, but I could do two things at once because we're sort of multitaskers. And as women, we're constantly analyzing the content of the conversation, always playing it back. "What did that mean?"

And then I realized that he called his male residents "fat boys," and I thought, "Kitten? Fat boy? I think he's an equal opportunity abuser."

In general, I would say I was often the only woman on the team, but I didn't feel like it got in my way whatsoever. Never. And in many ways, it may have worked for me because I'm kind of a talky girl. So I just got right out there and in it.

Margaux: In line with that and kind of the current events of all the producers and big-shot Hollywood men that are being called out on their sexual harassment and abuses that they've done, I'm curious if you experienced or ever knew that women were being in the same position in your time or in your rotations.

Dr. Jones: Yeah, that was asked of me at a little dinner table conversation with some young women. And I don't remember that except for that "kitten," where I thought, "Am I being called out or harassed, or am I being sexually abused?" And the "fat boy" part, I mean, if they called me "fat girl," that's kind of a Trumpism and I wouldn't have liked that. So no. But they didn't call me that, so I don't think so, but that may not have been everyone's experience.

I think I was fortunate. I was at a university that really cared about medicine and cared about taking care of people.

As a resident at the Boston Lying-In, and then the Brigham, once again, as an intern, I was on with all-male teams, but I don't remember any time when I was treated differently than any of the guys.

Margaux: That's encouraging.

Dr. Jones: Yeah, it was. But remember, I told you that if it came, I'd just kind of . . . It's like, "Oh, he's a jerk. Too bad for him."

Margaux: Yeah. That's a good attitude.

Dr. Jones: Well, it is, but many people don't do it that way. And because I did that, I didn't call people out, which I maybe should have. So I apologize for all the women who got it when I should have stood up and walked out of the classroom. I should have.

Harjit: I think, in a way, I feel like you are because you're talking about it.

Dr. Jones: Oh. Well, thank you.

Harjit: I think that just even seeing that . . . There are oftentimes things I've done in the past, and I'm like, "I cannot believe I wasn't there standing for this person." But then I remember that at least I'm acknowledging it and didn't just erase it from my memory.

Dr. Jones: Right.

Harjit: Kind of along the same lines, we've been talking about things that have gotten better and changed for the better, but are there things that have changed that you wish didn't change, like medical school, medicine?

Dr. Jones: With respect to being women or men in medicine, I'd say no, but there is something that's changed that makes me sad, and that has to do with the boards. Now, you've heard this probably from a whole lot of your attendings. So 40 years ago, we took the boards. No one studied for the boards.

Margaux: That's amazing.

Dr. Jones: You just sat there and you took the boards, because it was taken as a pass-fail kind of concept. You just had to pass them. Now, of course, there was a number, but it was really our grades that mattered.

So it wasn't my boards that made me AOA. It was my grades, my grades in my clerkship, my grades in my first two years. So the boards scores have nothing to do with whether you're AOA or not.

We didn't see the board number as being an advantage in getting a residency or not. So we went to class, and we did the work, and we took it seriously, and the boards were never on our horizon. Once again, it's me. But I just walked in, and you took them. It was just one of those things you have to . . . "Oh, gosh, this Saturday, I've just got to take this test."

Harjit: Fascinating.

Dr. Jones: And so we didn't study. No one gave us time to study. It was just a measure of whether you could drink from the fire hose of knowledge. Could you do it and pass? So no one said, "Oh, I got whatever." And I'm sorry because it seems to be an overwhelming, obsessive concern.

Margaux: It is.

Dr. Jones: And people lose. You don't learn to be a doctor from a QBank.

Margaux: Right.

Harjit: Yes. I love that you say this because I go to lecture because I want to know, "What do I need to know when I'm going to start rotation? What do I need to know to understand the system?" But I feel like a lot of times, I then start asking my question . . . which I hate that I do this, but sometimes I'm like, "Oh, what do I need to know for the boards?" It makes me sad that I need to think . . . A lot of people are like, "Oh, this thing you don't need to know because it's not on the boards." But I will need to know this when I . . .

Margaux: Have a patient in front of me.

Harjit: . . . have a patient in front of me. Like a certain type of staging, staging of cancer, or things like that.

Margaux: Right. So along those lines, today they use the boards score to kind of dictate which residency programs you're eligible for.

Dr. Jones: Not true.

Margaux: But I'm curious . . .

Dr. Jones: Who does that? That's bad counseling, I think.

Harjit: I know. It makes me sad.

Dr. Jones: All a high boards score means to me is someone knows how to game the system. Someone spent a lot of time in the QBank. It does not predict what kind of a doctor.

So during all the years when I was on the residency selection committee, if it was anything, I just wanted them to get about 220. Over 220, that's great, but I paid no attention . . . After that, it was who got honors, who got letters, who was good at everything. Because OB-GYN are the seven domains. You have to be a real doctor.

Margaux: I know there was a point in history when women felt like, or were pressured, to only enter a select few careers and specialties. Did you feel that pressure at all when deciding your residency?

Dr. Jones: No. Well, yes, in the sense that I originally thought I was going to do internal medicine and genetics, but nobody got better in internal medicine. It was very tiresome. You micromanage people's electrolytes, and they don't get better. They just don't die. And so I said, "Well, forget this. I'm a seamstress, I know how to sew, so I'm going to be a surgeon," which was great, but the surgeons were all guys and they were . . .

Margaux: Rude.

Dr. Jones: That's right. They were. And I thought, "Do I want to spend six years of my life with people who aren't very nice to people or kind of don't talk nice about their patients?"

And it just happened that as an OB-GYN, the people I worked with, they cared about their patients. They had continuity, and they got to operate. So I didn't think about neurosurgery because neuroanatomy was my one not-perfect grade. So I'm not good at that.

Harjit: I love how you remember that, Dr. Jones.

Dr. Jones: I do. I remember my grades. Not how I did on the boards, but what I did in neuroanatomy. So I don't think it mattered, and the hours didn't really matter. It was what did I think I could really be good at?

Margaux: That's great.

Dr. Jones: I thought, "I think I can be good at this." So as a mentor of students, people would say, "Oh, I've been told I should never try to apply for OB-GYN because I got 200 on my board scores," and I'd say, "That's a pass." I really want to look for people who were totally engaged in what they were doing, were the very best student doctors they knew how to be, and that was reflected in their evaluations and their letters.

If someone really wants to do this . . . You may not get into a program for which they pride themselves on their boards scores, but there you are with a bunch of people who game the system. Do you really want to be there?

I understand evaluation drives performance, right? That's the fundamental driver of med ed. How you evaluate students is . . . what you measure is what you get. So if we measure board scores in a big way, it becomes a must-pass or must-excel kind of thing, and that's where students are going to put all of their time.

Margaux: I want to revisit back when you said that you found OB-GYN, and it contained all seven domains of medicine. For our listeners who don't know what that is, could you give a brief description?

Dr. Jones: Oh, thank you. Come visit our podcast, "7 Domains of Women's Health." So many people and physicians might think health has to do with your cholesterol or your blood pressure. Your physical health is important, but so is your psychological health, your social health, your emotional health, your financial health, your spiritual health, and your environmental health.

So there are many aspects that women have told . . . We didn't make this up. Women told us, "I'm only as happy as my least happy child." Duh. Well, I didn't get that told as a mom. I only have one kid, so if my kid's not happy, I'm not happy. But even people who had five fabulous kids, but their sixth was struggling, they're not happy.

If your financial health is . . . if you're struggling financially, you don't sleep well, your tummy doesn't feel good, or maybe you eat junk food because it's your comfort food.

And if your social health . . . Where are your friends? Who's your support?

So if you want to, you can actually Google "University of Utah Center of Excellence in Women's Health," go to their web page, and you can actually do a questionnaire in each of these seven domains, and you can get a little snapshot of things that we think are important in each of those domains and see what part of your "health," your wellness, you need to work on.

Margaux: I think that's great. I'm a firm believer that your health and well-being is a composite of all those different parts of your life, not just your physical health.

Dr. Jones: Right. And there are women who feel well even if they have critical medical illnesses, which are maybe fatal, but they are healed by the other parts of their seven domains. Their spiritual health buoys them, their social health, their family supports them, the environment around them is safe, even though they have a devastating fatal illness.

So do we ask those when we take . . . We sort of do in the social health. "Do you smoke? Do you have sex with men, women, or girls, or whatever?" I mean, we don't somehow put together the patient as this round whole all the way, but we do ask, "Are you safe? Do you have enough money to buy this prescription I just gave you?"

Margaux: So often the social history part of taking the history of a patient is so small and forgotten, but may have the most important information about that patient's health.

Dr. Jones: Yeah. I mean, we do ask, "Are you safe?" And sometimes we get that, "What does that mean?" And we ask, "Do you have sex with men, women, or both?" But that doesn't really get down to the core of who they love.

Margaux: Yes. Are you satisfied with that?

Dr. Jones: Maybe their dog is their number one person in their life, as it is for many people.

Harjit: I love that, and we also, at the "Bundle of Hers," we try to talk about all the different parts that go into making a person as a whole. We try to shed that light with medical students. We all have different identities and how that bridges in together, and so I'm really happy that you are talking about these and you seem so wise.

Dr. Jones: Everything I have, I've learned from my patients, and often my young patients. So I was happily listening to your birth experiences and your cultural birth experiences, and I think all of you experience this with some tenderness.

Margaux: That was a great episode.

Harjit: I know. We loved doing that one. I actually read online . . . it was a blog, I think, by Dr. Lee, "The Remarkable Career of Kirtly Parker Jones." There was a specific part where I loved how you said, "In academic medicine, one needs to move over so people can move up." Can you explain that a little bit more?

Dr. Jones: Well, if you're really nurturing those fabulous talents below you, I don't want to be their ceiling. I don't want to be the roof that they bump up against. Many of them have more talent in either administration, they have more vision than I have, and they also come with a young mind that is developmentally fresh and culturally fresh.

I'm a boomer. I am such a boomer. I'm stuck being a boomer, so I don't want to be someone's ceiling, and especially young people that I love.

So if these are people that I mentored, then the best thing I can do when they have grown is to move out of the way. In many ways, that's what we do for our children, right? We hope that when they are ready to fly, we are not their ceiling. We're not their cage. We move aside to let them free, and I want to do that.

So I did that at a moderately young age. When I think of either legislators or academicians who are occupying . . . there are only so many spaces in a department. And the most productive members of an academic department are the 40- to 50-year-olds. Thirty-year-olds are still kind of getting their training shoes all laced up, but 40- to 50-year-olds are remarkably both productive and innovative. And also, they speak to the time, and I speak to a time that's been passed. I don't want them to feel like they have to leave.

So the paradigm was if you wanted to move up, you had to move out. And the paradigm in academic medicine, you had to leave. Well, now many women are married to physicians. Fifty percent of women physicians are married to other physicians. So moving to academicians is a very difficult thing. If, for some reason, they are happy here and they're good, why not let them rise? That's what I want for you guys. I want you to rise.

Harjit: I love that. Thank you.

Margaux: I think that's so encouraging, and it kind of speaks to the paradigm shift that I see in medicine now away from the kind of linear hierarchical patriarchy, if you will, now to a more team-based approach to caring for a patient and medicine. I notice, as a student, that I've heard so many horror stories of the doctor "pimping" you or just completely belittling you, but my experience has been that of a team.

Where I am now, I'm seen as a member, even though I'm just a second-year medical student. I feel valuable and helpful in the team setting, and I think that this paradigm shift that you're explaining kind of outlines that shift. I think it's such a positive thing for medicine.

Dr. Jones: Well, that's definitely a change in terms of the team idea. And what I've found over the years is often if the medical student may have had the extra time, if they took it and weren't studying for the boards, they may have had the time to actually learn about the patient a little bit more.

So everyone has something to offer, and it may be the medical student who says, "Do you know this patient we admitted for preterm labor who's in the hospital has two children without care at home?" And she's probably going to walk out because the baby who's in her tummy isn't the one that she loves. It's the two children with no care at home. And the medical student picked that up. So everyone in the team has something to offer, usually.

Margaux: Usually, yeah.

Dr. Jones: If they're engaged. My world anew. It's like having a 3-year-old. It's like, "The sky is blue, Mom." It's like, "Yes, the sky is blue. Oh, wow, it really is pretty, isn't it?"

So medical students, if they're engaged, they give you the world anew, and residents and fellows are coming up with new ideas. You are never bored.

And when you're tired of clinical medicine, there's teaching, and if you're not so good at that, there are some research questions, or maybe you can just make the boat go in another way as an administrator.

So I never really was at all tempted by the finances or what I consider the treadmill of private practice, but that's my perspective. I've been spoiled, but you guys take advantage.

Harjit: I will.

Dr. Jones: Go do something fun. Open your eyes big. There is life beyond the boards and whatever you're going to do. I think you spend so much time thinking, "Where am I going to get my residency?" and worrying about the next four years. I think the trick is to make this day, this rotation, this learning the best you know right now, because it goes by very quickly, and you'll never be this young, this smart, this energetic again.

Harjit: I love that.

Margaux: That's great. Thank you.

Harjit: I do want to ask one final question that we usually ask to our guests, and it is what is the legacy that you want to leave behind?

Dr. Jones: Well, my first legacy is more than 100 fabulous residents who are out there taking care of women. And if I taught them reproductive medicine and reproductive biology, if they think of me when they see a woman with hot flashes, then good. And it's the thousands of students who came through my clerkship, who I didn't terrorize, who say, "I think I'm going to treat this woman with a little extra care."

Margaux: Thank you for listening to the "Bundle of Hers." Make sure you check out Dr. Kirtly Jones' podcast, the "7 Domains of Women's Health." And check out our podcast on iTunes. Or if you want to leave us a message about this episode or any other episodes, check us out on Instagram or Facebook. Bye.

Harjit: Bye.

Dr. Jones: Bye. Thank you, ladies.

Margaux: Thank you.

Harjit: Thank you so much.

Dr. Jones: See, you guys are the stars.