Equity is usually a complex topic. As emergency medicine physician Emily Binstadt has observed throughout her profession, opportunities to make change or move conversations forward may be lost, not simply because of the establishment but in service of genuinely good things.
Dr. Binstadt, who also serves as director of simulation at Regions Hospital, has seen these situations way back to residency and as recently as the COVID-19 pandemic. During the height of the Me Too movement, there was lots of attention on gender equity in all facets of society, including the medical community. But then the pandemic arrived. Between that and the death of George Floyd, the attention of the general population moved away from gender equity and towards conversations that, completely understandably, were more pressing.
It is a large-scale example, but similar dynamics may be seen in multiple other examples Dr. Binstadt brings up. On this episode of Off the Charts, Dr. Binstadt helps us frame gender equity inside the larger equity conversation and descriptions what care providers can do to make changes inside their institutions. Hearken to the episode or read the transcript.
Facing uncomfortable implications
Step one toward change is making space for conversation, even when the conversation isn’t comfortable. Dr. Binstadt cites an example from residency that’s common amongst female providers: despite being an emergency medicine specialist, she was asked to do lots of pelvic exams for ladies who requested a female provider. She points out that those patients deserved to have their preferences honored, but helping them meant that she wasn’t helping patients who were relevant to her specialty. She missed opportunities to achieve experience that would have informed her profession in many various ways.
The answer to this issue probably isn’t so simple as informing patients of those sorts of dynamics – again, people should get care in ways they’re comfortable with. But without open and honest conversation about these dynamics, they’ll only proceed. Talking about them, on each the patient side and the provider side, is the only approach to make people aware of them and to start out moving towards something different.
Making space means changing expectations
The pelvic exam example illustrates greater than the importance of conversations – it also illustrates how expectations shape medical spaces. As one other example, Dr. Binstadt and our host Dr. Kari Haley highlight feedback female providers get on the affect they present at work: they’re encouraged to be “confident” even once they don’t feel it to be true, they usually’re encouraged to talk in lower vocal registers when working with patients. At the same time, our host Dr. Steven Jackson notes that he’s regularly known as a “Black doctor,” versus simply “a health care provider.”
These sorts of comments are based in history. For a very long time, medical examiners have been white men, they usually’ve been treated as total authorities in their spaces. What we see now could be that expectations rooted in that history clash with who’s actually doing the work: women, people of color, people of various degrees of experience. If we wish the medical workplace to be more equitable, we now have to permit people to indicate up as their whole, true selves, and treat that as the norm.
Power just isn’t a zero-sum game
The ultimate big point of debate on this episode is that power needs to be shared. Dr. Binstadt points out that while applications to medical schools at the moment are fairly evenly split between men and girls, leadership and higher-level positions still aren’t. If the people in those positions don’t participate in making change, it’s going to be loads harder to perform.
What this participation looks like could take plenty of different forms. Dr. Haley sees potential in shifting the mentorship dynamic of the medical field to one in all sponsorship, in which mentors use their authority to get more diverse voices and perspectives into spaces they otherwise won’t. It doesn’t mean the mentor gives up their power, but quite that they use it to assist others construct theirs.
Dr. Binstadt believes that sharing power like this advantages everyone. Having more diverse experience and perspectives in medical spaces means more collective knowledge and higher take care of more people. What’s more, making spaces more equitable doesn’t only profit one group. For example, Dr. Haley points out that it was the advent of maternal leave that eventually allowed us to make parental leave a norm.
There’s still lots of work to be done to make the field of drugs as equitable as it could possibly be. But as Dr. Binstadt shows us, we all know what has to occur. We’ve got to be open and honest about everyone’s experiences and make space for them at every level, from policy to every day operations. To listen to more from Dr. Binstadt, hearken to this episode of Off the Charts.