Dr. XYZ Syndrome: Gender discrimination and the power of ‘Twisterhood’

In medicine, we learn that diseases usually have a clearly defined cause, distinguishing symptoms and treatment options.

Syndromes, conversely, are groups of symptoms that occur together and characterize a particular condition. Syndromes are often multifactorial and experienced differently by individuals, thus more complicated to manage.

As female colleagues, we have bonded over shared interests and passions for achieving gender and racial equity in health care. Last fall, we began to address gender bias and discrimination in our own Department of Family and Community Medicine by cohosting our first gender-equity symposium with colleagues across our institution.

Not long after, two separate experiences reminded us that gender inequity is not a simple, treatable disease; we are dealing with a deeply embedded syndrome. We have dubbed this condition “Dr. XYZ Syndrome,” a constellation of structural, institutional and cultural factors that lead to systematic gender bias and discrimination against women, while simultaneously bolstering the standing and credibility of male colleagues — Dr. XYZ.

The first violation occurred in a professional email, when a junior male faculty member addressed one of us by first name and a male colleague on the exchange as “Dr. XYZ.” When the woman asked him to redress the mistake, he said he assumed he had been given an invitation to address her informally. She instructed him to be consistent and address them both professionally or informally.

In a second encounter, a male medical student arrived for the first day of his family medicine rotation. The student asked the staff where he could find the attending physician — using her first name. Unbeknownst to him, she was standing right there. Again, the woman physician instructed him to refer to her by title. It is notable that he referred to all male physicians as “Dr. XYZ” upon first encounter or introduction until told otherwise.

Both situations left us outraged — but unsurprised.

Research shows that women are far more frequently introduced at conferences, Grand Rounds and in peer settings by first name alone, and an overwhelming majority of women experience microaggressions (or worse) in medical school settings. Frankly, it is exhausting. We expend energy ignoring bias, fighting it or carrying the burden of being labeled as too emotional, too sensitive or just plain “rocking the boat.”

But this time, when these incidents occurred, we resisted the inclination to isolate and stay silent. Instead, we took our grievances to Twitter.

It was our hope that airing our own experiences would create space for other women in medicine to share theirs, as well as glean insight on how others respond to similar events. We wanted to know that we were not alone.

We were not.

Almost instantaneously, a “social media sisterhood” arose, what we now call our “Twisters” — Twitter sisters. In less than 24 hours, a single tweet had more than 300,000 impressions and engagements; within 72 hours, it reached almost a million. Hashtags surfaced, including #WomenInMedicine, #WomenInScience, #microaggressions, #genderbias, #BlackWomeninMedicine, #Unconsciousbias and #HeForShe. The conversation had struck a chord for both women and male allies.

We learned three powerful lessons from going public with this conversation.

1. Crowdsourcing solutions and sharing experiences are tremendously valuable.

The majority of engagement was from women sharing their experiences of gender bias and discrimination. Many provided links to resources, manuscripts or articles, and many more asked for workshops on addressing gender inconsistencies. Social media clearly offers a virtual community where it’s safe to give voice to and own our experiences. Even if women feel isolated or marginalized by the Dr. XYZ Syndrome in their institutions, they are not alone in this wider forum.

2. Education is a powerful tool to dismantle bias.

Our conversation was a catalyst to educate the community and raise consciousness of discrimination, with numerous comments expressing gratitude for information about the issue and reminders that bias is prevalent even among the most senior and seasoned professionals. It also provided space for people to ask questions and explore ways to promote equity in their own institutions together.

3. Calls to action do not magically happen; we have to sound an alarm.

One particularly memorable tweet read, “If we aren’t intentional about trying to correct this form of discrimination and gender/racial bias, we can’t be surprised when this behavior carries through to our trainees and other hospital personnel.”

The conversation compelled individuals to hold themselves and their colleagues accountable in their daily interactions, served as a bravery boost for women to speak up with pride in their accomplishments, and reminded those in leadership positions that they have the power to affect culture change that creates an expectation of equity.

Can we cure Dr. XYZ Syndrome?

To be fair, the social media sisterhood will not altogether treat Dr. XYZ Syndrome. The underlying disease is embedded in our systems. In academic settings, as many as 70% of women faculty report experiencing gender discrimination, leading to lower career satisfaction than women who do not report discrimination. Additionally, women faculty report a diminished sense of belonging in the workplace, and, even after adjusting for age, experience, specialty, rank, research productivity and clinical revenue, earn significantly less than male counterparts.

But these kinds of communities do afford victims of discrimination an outlet to share their experiences, validate reactions, gather ideas and generate support.

At The Ohio State University (OSU), where we work, we are proud that we are making strides in gender equity. In the past year, the OSU College of Medicine has hired four women chairs and 30% of chairs are now women, up from 15% in 2017. The Department of Family and Community Medicine has created a new vice chair role for Diversity, Equity and Inclusion, dedicated to identifying and eliminating inequities in hiring, pay, recruitment, programming, education and practice. Our chief diversity officer and vice dean for Faculty Affairs regularly offer training to enhance awareness of and sensitivity to implicit biases, while enacting policies to improve the environment and experience of diverse faculty. In addition, the College of Medicine has a Women in Medicine and Science Committee, a special interest group promoting gender equity and advancement, as well as initiatives to bring more women into the pipeline.

And we have social media — a space to promote gender diversity and honor the lived experiences of all those managing in this imperfect system.

As long as Dr. XYZ Syndrome is present and prevalent, we must continue our work to mitigate and eliminate all forms of discrimination in medicine. We can leverage social media in new ways: to share and validate our experiences, create alignment, draw individual and collective power, amplify our voices and foster accountability. We must create safe spaces and cultures in which everyone is respected, included and resourced to advance equitably. And we must commit to curing Dr. XYZ Syndrome as a profession.

Also: Never underestimate the power of our Twisterhood.

References:

• Butkus R, et al. Ann Intern Med. 2018;doi:10.7326/M17-3438.
• Carr PL, et al. Ann Intern Med. 2000;doi:10.7326/0003-4819-132-11-200006060-00007.
• Espaillat A, et al. Perspect Med Educ. 2019;doi:10.1007/s40037-019-0518-1.
• Files JA, et al. J Women’s Health. 2017;doi:10.1089/jwh.2016.6044.
• Pololi LH, et al. J Intern Med. 2012;doi:10.1007/s11606-012-2207-1.