Tuesday, May 26, 2009

Friendship and Female Physicians

I've noticed over the past several years that it hasn't always been easy for me to make friends.

Sometimes I wonder if I'm the reason. Am I simply un-like-able?

When I was in grade school I constantly found myself blurting out goofy things and wincing afterward. I'm sure my social awkwardness cost me some friendships at that age.

Then there was high school Oy. Recently a friend from high school whom I've always admired told me I could sometimes be intimidating back then. ME?! Intimidating?! But I'm so sweet! And shy, and awkward! And un-tall! But I suppose my love of Renaissance history, French poetry, and molecular biology might have struck some people as off-putting...

I had a great time in college. I found like-minded people, kindred spirits, people in different spheres who loved a lot of the same activities, subjects, books, etc. I made some life-long friends in college, as many of us do (and a few good friends in med school and internship as well, though not as many).

I can think of a few things that can make building new friendships and maintaining existing ones hard after college. Relocation. Marriage. Parenthood. Jobs.

And if your job is in medicine as a resident of some kind, you get the added challenge of sleeplessness, no time, no energy, no patience, high stress, contact with suffering on a daily basis, making lonely decisions in what can be an isolating profession, all free time spent sleeping or running errands. Relationships of all kinds suffer during residency; friendships are no exception.

But I think there's yet an additional layer for female doctors. I can't quite put my finger on what it's made of, but it's there.

When people find out you're a doctor - that's if you can even get around to meeting new people in the first place - sometimes their whole vibe toward you can change. It's almost imperceptible, but there's a turn somewhere. It's there. A pulling back, maybe, or the inexplicable sudden presence of an invisible veil between you and the person you'd like to befriend who happens not to be a physician.

I'm not sure why that happens, or even if I'm making something out of nothing. Women-doctors want to hang out and watch chick flicks as much as any group of women friends, or go to cafes to chat, or cook together. Why the sudden barriers?

I have a friend - a drop-dead gorgeous, brilliant, super-sweet, supportive-beyond-measure, talented, couldn't-be-nicer friend, fellow-mom, and fellow-physician - who meets with a group of women on a regular basis to engage in a much-enjoyed activity. She told me that for a long time she didn't tell the other members of the group she was a doctor. She was concerned they might not be as relaxed, or their attitude to her might change, with the knowledge of her profession. I have another, newer friend - also multi-talented, also a fellow-mom and physician, very nice, with lots of different interests - who has observed a shift in others when she strikes up a conversation but then reveals that she's a doctor.

I don't think we're all just imagining this. There's something about us female physicians that seems to make some people hesitate to get too close, which makes making friends even harder in the context of busy, demanding lives juggling work and family. I tried googling "women doctors" and "friendship" to see if I could learn more, but no one seems to be talking about this much, or I'm not looking in the right places, or no one else thinks there's an issue.

Do male physicians experience anything similar? Am I just being over-sensitive? I don't know. But I do think the whole subject of physicians and friendship in general, and women doctors in particular, is worth exploring.

The painting above is by Filipino master Fernando Amorsolo, whose depictions of ordinary country life in the Philippines are among his best-loved works.


Hinzi said...

Well, I consider you a friend, because you signed up on my Oboists for Obama list. Not that I ever did much with that list, and I understand it's not the kind of friendship you are looking for. At least I read your blog semi-regularly, and I like what you write.

As to protecting yourself; maybe you can make up an euphemism for your job, like the 747 transatlantic airline captain who was tired of being drawn into conversations about his job and ended up replying, when asked, that he was a 'heavy equipment operator.'

T. said...

Thanks, Hinzi! And about Oboists for Obama - I just think it's wonderful that it EXISTED! :)

I definitely feel I've become friends with some readers I've never even met. Sociologists should start researching the psychology of blogosphere friends! I think there can be genuine care between people, just from having shared each other's thoughts in a supportive forum. I've worried about illnesses, family crises, child mishaps, etc. for other people even without knowing them face to face...

I like that pilot's euphemism! I'll have to come up with something clever. Drug-pusher and back-stabber don't sound too savory...

Map said...

I often feel the same way, T. When I meet the other school mom's, I hesitate to say that I work at all, let alone share that I am a physician. For me, part of it is working mom guilt. The other part? I don't know either. My husband has observed me interacting with others (male and female), and commented later to me that I make efforts to minimize my accomplishments in conversations. Not just modesty, he says, but almost ashamed of what I do. I am not consciously doing so. I think I am just trying to blend in; not wanting to stand out in any way. Perhaps a form of peer pressure? Perhaps a way to avoid criticism of the life that I have chosen for me and my family?

Oh, I often refer to, "pushing drugs," when talking to friends and family.

Resident Anesthesiologist Guy (RAG) said...

I avoid telling people I'm a physician (or resident or intern or whatever) because there's ALWAYS a change in their behavior. Either they start asking me questions about their ailments, talk about how I must love helping people, how much money I'm making (which, as an intern, is quite low - obviously),or they'd make some comment and move on to another person, etc. It's annoying. I actually don't have anyone that I'd call a "friend" currently - more like aquaintances with whom I get find agreeable. I did for a while let people know I was a med student, but I'd be met with similar problems.

I think part of it, however, is that women physicians are known (at least in some circles) for being very motivated and driven, tossing aside personal relationships to further their careers since there's a perception of a glass ceiling. Don't know if that's part of it, but I think it would play a part.

Anonymous said...

It's not you, it's us (the rest of the world). To go from the common view of doctor as "in charge" or "better than" or "smarter than" to a normal peer relationship can be a tough change. Once the shift is made though, it is easy (for me anyway) to then overlook the profession and see the person.

For example, one of the girls in our GS troop is the dtr of a doc at the hospital I work at. It was strange at first going from calling her Dr Lastname, from a position of deference (as an LPN to an MD) to more even footing, calling her Firstname at the meetings. I think and hope that I'm no different in relating to her than any of the other moms.

It does beg a question though: when you see someone you know socially at the hospital, do you expect them to call you Firstname (or whatever they'd call you outside, in the real world) or Dr Lastname (or whatever you go by in the hospital)? Do you mention that preference to people?


Elaine Fine said...

I wonder if it is like the "English Teacher" thing. Sometimes, when people find out Michael is an English professor, they tend to say something like "I was never very good in English."

Doctors do have a certain authority in our culture, and women, who always feel inferior about something concerning their bodies, tend to feel judged by physicians, even those that they meet in social situations.

Consider the relationship that most people have with physicians: you make an appointment, which is at the convenience of the physician, and you wait for a long time in a waiting room. When you are called in you are asked to take off your clothes and wear a piece of paper, while your physician, who is fully dressed, does what s/he is there to do. Usually if the doctor is a woman, she tries her best to treat her patient as a person.

Some male doctors do this too, but I think male doctors are more comfortable with the traditional position of authority that being a doctor holds.

I know that I'm "speaking" to a bunch of doctors here, but from my experience physicians are regarded as shamans who hold the cords of life and death. How intimidating is that? Very.

We female lay people need to remember that there are a lot of physicians that have specialties in fields that do not put us in uncomfortable positions, literally and figuratively.

T. said...

So may rich comments to discuss!

Elaine - there's definitely an element of the "English Teacher" thing (maybe it's even worse when they find out I'm a doctor AND an English major? Yikes!). You bring up a great point about the usual model of physician relationships with others - it's understandable that some folks might not trust entirely that when we take the white coats off, they're off.

lpnmon - all the folks who interacted with me backstage for my daughter's recent school musical called me by my first name, even the ones who were aware of my profession. I was just a regular mom, and not THEIR doctor, and boy was I glad they could treat me as such! As for the hospital environment, I do prefer formality when I'm first getting to know patients, and out of respect for all our roles I do address other doctors (even my friends) as "Dr. So-and-so" in public in front of patients, and they do so for me too. But in the corridors, or lunch rooms, when it's "just us," we all call each other by first names - nurses, doctors, housekeeping staff, techs, administrative assistants, etc.

RAG - I agree, very often women in medicine have fallen into the patterns you describe or get lumped into the stereotype that has evolved from the patterns you describe. I, too, have mostly "good acquaintances" rather than "good friends" in the field. I guess we can't have it both ways - partake in a profession that's seen, rightly, as a sacred duty, by us and others, and not be set apart somewhat. The question is, how to enjoy more "regular" life when we're off-duty?

Map - your comment confirms for me that it's just just me and the two women friends I mentioned here. Something DOES happen. I don't think you subconsciously hide your job out of a sense of shame; I think we probably both just want to avoid being ostracized for it!

I do tend to assume a tone of authority at work, because I HAVE to in certain instances. Many of the orders in a clinical situation have to come from me; I may be the only one in the room who knows what to do next for for an airway situation, just as the surgeon knows what he needs to control a particular kind of bleeder. But when I get off work, I'm just a regular gal. I go to the Star Trek movie and love it. I look for sales at the mall. I worry about my kids. If people would give me a chance and get to know how GOOFY and ordinary I am at home - losing keys all the time, indulging in (the last of some) ice cream out of the container in front of an old movie, cracking up over bad hair, or what-have-you - they might be able to trust better in the fact that being a doctor is just PART of me, and a harmless part at that.

Doc said...

I would have to agree with you regarding the difficulty in forming friendships. I am a male, practicing Anesthesiologist and have been for 14 years. I find it very difficult to form friendships. People feel intimidated by physicians and feel that we are too intellectual to be any fun. Our hours are crazy, which doesn't make friendships conducive. As others have stated, if you do introduce yourself as a doctor, people tend to ask medical related questions. All in all it is difficult.

Anonymous said...

i had a different experience than you in college (i went to the same one as you). elementary school & high school were filled with intense friendships, best friends, "LYLAS" (love ya like a sis) people, some of whom I still keep in touch with. as for the college i chose to attend, i actually found that to be the loneliest times of my life. unlike you, i didn't really feel like i fit in there... people were too smart and abstract and aloof for me! i think i keep in touch with only one friend from that period of my life. your blog has got me thinking alot about my friendships now as i'm in my 3rd yr of anesth training. i haven't found it to be a problem making friendships, even with people whose jobs in the medical hierarchy are "lower" than a doctor's; some pacu nurses know details of my personal life i haven't shared with fellow resident physicians; a respiratory therapist this weekend invited me out to dinner after discovering a common life experience that bonded us together, etc. most of my friends are also physicians, but a significant number are not. i haven't noticed being treated any differently by non-medical people. i think that if you are charismatic and down-to-earth, taking a genuine interest in other people, people find themselves liking you whether you're a physician or not.

Michelle said...

I am an anesthesiology resident and wife, and mom to 4. I moved around a lot as a kid and don't really stay in touch with any of my friends from high school or college. Interpersonal relationships have never really been my forte...which is one of the reasons I may have always been quietly studious. I am amused when we are out with all of the kids and someone asks my husband what he does and then asks me if I stay home with the kids and I tell them what I do. I have always enjoyed being unexpected.
There is a pretty strong social community among the other anesthesia residents where I am, but having 4 kids precludes hanging out with peeps 5-10 years younger than me on a Friday night!
I am who I am and I do what I do.
I have heard of other female docs who shamefully hide their academic and professional acheivements...and that is a very sad commentary on our society. (not on the women who feel pressured to hide their acheivements..but on society!)

Anonymous said...

True confessions, time. As a patient, I find the formality of having to call my doctor, Dr. X, and having him or or her call me Ms. Y, incredibly degrading. It is one of the few accepted class designators remaining in our society. I can meet with CEOs of large corporations and call each other by first names, but I am expected to call a resident who was born when I was in college, Dr. Z? Maybe if he calls me, "Your Royal Highness"...

Fordo said...

Interesting topic of conversation. Hmm. I, too, have difficulty making friends, and so assumed it was me. These are my thoughts on the matter:

1. Being so focused over a lifetime, you never really learn how to take life casually. You never learn to blow things off. Making friends was never the priority, if you take my meaning.

2. I am a considerably above-average intelligence woman with a masters degree. Would love to get my doctorate. I explain this, because in most quarters I think I am considered intelligent.

I have met doctors in social and company circumstances (men and women) and have felt this wall go up between us that I don't experience with DHAs, PharmDs, Ph.Ds or any other people. The onus is on me and I've struggled with the source. I think there is a feeling on my part that the MD or DO is better than I am. They're smarter, more perceptive, and they're judging me, which intellectually I know may not be true. Trouble is, even though I've never seen it in practice, its still the way I feel.

What's even more odd is based on aptitudes, interests, personalities, and things I read on your blogs, I think I would have much in common with many of you (medicine aside).

What it comes down to, I think, is the feeling of my own inadequacy or failure to measure up to you and what you've achieved. And there is absolutely nothing you can do about it.

3. It sounds like a wall goes up with you too. For so much of your lives you've competed with everyone your own age and your own level. You've never learned how not to compete- so you do the opposite with potential friends. You downplay yourselves to make you more equal to people. But that won't work either. Doing so limits who you are. (You don't really want to be friends with someone who doesn't know the real you, do you?) But I think it also demonstrates you know you are "better" than they are. When they find out the truth, its almost a "gotcha" moment. If people are worth knowing and worth befriending, then they will take you for who you are - all of who you are. They will feel happy for you and your accomplishments.

4. It could be that part of it is also the professional demeanor that is taught to both doctors and patients. We are supposed to call doctors "Dr" when dressed inadequately. We are supposed to treat them with the respect due their education and years of training. It puts us each on completely separate pinnacles. It makes it difficult to both hop onto the same level ground after we're out of the treatment room.

As I was writing the above, I found myself wondering if it would put you on more equal footing with people if you could "admire" something they do well that you don't- cooking, gardening, writing, playing a musical instrument. Right now, you know something most of us don't know. What if you demonstrate they know something you don't? It won't limit you in any way, would make the other person feel good about themselves, and create a talking point to start from. Just a thought.

Anonymous said...

I just want to make a comment about always being asked medical questions. Yours is not the sole industry that becomes a problem. Chefs get asked for recipies and how to cook frequently. People in IT are constantly asked to "take a look at" other people's computers. The car mechanic is besieged with requests to trouble shoot or work on cars. The hair stylist has to schedule time around cutting friend's hair, for no pay.

It shouldn't prevent meaningful friendships, should it?

T. said...

It's a good point about getting asked questions based on one's expertise. I imagine it happens to anyone with any kind of expertise. I don't really mind that, and it has never gotten in my way.

As an aside: not all physicians lapse into competitiveness to get where they get. Some don't need to, some don't care to, and some don't give it a second thought. I was lucky to have a spouse and kids during med school, so my first priority was always being a good wife and mom, and doing well enough to learn to be a good physician. Period. That didn't take competition; it just took diligence.

My problem NOW isn't that people don't seem to enjoy talking to me or hanging out with me. In fact, as they start to get to know me, many seem to like me quite a bit, and I think, oh good, maybe we can go hang out together on my next post-call day.

THEN I mention that idea, THEN they realize I'm a doctor, THEN they seem to pull back, as if they're thinking, "You're a doctor? OH. Never mind, then."

So I'm not saying I have a hard time making friends because I don't know how to make friends. I have a hard time keeping friends interested after they've started to get to know me, because once my job comes up - it's never the first thing to come up - it's as if none of the good things they started to see count any more. Instead of being seen as a person first, I often find my profession becoming the only thing people see.

It's easier in the hospital system because doctors are a dime a dozen and people can accept the person behind the day-to-day tasks more easily. At my last job I had friends among nurses, techs, the housekeeping staff, and physicians. People I still facebook-chat with and email, people I would feel comfortable calling or hanging out at a barbecue with (if we could just coordinate all our schedules!). OUTSIDE of medicine those connections just seem a little harder to forge from scratch, with people who didn't already know me, ESPECIALLY since I've NEVER felt any particular need to either hide OR advertise my job. If people know, it's fine with me; if they don't it's fine with me; but somehow it's not always fine with THEM after they find out, regardless of the fact that initially they thought I was great fun to talk to and very warm and welcoming.

That's the part I wish were different. That shift that occurs.

K. said...

Wow, great post! First of all, you are a total sweetheart (and total exaggerator, but I love you for it!) for saying those nice things...
I can relate to SO MUCH of what is written in your post and in the comments. It's funny...I never thought much about how I modify my behavior--I just did it and have done it for so many years--so this is such a great thing to discuss. Again, this would be a great article for a magazine (you are so GOOD!)
Like someone else said, I sometimes think people must think I am ashamed of being a doctor or something, because of how MUCH I suppress it in my day to day. Of course, I am not. I am so proud of my accomplishments, but I have to say, I never, ever bring it up unless absolutely necessary. People DO treat you differently when they know you're a doctor. You are no longer spoken to like a "regular" person. I feel so inhibited by it sometimes. I feel like I have to be sophisticated and serious, two things I am not. I am just like everyone else! I like stupid humor, I like chick flicks like you said, fashion, and sometimes I yell at my kids at the supermarket. Somehow, these things don't seem compatible with the public's perception of a doctor and I worry that I will a. lose respect as a physician, and b. be held apart from others, and therefore be unable to have normal relationships with others. I think my blog is helping me break out of my physician-shell, for sure, and I hope that people see that doctors are normal people too. I also hope that it doesn't upset people to see us in that way!

Jo said...

A very interesting topic...

As a non-medical person, I don't think that I have any awkwardness when it comes to meeting doctors of either sex socially, but then I get to know them through various activities before the question of jobs comes up (it took me about three months before I slowly twigged that out of the sixteen or so people in my hockey club, I was distinctly in the minority because I didn't have anything to do with medicine!). I'm also of the type of person who goes "Doctor? Cool!" (hence me hanging around various medical blogs ;-) )

ShrinkingDoc said...

I try to omit the fact that I'm a physician from conversations as long as possible. People do seem to act differently once they find out. I think that if they can get to know me first and see that I'm very down-to-earth, that helps. I think the fact that I'm obese actually helps--makes me more "real" somehow.

More often than not, it' Hubby who ends up telling people because I don't. He's uber-proud. A lot of times then they won't even mention it to me--interesting.

T. said...

I got some comments on this post at Mothers in Medicine too, where I'v cross-posted this. I hope the commenters don't mind my sharing their perspectives here as well; I think their thoughts are an important part of this discussion. See below.

Kathy said...

I'll comment since I'm in the "non doctor" group...

I can't profess to explain why this seems to happen, but I have caught myself doing it - ie: behaving differently once I find out a woman is a doctor when I meet her in a social setting - whether it be a book club or on the sidelines of my kids sporting events.

I don't know if for me it's a sort of awe! Because as a kid I wanted to be a doctor but for many reasons it didn't happen, and when I meet doctors outside of their offices...it's often hard to relate to them as normal people...and doctors who manage to balance that proffession with motherhood - now that is indeed an awesome accomplishment...

This may sound silly, and maybe it's my own self esteem issues, but it's like I almost don't feel worthy of actually having doctor "friends"...they are like another species that are far superior (even though I know you may all not feel this way about yourselves...some doctors sure act like they do...but that's another story)

Love this blog by the way, I hope you don't mind me lurking as I think you are all fantastic and it's like being a fly on the wall of what it's like to have a job that actually matters!

Anonymous said...

I absolutely agree that identifying onself as a physician changes the interaction between me and a potential friend. I have lots of friends from before med school, med school, residency, but not a single one from the more than a decade I've been in practice. I feel this lack sharply and can't explain why this is such a problem. I have tried to join book clubs and so on, but seem to run into an invisible wall. I have tried to conceal my profession but living in a small community, the word gets out. I wish I could understand this.

Libby said...

A big amen to this post! Also to the comments above - living in a small town as one of 3 docs makes friendships extrememly difficult. Not only do others act differently with me, I also have to be careful - what I say and who I trust - because of the small town dynamic. Recently one of my trusted friends (one of just two in town) moved away and it just all but crushed me - it's an empty feeling but probably why I'm out of town most weekends not on call to be with my friends from college/med school and family!

KC said...

I sometimes feel self-conscious revealing that I am a doctor to other would-be friends. I think it does change the dynamic for some - not all - but some. One time, a woman seemed to feel guilty for needing to take a smoke break in front of me (I'm not judging you!)--I can tell that there's some fear of me judging them like their doctor would. Another felt embarassed to be eating a donut in front of me. We do, like it or not, carry the weight of our profession over to our personal lives. I can reassure to this person that I really don't care about what she eats and am not keeping nutritional scorecards on everyone, but I'm sure those secret thoughts would linger. You can't be BFF with someone who doesn't want to do anything "improper" in front of you because you might think less of them.

There's a status element- real or perceived - that can get in the way. I'm very self-conscious about mentioning anything relating to material things.

I do still find new friends who are not threatened at all by my profession - I love this. I wish it were always this way.

dr. whoo? said...

I completely agree with your post, T. I have felt this "pulling back" time and again in my female friendships. Just this week I got a thank-you card from a patient (with whom I have a really great rapport) that said..."I wish you weren't a doctor, because then we could be friends!" Er, thanks?

I have only made one good, non-physician friend since I left residency. She is the only one who did not pull away when she learned my profession...everyone else stays at arm's length. Anyway, long comment, but basically, I am right there with you. What to do about it? I have no idea.

T. said...

Jo - SO GREAT! Thanks for thinking of doctors as "cool" in a positive way!

HugeMD - your husband sounds sweet! I guess it's pretty common, this down-playing so many of us do...I can't imagine the GUYS in our profession leaning that way, though. What does it all mean?

Mim Women (Kathy, Anon, Libby, KC, dr. whoo) - you're all so incredible! I hope you don't mind my sweeping you into this forum. You've made me feel less alone and less hallucinatory/paranoid over this issue. Kathy - no job matters more than yours!

There have been a couple of other commenters after the above-quoted from Mothers in Medicine - please wander over there to check it out. We're having a kind of blogiversary festival over there too, celebrating one year of MiM.

Anonymous - originally posted on Mothers in Medicine said...

Being in a bigger city helps, but I definitely still bend over backwards when meeting other moms to avoid saying what I do, for as long as humanly possible. And when I do "confess", I find I immediately try and minimize it "well, um, I'm a family doctor actually, but, you know, just part time, mostly I'm with the kids". I never know if it's me or them, but I feel it. They are freaked out.

A very funny moment came once last year when I finally had to confess to a woman I'd been chatting up for several months at a playgroup -- and she practically jumped for joy as she confessed that she, too, was a family doc and OMG!!! it was too funny.

I find it really hard. All of my previous friends are far away. It's lonely, you know?

Transor Z said...


As someone who does not know you personally, I might think you are pricing yourself out of the friendship market in some ways. As nearly all have said, being an MD imposes time and status baggage. But beyond that, at least from your posts, it seems important to you that your friends be "accomplished" in some way -- and intellectual pursuits are very important to you. You make frequent reference to the excellent schooling you had growing up and through med school. You are clearly a brilliant and accomplished person. Forgive me for asking this but are you conflicted in some way about having some tendencies some might view as "elitist"?

I don't think your issues finding time and opportunities for friendships are unique to physicians.

T. said...

As I alluded to in the post, what I'm looking for in a friend is someone who can laugh over movies like "Legally Blonde" and "School of Rock" with me, chat on the phone about topics both silly and serious, and do other fun things, yet also be there when the going gets rough. I would hope to provide the same enjoyment and comfort for my friends. I'm not sure how you made the leap from those criteria to the requirement that someone be "accomplished?" It doesn't take a master's degree to hang out at the park or local town center.

I'm curious - do you always read elitism into individuals who happen to enjoy various spheres of learning and value education? It seems an unfair prejudice to hold...

Lisa Johnson said...

Great post! And very interesting subject matter. First let me tell you my reaction to it as I read and you can probably picture my facial expressions. You unlikeable! What are you talking about??!! You couldn't be any more likeable. And I've had great fun with you with us both being "un-tall" together. : )

And to a certain extent, I imagine that there might be a bit of a barrier put up by some people. People may feel a bit insecure or intimidated by the sheer brain power that it takes to be a doctor. And the idea of what it means to be a doctor in our society.

I could see not wanting to say what you do right away. I do the same thing sometimes with the lawyer thing. Some people really hate attorneys. I was practically assaulted with a barrage of anti-lawyer talk at a barbecue! I was only in law school at the time and my friend introduced me that way. I wanted to hide! And you know that what I wanted to focus on was the food. :D

Transor Z said...

T., Please feel free to take my question about elitism as coming from the "if the shoe fits" department. If you don't feel it applies to you then that's the answer. It was an honest question based on my reading of a number of posts on your blog -- and this entry in particular. You describe yourself in your younger years as possibly off-putting to other kids because of your intellectual interests. You never really say whether you were able to bridge the gap at a later time so that made me wonder how successful you are at finding common ground with people generally. I also wonder because you have written in past posts (recently about your daughter and what she might want to do career-wise) about the extreme time commitment it takes to study to be a doctor and then to practice.

It just makes me wonder about the size of the pond you do your friend-fishing in. That's all I meant, and I honestly intended no offense.

T. said...

Anali - these past several months you've been my beacon of hope that it doesn't always have to be so hard to find and make new connections. Thanks for being a great friend! Lookin' forward to our next get together. :)

T. said...

Transor Z - I'm not sure I follow - what's the connection between the extreme time commitment and my daughter's career hopes?

My response to your question was prompted by a comment I remember you leaving on a post a while back - "In an earlier life I lived in Cambridge, Mass. and tried to fit in with a self-styled high-octane intellectual set. I left that life once I realized that, deep within my soul, I love 'South Park' and hot dogs." You seemed to lump people in this town into such a monolithic category; it puzzled me because all my friends from college are such adorable people, intellectual certainly but not off-puttingly "high-octane." I've occasionally detected, perhaps wrongly, an "us v. them" attitude from you about "accomplished" people. Perhaps I'm the one who has read too much into just a few sentences?

As for the size of my pool of potential friends / "pricing myself out" - it's hard for me to think I'm being too narrow when I've been friends with people who have very diverse interests, backgrounds, and walks of life (which I also alluded to in the post). Rather, I think the barriers come from what the majority of commenters have described/confirmed here - preconceived notions (i.e., prejudices) about doctors by non-doctors.

And to all you non-doctors out there who've been such terrific friends, both in the blogosphere and outside of it (you know who you are), THANK YOU! You can't imagine what a difference you've made!

Transor Z said...

T., Okay, good. I was afraid we were missing each other completely. Yes, elitism is an issue I have wrestled with for a long time. I think your observation/intuition is a fair one. I don't mind copping to that. And it's been very much on my mind lately in connection with what's been happening in the economy and what I view as an unprecedented redistribution of wealth to an elite class. And even before last fall I began converting to the belief that classism is the new racism.

So when I read things these days, on some level I'm probably on the prowl for themes of class division, differences in social status, etc.

I think GB Shaw gave a character the great line "All professions are conspiracies against the laity." I think my bottom-line issue with the way you frame things in this post is precisely an "us vs. them" posture between doctors and non-doctors. As a member of the "benefitted" side of that equation (higher salary, higher social status), I think the burden falls more on you and other doctors (and professionals generally) to put non-professionals at ease and find common ground. Maybe that's unfair, but so is the fact that you made out better in the birth lottery.

T. said...

Hmm..."birth lottery?" Doctors become doctors through hard, hard work, not by birth.

And I couldn't disagree more with your statement about the burden being on professionals to put non-professionals at ease. That's like saying, "Im not comfortable with you, but that's YOUR fault."

My big reason for disagreeing is this - and again, it's been described AT LENGTH in the comments above - many people ARE perfectly at ease with kind, sweet, fun-loving professionals when they're starting to get to know them, AS LONG AS THEY DON'T KNOW their professions. They're at ease with the PEOPLE. They're ALREADY AT EASE.

Then all of a sudden it comes out that the person they've SO enjoyed hanging out with is a lawyer, or a doctor, or an English professor, and all of a sudden the cold shoulder from the non-professionals? All it takes is the mere mention of the word "doctor" or "lawyer," and they change their behavior and attitude to you? If that's not prejudice, I don't know what is.

It probably comes from a lot of very incorrect assumptions about those who work in those professions, unfortunately. I think it's those who have the prejudices that have the responsibility to be reflective and develop greater comfort with who people are, including themselves.

Finally my most successful friendships have come from situations in which my friends and I found ourselves at ease with each other almost naturally and unconsciously. While I always try to be warm, respectful, and kind with others, and that effort usuallly results in people telling me in one way or another how comfortable they feel with me, I don't actually feel it's my job or "burden" specifically to "put" others at ease (patients are an exception - i think all doctors have a duty to actively increase their patients' comfort if they can).

Socially, people's comfort is in great part their own creation and responsibility. (For instance, I'm not particularly comfortable at huge cocktail parties, but I take full responsibility for that; it's my temperament, and neither the host nor the other party guests should be expected to bend over backwards for me just because I shy away from small talk.) The "us v. them" attitude seems to me to be stronger from non-doctors toward doctors than the other way around, as many non-doctor commenters here (or anecdotes about them) have shown. Those incorrect assumptions I mentioned earlier, and that others have mentioned already (e.g. "You're all competitive," "You all want your friends to be high-achievers," "You like Michelangelo's David and oboe music; you MUST be an elitist"), are probably the biggest reason for that.

Transor Z said...

T., I think one important point where we differ is that I think members of the medical profession collectively reap what they sow when non-doctors feel uncomfortable or engage in stereotyping. If you don't like it, get active in the AMA and advocate for an AMA branding makeover campaign, maybe with a media campaign portraying doctors as just fun-lovin', down-to-earth regular folk. And while you're at it, maybe consider embracing a single-payer healthcare system . . .

I wouldn't label someone as an elitist who likes Michaelangelo's "David." I'd label them a tourist.

And yes, you were a big winner in the "birth lottery." You are equipped with the intellect, talent, drive/emotional grounding (brain chemistry + family) to excel in a highly valued profession. There are a lot of hard-working people in the world who work three jobs just to hold together families on very little. No amount of hard work would make them doctors.

I understand your point about friendships developing naturally and being the responsibility of both parties. Of course that's true. But if the professional overlay gets in the way, that's the image of the profession manifesting itself.

Doctors complaining about social prejudice against them on the part of non-doctors is one of the most absurd and unsympathetic things I've heard in quite a while.

T. said...

I'm sorry you feel that way. I guess we'll have to just respectfully agree to disagree.

One other thing I disagree with you about is the myth of the birth lottery. Yes, I believe some people have a particularly fortuitous combination of genetics, environment, temperament, and family circumstances, and I believe the interplay among all these factors is crucial to an individual's development. But there's a flip side. There are med students with learning difficulties or disabilities, family strife, physical constraints, hard struggles with science classes, or any number of such challenges who don't use the "poor me, I got shafted in the birth lottery" as an excuse for not getting through med school. It's just not that black and white; not everyone who succeeds in a given profession does so because they got "dealt a better hand."

As for the idea of our profession's image causing friendship hindrances: "If the professional overlay gets in the way," then that says much more about the individual who allows it to get in the way than about the profession. People who will be true friends will see me and not be distracted by or insist on clinging to preconceived notions. I am very comfortable with the kind of physician I am and the kind of "image" of the profession I project. I also have faith in the core self I try to share with others in the hope of friendship. What others do with either of those is beyond my scope.

People have been using the same rhetoric of "I'm uncomfortable with you, therefore you must change" throughout history for almost every group that has ever had a stereotype ascribed to it. Pick a group. Any group. Envision a second group that is uncomfortable with the first group. I can hear any number of those people saying, "If you don't like our image of you [women / Catholics / Black people / Jews / immigrants / disabled people / people with learning disabilities / Democrats / Republicans / poor people / rich people / young people / old people / Asians / Latinos / Arabs / Americans], then talk to your local chapter and change your image."

Isn't that more absurd than the idea that there might actually be some incorrect preconceived notions - i.e., prejudices - about a particular group, even a privileged one? Insisting on lumping doctors, ALL doctors, into some kind of negative stereotype simply because the stereotype exists is no better than any other sweeping generalization. Talk about unsympathetic.

Dragonfly said...

I often avoid telling people about being in medicine as well. I've had a few memorable incidents where someone has heard I am in medicine and launched into a diatribe about the EEVIL medical patriarchy (particularly obstetricians) and how over half of illness is iatrogenic, doctors are horrible beings who profit from illness and all the rest. I end up being like a rabbit in headlights, trying to be polite but unable to extricate myself. Even if the hostility isn't aimed at you directly, having it voiced around you can still be very exhausting. Though I suppose I should be grateful that this causes people like that to declare themselves, as we possibly wouldn't be friends anyway if they are so hostile.

T. said...

Exactly, Dragonfly. If others are going to decide not to give me the time of day because of my profession, or to be openly hostile, I'd rather just know up front.

Transor Z said...

T., Please don't count me among the conspiracy theorists who attack the medical profession along the lines of the dim bulbs that Dragonfly referenced!

I am writing this after your terrific post about your prematurity so I want to go back to the "birth lottery" issue. I can fully understand your resistance to using birth circumstances as a crutch (and you know that I am sincere when I say that given my own family experiences). Yes, the "birth lottery" notion needs to be tempered by considerations of personal responsibility. But beyond that, I don't have to tell you as a person of science that statistics don't lie when it comes to the spectrum distribution of "adverse outcomes" -- both medical and social -- when you look at a population from the macro perspective. It's a plain fact that not everyone has the same genetic/social opportunities and that (I believe anyway) a great deal of gratitude is in order for those of us fortunate enough to be among the "haves."

Why do I have such a bee in my bonnet about elitism? I don't really know, but it certainly isn't because I hate doctors. In fact, if the "social prejudice" alluded to comes from ignorant perspectives then count me as an ally. But that isn't how I interpreted your original comment.

I took you to mean that many non-doctors feel uncomfortable around doctors because there is a perceived gap in social status -- a view that doctors belong to a social elite "priestly caste." That I have seen and that is a public perception that I think the medical profession must accept some responsibility for perpetuating/benefiting from.

T. said...

This is perhaps where my own writing has been inadequate to express my meaning. I never meant to imply that doctors feel uncomfortable around non-doctors (we don't, I think, for the most part, since non-doctors are just people, like us), but rather just the opposite - that many non-doctors seem subtly but noticeably uncomfortable around doctors.

You do have a point that some of that discomfort may be due to the "priestly caste" thing. But see, I don't think that image should be a PROBLEM. We ARE engaged in what I think of as sacred duties. But so are teachers and child care providers, yet I don't think the public holds them at arm's length.

I thought the problem was another facet of the image of physicians - not the priestly side, but the demonized side. I was thinking maybe there's a mistrust of doctors as potential friends because people don't think doctors are really all that nice as people. I was all set to argue that just because a FEW arrogant, self-absorbed, unfeeling individuals within the profession have contributed to a negative stereotype of doctors doesn't mean it's right to hold all the rest of us nice ones accountable for it; that that's like blaming ALL members of a given minority for the stereotype of the minority gang-banger, or saying ALL Catholic priests are child molesters until proven otherwise. But now that you point out the whole "priestly caste" issue, I think it's my own assumptions about what people are thinking that are flawed! See, taste of my own medicine with the whole "preconceived notions" thing.

You're absolutely right about the macro-perspective on social inequality. But as you say, the "uneven slate" argument can only go so far before individual responsibility has to kick in. Just as not all successful professionals succeed because of a better hand, not all "have-nots" fail because they were dealt a bad hand. Even Rawls never meant for the birth lottery concept to become a convenient excuse for social inequality; in fact, just the opposite, from what I understand - it was a thought experiment to motivate the formation of societal opportunity-equalizers to reduce the role played by the vagaries of luck.

Whether those equalizers (e.g. universal public education) succeed or fail is a whole other ball of wax, since many failures are also attributable to (and at times end up perpetuating) the very inequalities such institutions are meant to reduce.
(We were just party to a meeting about our now-troubled local public school system, in fact, in which the inequality issue was an undercurrent, though not explicitly expressed.)

I must thank you for both the reflection AND the discussion you've helped generate, and also for not letting differences in opinion/ways of expressing it cause you to walk away from the dialogue. I appreciate what I'm learning / relearning.

Transor Z said...

T., You're very gracious -- and brave to put yourself out there. I respect that very much. I worry sometimes that my comments can seem more acerbic than I intend them to be.

I couldn't agree more about public education being a basket case. I am very afraid that some powerful trends in the last 40 years have really undercut social mobility. The GDP distribution ratios in the US are on a par with developing nations -- I wish I could say that is an exaggeration. I am in the camp that thinks things are about to become much worse economically than most people realize. I hope I'm wrong.

Bill Moyers covered the single-payer issue on 5/22. There's an advocacy group, Physicians for a National Health Program, led by a Cambridge (egads!) physician, David Himmelstein. IMO, this is an idea whose time has come (long overdue, really).

Anonymous said...

I've been reading the exchange with Transor Z with great interest and I'm compelled to jump in. As someone who does know you personally, T., I don't doubt that the feelings you describe in the original post are very real, and that you have devoted a great deal of though to the dilemma.

Going back to an earlier theme in the conversation, I want to say that -- having known you for many years now -- you are not a person who seeks out people who are brilliant or important for friendship. Rather, you have a particular talent (which I admire) of finding the brilliant and important _in_ the people you hold as friends, whether we are brilliant or not!

Also, as your posts reveal, you are a person of wide interests and great curiosity, so perhaps part of your difficulty lies in the fact that you may not be entirely at home in any one of the places you seek friends (oboeists are not all doctors, doctors are not all parents, parents are not all lovers of literature, etc.). For a ridiculous analogy, Shrek comes to mind: you're an onion...onions have layers. It can be hard to make friends with an onion.

T. said...




I've been called a kumquat before, but never an onion! :)

Mirth aside, you've brought up a point I hadn't thought of, regarding my particular situation. You're right - it would be hard to find LOTS of things in common with another - or to feel I could only be friends with a fellow-music-taking, medicine-understanding, literature-loving parent.

But friendship doesn't require a TON of interest-overlap, I don't think - as in marriage (at least mine), common values, worldview, and sense of humor may be more important than common activities or interests.

I'm so blessed to be able to call you my friend! Thanks for being there!

Pleochroia said...

Interesting post. The first thing I was reminded of was how my graduate advisor used to describe her job to other moms: She said she worked at X University. It left out a great deal.

I think one of the issues that comes up is the fine line one must walk in terms of how important one's job (or intelligence, or accomplishments) appears to be, either socially or in the balance of one's life. Sometimes a dismissive attitude is just a social strategy for saying, that's not important right now. I do it, too. Now that my job is one that isn't easy to pigeonhole (unlike being a doctor), I have a lot of latitude in how I present myself.

Of course there is the humor route. A friend of mine in grad school, when asked what she did, used to say, "I get rats stoned."

Dragonfly said...

Transor Z: Its nice to know that it wasn't just me wondering about the reactions of those people. (Its not liked I kicked them in hte face at the same time I said I study medicine....er, to help people) I have to say that in some cultures medicine (and the people who study/practice it) are idolised, which I am not comfortable with on so many levels. I love the happy middle ground, where everyone gets along and there is mutual respect *hums to self*

Beach Bum said...
This comment has been removed by the author.
Beach Bum said...

I started to write my thoughts on this post/thread, but it got rather long. So I posted my thoughts on my blog.

Thanks for a wonderful conversation.

Pleochroia said...

I've been considering this some more and I think it makes a difference whether you answer the question "what do you do?" with an identity answer or with an activity or purpose answer. When I say what I am, that tends to shut down the conversation. And sometimes I get the "you must be smart" reaction too. When I say what I do (mostly, why I do it), I get more interest.

T. said...

I'm quite behind on blog comments!

SpeducatorLVC - I can't BELIEVE I forgot to come back with the line about layer CAKE! I am out-of-shape with my Shrekking. :)

Beach Bum - thanks for reading, and writing. I was struck my many of the points you made, especially about the need not to devalue one's own work in the midst of admiring or even being in awe of another's.

Pleochroia - thanks for stopping by! Interesting thought - though I have to admit, when I say, "I'm an anesthesiologist," the conversation does keep going at least for a little bit. :) Honestly, I haven't really felt the need to be anything other than straightforward about myself. I've finally reached the point of being comfortable in my own skin (comes with getting older, I guess). What I'm trying to figure out is where others' discomfort comes in...and I think this comment board has generated much food for thought!

T. said...