Defiant Bitch, MD

I am delighted to present a guest post from a good friend and talented scientist, Defiant Bitch, PhD! Her story is one of many; I am proud that she has held her head high following sexual harassment from her former boss, and continues to persevere in the competitive world of scientific research.

Defiant Bitch, MD

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Very, very slowly, some of the biggest harassers in biomedical research are facing consequences for their actions. Oftentimes, it is decades after the abuse has occurred, and universities were well aware of these events. Sometimes, even when the university has found a harasser guilty, he gets a slap on the wrist and returns to teaching after a semester of paid leave, leaving a broken department in his wake. Beyond just bringing the misconduct to light, though, it has been a long, slow fight for these harassers to be stripped of their prestigious titles as well. While it is somewhat heartening to see some action in this arena, I am continuously frustrated with how much work is yet to be done. How many continue to fly under the radar? And how many trainees and colleagues’ careers have been irreparably harmed during that time?

Recently, Science magazine reported on a study conducted by the National Academies of Sciences, Engineering, and Medicine that outlined some of the consequences of sexual harassment on women’s scientific careers, including that “women in science, engineering, or medicine who are harassed may abandon leadership opportunities to dodge perpetrators, leave their institutions, or leave science altogether.”

I should know, because I almost left science myself for this exact reason.

After completing my Ph.D., I landed a job in what I had considered to be my dream lab. It was extremely well known in our field and incredibly productive. As I met the PI and lab members at various conferences over the last couple years of my doctoral work, I also felt they were a fun and vibrant group of scientists. For the first few months of my postdoctoral work, I genuinely enjoyed coming into lab and started a number of very exciting projects.

Slowly, there were a series of events that started off as small red flags you feel in your gut but don’t know how to address, and eventually progressed to me documenting interactions with my PI that happened almost weekly. A disappointed chiding that I hadn’t mentioned starting a new romantic relationship. Lamentations about being bored and that I should either dance for him or tell jokes for entertainment. Lab Christmas parties where holiday-themed lingerie was encouraged. Annoyance that I still talked to my old (also male) advisor and considered him a great mentor.

Eventually, I was flat out told that he found me attractive, and asked me what I wanted to do about it. Absolutely stunned, I was barely able to blurt out, “Nothing!!” Mere months later at a conference while debating a few issues in the lab, my PI began to yell and curse at me — in front of several other colleagues — that I was apparently critiquing him and his leadership efforts and how dare I call him out. Mercifully, I managed to hop in the next cab back to my hotel room before I burst into tears. Not a single one of my colleagues ever mentioned the event again or ever reached out to me. I often see them post on social media or speak at conferences about the importance of supporting women in science and wonder if they’ll ever have a moment of self reflection on their role in the current culture.

Not long after the cursing session from my PI, I made an appointment at our university’s counseling center. After the events of the past year, I had found myself paralyzed at work and anxious at even the sight of my advisor, because there was no way of telling if he was having a “good day” or “bad day,” and I now had witnessed a variety of “bad days” that seemed to be increasing in frequency. The conversation with this counselor was incredibly helpful and we unpacked a lot in that hour, including how I was chastising myself for even the thought of leaving science and worrying that it made me a less dedicated professional. Let that sink in– the verbal abuse was causing me to burst into tears just driving into work every day, but my first worry was that I simply wasn’t trying hard enough.

Towards the end of the session, the counselor paused and said, “So it sounds like you aren’t planning on reporting this?” I was a bit surprised at the question and confirmed that the thought of reporting everything formally just seemed too daunting to even begin. We work in a small enough field, and one where my mentor had literally decades of friendships. What she said next left me in complete silence.

“Good…whistleblowers don’t fare well here.”

We continued to talk, and she explained how desperately she wished she could tell me to report it and that justice would prevail, but she knew better. Rather than push me towards a system that was interested in no more than lip service to supporting employees, she wanted to be sure I pragmatically knew the cost I would have to pay. Years later, I still doubt myself on that choice, but I don’t regret avoiding the ensuing trauma that would come from the institution, in addition to my advisor.

One saving grace in my situation is that I had robust systems in place to cope with these experiences. I have had some incredible female mentors at every stage of my career (among those, a quick shoutout to the amazing Defiant Bitch, MD!), access to mental health services, and friends and family that have listened to hours of phone calls and coffee breaks trying to wrap my head around it all. I was “lucky” in that about a year after things came to a head, I was able to make a lateral move to another institution across the country. I’m happier and more productive here, but it has also meant years of long distance flights for myself and my partner, all so I could just get up and go to lab each morning without fear of harassment.

There are some in the scientific community who fear that getting rid of harassers from science will be a detriment to scientific progress; however, that notion rests on the unfounded assumption that the price we pay for intelligence is at best rudeness and at worse harassment. The truth is that there are more than enough scientists who are able to conduct all aspects of their work with integrity and decency that are fully capable of moving the scientific enterprise forward. No positive aspects of perceived or actual genius outweigh the negative impact of harassment. We have a lot of work to do, and science will be just fine without the abusers.

Defiant Bitch, PhD

To be quite honest, I hadn’t put much thought into the concept of the “minority tax” until recently. One of my classmates in residency, who is black, had explained that back in med school, he had been coaxed into organizing minority student groups and leading minority outreach to prospective students. He felt that this work was important and was happy to help.

But then, he started to feel the weight of this added administrative work onto his already very full plate of coursework. Every hour that he spent organizing an event, or leading one of these meetings, was an hour that he was not studying. And remember, in medical school, it’s those hours of studying that manifest in higher grades, higher board scores and better performance in clinical rotations, i.e. everything you need to succeed and land a competitive residency.

“So essentially,” he told me, “I was sacrificing study time because I was black. This is what they mean by ‘The Minority Tax.'”

This was the first time that I had heard the term; as an Asian person, a part of a relatively over-represented minority group in medicine, I really hadn’t encountered this before.

Until…last week.

In what should be the least surprising part of this story, it all happened during a brief (~10 minute) encounter with Mansplaining Program Director (MPD). It was Monday morning, and I was busy catching myself up with the details of the new patients being admitted to our service. I was busy, and really not in the mood for his shenanigans.

And so it begins:

“I need your female perspective on something.”

Jesus. Now what. Why does he think that we’re friends?!

“Did you hear about what’s happening with Morgan Freeman? There was something on TV about how some woman is accusing him of staring at her. So does that mean we can’t even look?! I’ve completed so many hours of sexual harassment training, and I’ve never heard of this!”

I still had more patients to review. Ugh. Ugh. Ugh.

“Look, Dr. MPD, from what I’ve heard, the allegations are pretty serious, and involve much more than just looking.”

*Blank stare from Mansplaining Program Director*

Sigh. I actually said aloud, “Ok, FINE, I’ll stop what I’m doing right now and Google this for you.”

It took less than 10 seconds to find information about accusations from his *eight* accusors, involving all sorts of unwanted touching and comments, despite repeated pleas from the women to stop. “So, it’s 8 women, and lots of unwanted touching. That’s why he’s in trouble. I’m going back to work now.”

“But does this mean we can’t look?”

Essentially, he was trying to imply that the entire #MeToo movement is bogus, based on nothing more than accusations of occasional, accidental glances in the direction of a woman. Like, “Wow, none of us men are safe! I mean now we’re in trouble just for looking at a woman!”

I really had quite a bit of work left to do. My voice raised- “Look, I don’t care about staring! This isn’t just about staring! He groped a bunch of women! Just, don’t do that!”

I turned around, fuming that I had to stop my work to explain something that was both 1) so incredibly obvious and 2) implicitly dismissive of sexual assault survivors who come forward.

So, that was my minority tax of the morning. It’s when you have to fight to get your work done, despite being given additional work to justify the rights of your particular minority group.

Thankfully, I got my work done. And, it was a happy outcome for my classmate from residency as well, who did match at his #1 choice of residency program (that prestigious place in the northeast where we did residency together).

The minority tax can be overcome…just with healthy dose of morning rage.

Defiant Bitch, MD

Who knew that your attitude could be such a major determinant in how much you can learn?

The basic idea of the “fixed” vs. “growth” mindset posited by Carol Dweck (great interview with Dr. Dweck here) is that we have a choice in how we perceive learning and intelligence. We can view the ability to learn as a “fixed” trait that you either have or don’t have, and so your ability to succeed in any new skill is based solely on your innate intelligence. Or, we can think of learning any new skill or concept as a process available to anyone who can access good teaching and is willing to work at it.

Based on my experiences during 13 years of medical training (and going…), I am not at all surprised that the original researchers found that children with a “growth” mindset were more likely to seek out challenging courses and projects, even later in life. Conversely, children with a “fixed” mindset were more likely to shy away from difficult coursework, for fear of not being able to pick up the new skill immediately and hence not living up to the expectation of being a “smart kid.”

Now here’s an experiment: I am currently training in a fellowship program run by a program director who is firmly in the “fixed” mindset camp.

Yep.

There are a number of ways that this has come up. Early in the year, he called me into his office to criticize my reports from weeks earlier. It was an odd way to receive feedback; I would have appreciated hearing about my errors at the time, and I happily would have fixed the reports then!

Later in the year, once months had passed and I had received fantastic teaching from the other attendings, he remarked that I was doing very well. He then commented: “Yeah, I never would have known, based on how you were doing in the beginning!”

Essentially, he felt that in the beginning of a year-long fellowship to learn a new skill, with a fairly steep learning curve, that performance in the beginning of the year was an indicator of our overall fixed “ability” to perform in this specialty. The rest of the attendings, on the other hand, seemed to understand that we all came in knowing next-to-nothing, and needed to work through hundreds of cases and receive teaching.

At one point, he actually spelled out his views on the universal truth of the “fixed” mindset. As with any other residency or fellowship, we take a yearly “in-training exam,” which is meant to identify topics in which our knowledge base is weak. It’s meant to guide our studying…not to judge our ability as physicians. So, Mansplaining Program Director (can you believe this is really all the same guy..ugh) remarked that I had done well on our annual in-training exam this year, but “I would expect for you to do even better, like greater than the 90th percentile! I mean, you have a PhD, so you’re smart!”

Sigh. I explained that my PhD research has absolutely no overlap whatsoever with the skills and procedures that we are performing in this fellowship. My ability to design experiments and write papers is a completely different skillset from what I’ve learned this year.

He wasn’t having it: “Nope! If you’re intelligent, you’re intelligent!”

There’s no reasoning with a “fixed” ability believer, I suppose.

It gets worse, though. He makes decisions on which residents to recruit based on their performance in various random grilling sessions during the beginning of their residency. He will pimp* them on various topics (not even related to our subspecialty), I’m guessing with his usual condescending tone, and so if they freeze up and get an answer wrong, he will see to it that this resident does not match with us for fellowship.

The consequence? In what he believes to be a random, unrelated stroke of bad luck, we had 3 fellowship spots go unfilled for next year.

Let that sink in. I will be taking extra call next year because of his woefully obstinate belief in the “fixed” mindset.

We need a consult from Dr. Dweck, STAT!!

Defiant Bitch, MD

* “Pimping” is a term used in medicine to refer to when attendings present questions to trainees (medical students, residents or fellows), and progressively ask harder/more obscure questions until the trainee doesn’t know the answer [or cries]. It can be done in a perfectly professional, friendly manner, but it is famous for being performed with a very aggressive and condescending tone.

We’ve all received the phone calls from our alma mater universities and medical schools, calls asking to contribute to help out future classes of students. I tend to be sympathetic. It’s clear that we have a shortage of funding for medical research and education in this country, and so, I’ll help do a small part to defray the costs of educating the next generation.

I really don’t ever say no. But, this week, it got absurd.

Some administrators from my medical school had invited me to have coffee. The conversation started out about the recent successes of our MD/PhD program, and how exciting it would be to expand the program. I figured I was asked to give some alumni perspective about how to recruit students or identify donors.

Once again…famous last words.

They then showed me a flyer regarding “Alumni Fundraising.” They had conceived of a plan to expand the program using alumni funds; they needed over $1 million from us.

“We wanted to see if you had interest in contributing.”

Wait. What? They had mentioned that they were looking for a certain number of “major contributors” (the wording was along these lines). I asked what that meant.

“Oh, you know, $25,000 over 5 years. It’s really not that bad.”

*deep breath*

I then had to start from the beginning. “You know I’m still in training, right?” I explained that as MD/PhD students, we receive a free medical education and stipend; the entire purpose of this funding is to spare us from being burdened by >$100,000 of debt, which then frees us to take lower-paying jobs in academia to pursue medical research.

Furthermore, it is not a coincidence that we tend to choose lower-paying specialties on the whole, such as neurology, pathology or internal medicine. It’s not that we aren’t qualified enough to go into higher-paying specialties; these more common MD/PhD specialties tend to give more flexibility to junior faculty to set aside time for research, since our clinical time does not bring in as much income. Conversely, in a clinical specialty which bills more in 10 minutes than the cost of a front-row seat to a Beyonce concert, there is more pressure for the department to keep its faculty doing clinical work; it becomes more costly to take a risk and have a faculty member spend precious time in the lab.

And so. Based on our decision to become a part of the MD/PhD family, we have forgone hundreds of thousands of dollars of potential future earnings; in academics, we tend to earn 1/2 to 1/3 the salary of our contemporaries in private practice. We also tend to delay child-bearing, given the 13+ years of medical training…so any leftover salary tends to be spent on daycare, then college savings, until our late 50’s.

That then brings the pool of eligible donors with $25,000 to spare to the cohort of alumni over the age of 60. They should probably be saving for retirement, but let’s be serious, as doctors, we don’t retire. We just die at some point. So, that’s a small proportion of MD/PhD alumni that they could try to reel in, but, good luck in tracking these people down.

The administrators seemed disappointed that former MD/PhD students did not appear to be the cash cow they needed to balance out the expenditure of the medical school.

They did not, however, apologize for asking me to donate 1/3 of my yearly salary to an absurd fundraising campaign. If anything, one of them asked me “Don’t you feel like you should give back?”

*another deep breath*

To put this in perspective, I am visibly pregnant, with upcoming daycare expenses for this child. I also already have a child in daycare. I make $65,000 per year, and will continue to be paid a fellow’s salary next year. And you are trying to guilt me into cleaning out my savings for *your* budget?!

Of course I’d love to help! But the entire reason that I’m still in training, and will make a lower salary for the rest of my career, was due to taking the free medical school education that the MD/PhD program provided in the first place.

We need more federal funding for medical research in this country. Giving up a third of my salary as a “donation” cannot be the answer.

Defiant Bitch, MD

I know, I know. There was an entire storyline in Grey’s Anatomy about how the title character, Meredith Grey, was the daughter of a very prominent general surgeon (her mother!) in the program where she was starting as an intern. The chief of surgery would formally greet the other interns, then lean down and whisper in Meredith’s ear, “You are the splitting image of your mother.” Her co-resident, Christina Yang, was incensed about not having this same advantage: “My mother is not Alice Grey.”

It’s not some isolated incident relegated to the world of TV residencies, where everybody wears beautifully-fitted scrub pants that don’t fall off when you’re wearing too many pagers*. It’s real. There is privilege that comes from having the right “lineage,” when you have a parent who trained in the same program, or is well-respected leader in the field.

And let’s unpack that a little more– who was doing residencies back in the 60’s and 70’s? Generally men, overwhelmingly white men. It is even a plot point that Meredith’s mom was one of very few female surgical residents during the time of her training. And what does a physician parent confer to their children, other than sleepless nights with a pager and many missed childhood milestones (I’m guessing)? They are able to pass down keen insight into the medical school and residency admissions process that most other applicants do not have in their homes.

And so then, the privilege gets passed down to the next generation. I’m not saying that the children of these physicians are worse than their family reputation would suggest; they are often excellent.

What irks me is that we can’t even pretend that it’s an even playing field for the rest of us.

Let me give you an example from my residency. I trained in an institution in the northeast with a very famous reputation. It’s the kind of place where you walk down the halls and there’s portraits on the walls of people who have diseases named after them. The senior faculty are internationally well-known in the field; having a good word put in with them can be a serious leg up in the career game (i.e. opportunities to conduct research with them, introductions from them to other prominent department heads when looking for jobs, etc).

In our program, every year, after we find out which 4th year medical students have matched with us, our program director sends out an email to the entire department, including the senior faculty, with the names of each incoming resident. For each person, it includes their name and medical school.

But every now and then, one of these bright students will get a shout-out aside from the usual information; it will be intentionally noted if one of the incoming residents has a parent who graduated from our program. For example, “John Smith is the son of Abe Smith, MD, who graduated from our program in 1985 and is currently department chair at [insert esteemed institution].”

This is the only information that most of the faculty will receive about the incoming class. There is no counterbalancing information given about the other incoming residents, such as a mention of exceptional research or clinical work. There’s nothing which could give everyone else a memorable quality with which to create a positive first impression.

Having been through residency, it’s pretty clear that first impressions matter. I’ve seen first-hand what can happen when a resident makes a minor mistake that anyone else could’ve made, but has a poor reputation (whether warranted or not); this resident receives more criticism and the reputation then worsens. It’s not fair, but it’s the way it is. (To be fair, I think I benefited from the reputation game in a different way, having been a little older and more confident than my intern classmates, which then made me appear to have my stuff together more than I really did. I’ve seen both sides of this.)

Giving a wink and a nudge to the faculty about incoming residents with prominent family members only widens the divide.

Defiant Bitch, MD
*Re: the scrub pants: tell me I’m not the only one!!

Writing about the disastrous dog-eating discussion in the mandatory counseling session got me thinking…have I *ever* been a part of a resident “wellness” session that hasn’t been an abject failure?!

And now: The time my pregnancy was outed by a “yoga instructor” at a resident “wellness” session!

One of our younger, friendlier attendings had become passionate about yoga, and found one of her friends to give us a resident wellness session on muscle relaxation and yoga breathing techniques. It seemed innocuous enough (again…famous last words).

As we gathered in the room, I was catching up with a couple of my co-residents, one of whom had just heard about the early stages of my pregnancy. She gave me a warm, quiet “Congratulations!” (Of note, the reason that some of my co-residents knew I was pregnant so early is that one of my classmates actually figured out I was pregnant before I did. Another story for another day!)

The appointed “yoga instructor” was perky and young. She was one of those white girl yoga instructors who had clearly never been to an actual yoga class with an Indian person teaching up front*. She came from more of a Lululemon approach to yoga: take some basic principles and do them while wearing cute $100 tight pants and chatting with the crowd. She made some odd comments, like “All of you are now yogis!” Huh? Seriously? After this one class? Do you even know what that means? I bristled at the cultural appropriation, but stayed quiet, as she appeared well-meaning.

We got to the breathing exercises. She explained that we should inhale, then slowly exhale for a prescribed number of seconds. She then looked squarely at me, and said “Well, not everyone should hold their breath for so long.”

I looked up at her. “What?” I honestly had no idea what she was talking about. Why was she looking at me?

She looked back at me, paused, and then said “Well, not if you’re pregnant….”

I was stunned. She then clearly figured out that my pregnancy was not yet fully announced, and she appeared mortified. All I could think was “Bitch…did you just OUT MY PREGNANCY AT A YOGA WELLNESS EVENT?!” She basically thought that it would be appropriate to eavesdrop on our conversations prior to the start of the session, then throw out juicy tidbits to the crowd while we were supposed to be meditating. I did not feel my wellness improving.

Instead of announcing my pregnancy to a group of people attempting to meditate, she easily could have given a quick warning, to hold the breaths only as long as we don’t feel dizzy. For any reason. I doubt it would take a 100 hours of yoga teacher training to figure this out. (I did tell her this afterwards.)

We went ahead and did the breathing exercises. I used the opportunity to count the number of seconds left in this incredibly awkward situation, one breath at a time.

Anyhow. If you’re in residency, and sitting through a #ResidentWellnessFail, sound off in the comments below! This can’t just be me!

Defiant B, MD
*Of note, I am half Indian, and grew up with yoga. Once again…whether this gives me the right to criticize white women wearing Lululemon who teach yoga– I suppose this is debatable.

Hi everyone

My article got picked up by kevinmd.com– it’s about the risks of mansplaining in the hospital. I tell the story of the perils of the medical hierarchy, mansplaining, and an unfortunate patient death.

Ever been in a situation like this before?

Defiant Bitch, MD

In response to complaints of work-hour violations, work environments which thrive on the belittling of trainees, and overall discontent among residents, residency programs have come up with a “solution” to the problem. No, it does not involve fixing broken schedules or providing real change to toxic environments. Instead, they’ve focused on this vague idea of “resident wellness.”

What does cultivating resident wellness entail?

Apparently, it involves giving out free water bottles once a year (to be fair, I still use mine from last year). But sometimes, their idea of “help” becomes more intrusive and confrontational.

Enter the disastrous mandatory counseling session that we had during my third year of residency.

One day, I received a foreboding text message from our chief resident: “Resident wellness lunch! NOW!!” (Her text messages were a combination of frightening and oddly effective.) At noon, I headed over to a room with an appointed counselor and the two other residents who were able to make it to this session.

The counselor starts out by asking us about how we’re “enjoying” residency. We described feelings of loss of self, as well as burnout on rotations which were mired by paperwork and other scut. We spoke about how our job often involved telling families that their child was brain dead, and the toll that these experiences took on our personal lives.

Her response? “Well, if it’s that bad, maybe you should look into doing something else.”

Whaaa?? We looked at each other in disbelief. I remember cracking a smile at the absurdity of this notion, that our program director would have a counselor convince us all to quit simultaneously at a “resident wellness” lunch.

It got worse, though, somehow. She wanted to show us how much she could relate to our plight. What began as a quasi-counseling session for us turned into a soliloquy from the counselor, about how she had long considered becoming a veterinarian due to her love for animals. She ended up eschewing the profession, however, when she found out who it was that had to “put down the dogs.”

“So I understand what you all are feeling.”

Let me get this straight:
1) One time, you merely *thought* about taking on a job with an ethical conundrum.
2) Then, you chickened out and didn’t pursue that line of work.
3) Now you get to tell us how much you can relate to being a physician.

I wasn’t having it. For all of the mandatory therapy that I’ve had in my life, this was unbelievably bad. My co-residents felt too uncomfortable to say something…so I did:

“Seriously? SOMEBODY HAS TO KILL THE PUPPIES, like if they’re going to die anyways. I mean somebody has to do it.”

I was mad, so I just kept going:

“You know what? There’s Chinese people* who eat dogs. Dogs and people are not the same thing. We, as physicians, have to break the bad news to families that their kid is neurologically devastated and pull the plug on ACTUAL CHILDREN, not dogs.”

The counselor let out an audible gasp. My co-residents just stared at me. One of them sputtered “My wife is Chinese and doesn’t eat dogs.”

The counselor was flabbergasted. She stammered something about “Now let’s not make cultural judgements about people…” and was basically at a loss for words.

That was it for our “resident wellness” lunch. We didn’t have any more mandatory counseling sessions after that; they were cancelled for the rest of the year. I managed to convince our program to use the money instead for a monthly happy hour, at a bar of our choosing. These happy hour events were well-attended, and everyone got a chance to rant and tell stories in a truly supportive environment.

I consider my outburst at this “resident wellness” event, and the subsequent funding for monthly resident happy hour, to be one of my greatest achievements during residency.

Defiant Bitch, MD
*Of note, I am half Chinese. Whether or not that gives me the right to talk about Chinese people eating dogs…well, I guess that point is debatable.

Sadly…slut shaming can come from physicians. Female physicians. In reference to innocent pediatric patients.

Back in medical school, I did a rotation in pediatric hematology. In clinic, one day, we saw an 11-year-old girl with hemophilia. The patient was being given medication to aid with blood clotting, but even with this medication, the blood loss from her menstrual periods was still a significant medical problem. As a result, her mother and doctors deemed that taking daily oral contraceptive pills (OCPs) would be helpful for decreasing the risks associated with menstrual bleeding in a hemophiliac. This seemed reasonable to me; however, her mother was adamant that her daughter not be told about the birth control medication.

The patient, a bright-eyed, inquisitive girl, became puzzled when her mother and the hematology attending began speaking about her “hormonal therapy” in vague terms. She asked questions, but was repeatedly ignored. Her mother was trying to ask the hematologist if the OCPs, when taken for the indication of suppressing menstrual periods, would “still work for its intended purpose.” She was trying to ask if the contraceptive would be effective in preventing pregnancy, even if it was not being taken for that reason.

It was such a strangely-worded question that my attending initially did not understand. I interjected with “Yes, yes it will still work for that purpose. It will.” My attending understood and nodded. The girl looked at us and asked, “Why isn’t anyone explaining anything to me?”

This strategy of hiding a medical treatment from an astute pediatric patient seemed like a bad idea to me. It seemed particularly silly since there was absolutely nothing to be ashamed of; this girl has hemophilia through no fault of her own. Outside of the room, I confronted my attending, asking her why we were keeping the prescription and use of the contraceptive a secret from the patient. The patient was obviously old enough to understand that we were keeping a secret and could easily look up the information on her own.

My attending did not have an explanation.

Instead, she GIGGLED: “Oh, you know what the kids will say about a girl on birth control!”

Wait. So. We are not disclosing the reason for a medical treatment to a patient, because of the possibility that ignorant middle school students will slut-shame her for taking birth control pills?!

Aren’t we the grown-ups here? Shouldn’t we be the driving force to empower her with knowledge of her own medical condition, as well as give her the strength and support to stand up to bullies? Her particular medical condition is rare, but her need for oral contraceptives to deal with debilitating menstrual periods is fairly common. She, and we as doctors, should be on the front line in dispelling myths about birth control. Maybe if we did a better job of educating the public, we would have fewer ignorant rants about women’s health…like the disgusting tirade from Rush Limbaugh to slut-shame and insult Sandra Fluke when she spoke out in support of insurance coverage for women’s health. (And now, a summary of Rachel Maddow’s fabulous take-down of Rush Limbaugh, explaining basic anatomy.)

This was a day in medical school when my main take-away message was not a pharmacologic or disease mechanism (though there was plenty of that during the hematology rotation): I learned that as physicians, we can’t silently condone the bullies. We must empower our patients with knowledge to defeat ignorance.