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A Piece of My Mind
July 16, 2019

What’s in a Name?

Author Affiliations
  • 1Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
JAMA. 2019;322(3):211-212. doi:10.1001/jama.2019.8647

A father and son returning from a soccer game get into a car crash on the way home. They are rushed to the hospital. Sadly, the father dies in the ambulance on the way. When they arrive at the hospital, the critically injured boy is rushed to the operating room, but the surgeon refuses to operate saying, “I can’t operate on this child; he’s my son.”

Who is the surgeon?

This classic riddle highlights the prevalence of implicit bias in medicine. Even now, in 2019, many adults struggle to come up with the correct answer. The surgeon is, of course, a woman. She is the child’s mother.

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    3 Comments for this article
    Practical Solution
    Shirley Vaughn |
    While not disregarding the broader issue that you described so well, I would offer a simple suggestion that might have eliminated the specific incident with this particular student and others with whom you have only electronic contact. In the "old days" when written communication was done on paper, the use of letterhead stationery might have offered some information about your rank and position. In these days of email, the use of a formal "signature" with your full name, followed by MD and with your position within your institution listed below would alert the person receiving the message that you are not the administrative assistant or the library clerk or whatever other position they might think you hold. After typing your message, you can then add your name in whatever way you think is appropriate: Jen, Jennifer, Dr. Lukela, or Jennifer Lukela, MD, etc. This way however formal or informal your typed signature, the standard signature gives your full name, rank, position and contact information such as phone or FAX number you may want to provide. Once you set up the signature, it's very convenient.

    I think most people would want to give others the respect they have earned through academic pursuit and certainly would not want to offend the person they are reaching out to. In this case it seems the student didn't have a clue that you were a physician.

    On the other hand, this may have been a "happy fault" as it enabled you to have a worthwhile conversation with your colleague and gave him a chance to reach out to his student and gave her a chance to reach out to you and share her experiences. It also gave you the impetus to write this worthy article to bring the whole issue to the forefront again, giving readers a chance to ponder our own experiences. So thank you.
    Not Always Bias?
    Jaidev Nair, MB;BS | Scarborough Hospital, UK
    Thank you for this fascinating commentary into modern life! As I approach retirement I often encounter instances of behavior from others around me that make me go "I would never have gotten away with that!"

    I have had two instances of students I have never met before addressing me in emails by my first name in an email. (I am male) I have to confess feeling extremely annoyed by this and I went to my son who was a medical student to ask if he thought this was appropriate. Thankfully he agreed with me. In the event, I ignored
    it and signed my response with my full name and title which seemed to have gotten the message across.

    However, just yesterday, I found out a possible reason for this behavior! An administrative assistant at our med school introduced me yesterday to a student by my nickname; "This is Joe...."

    Joe Nair
    A Comment
    Rhoda Jiao |
    I appreciate the larger point you are trying to make here about the inherent gender bias in our field. It's because of that that I feel I need to express a point about the riddle you use to introduce your article.

    The surgeon in your riddle is not "of course, a woman." Among other possibilities, the surgeon could be a gay man. Our world is not so simple, that we can accurately and inclusively represent the people in it with such a limited metaphor.

    I'm glad you were able to speak to your colleague and the medical student
    and have a meaningful discussion. Being the one to initiate these conversations can be difficult, but they are conversations that need to happen for there to be any change.