#123 AI Identifies Physicians as Male
Duh. Are we Really Surprised?
When physicians Shikha Jain and Vineet Arora looked into how some of the most widely used artificial Intelligence (AI) platforms characterize physicians, the names and pictures overwhelmingly came back as male. They wrote “ChatGPT Thinks Doctors Are Male—How AI Mirrors Society’s Gender Bias” in the August 1 edition of Ms. Magazine.
When the authors were using the popular AI application to search for famous female physicians to speak at their yearly Women in Medicine conference, nearly all of the results of their searches were males. How, they wondered, could a seemingly unbiased computer program demonstrate sexism and gender stereotypes? Well, of course, the program mines all the data of society and concludes, unsurprisingly, that physicians are men.
My experiences mirrored their findings. When I started writing on my Squarepace blogpost and contributing to Medium.com, I noted something interesting when I wanted to use a picture of a female in the healthcare setting. In the stock photo program used on both platforms, Unsplash, I could not get an image of many females when I entered the word physician or doctor.
The photo above is one of the first images that comes up when the word physician is entered into the search function of Unsplash. To get an image of a female in scrubs, I must enter the word nurse.
Often, when I want to include a picture of a female physician on the job, I use a picture of myself. I took this shot on Christmas day several years ago. For many years, I took the early morning shift on Christmas day because my family does not celebrate Christmas. I collected a lot of great stories over the years of who showed up in the ED on Christmas day.
Physician selfie by Joan Naidorf
Why does it even matter what an AI program thinks? With more than half of the current medical student population as female, now or in the near future, most people will have female doctors. The doctor patient relationship established in the (almost) private room of a medical office or emergency department plays immeasurably into how the patient fairs in that interaction.
Nearly all of the patient side of the doctor-patient relationship come from the thoughts that the patient has about the healthcare professional. Do I think the doctor is well-trained? Is he listening to me? Does she care about me? Is she spending too little time with me? Did he examine me thoroughly or at all?
Does this person in front of me look and act the way that I think a doctor look? What images and personalities inform the patient’s ideas about how a physician should look? Was it Dr. Welby or Dr. House on TV? Is it Dr. Gupta or Dr. Fauci who we see on the news? If a young black woman with dreads walks into the room and introduces herself as the doctor, will the patient even believe her?
When the physician enters the room and does not meet the expectations of what the patient thinks she, he, or they “should” look like, what happens? They could doubt that person’s expertise or mistrust their opinions. They could disregard the doctor’s recommendation’s or not keep their follow-up appointments. What the patients and their families think of their physicians really matters.
I can remember one patient who I was seeing after she was transported to the emergency department by a team of the very well-trained paramedics working for the City of Alexandria. I introduced myself as her doctor and we commenced our interaction. I outlined for the lady what we would do for her and how we would proceed to diagnose and treat her.
She said, “That other doctor said I would be admitted to the hospital.”
I hesitated momentarily, wondering if she had already been seen by one of my colleagues. Then I realized that she was referring to one of the paramedics who transported her to the hospital. He was a man. Because he was a man executing medical procedures and making decisions, she assumed that he was a physician.
I realized that this paramedic may have inadvertently overstepped his role or led her to believe a notion or outcome that was not necessarily true. Likely, the seasoned paramedic did not actually say that she would be admitted, she just interpreted his words in that way. As an experienced physician myself, I know that patients enter the department with some incorrect beliefs and unrealistic expectations.
I was already, as it were, starting in the hole. The patient would be disappointed and upset if I did not align with the plan that she received by the person she thought was the doctor. I explained to her that as the physician in charge of the emergency department and her care, I would decide about admission or discharge from the hospital after her evaluation and treatment in the emergency department.
Our physicians who do not quite look the part that our patriarchal society portrays in media already have an uphill battle to fight. They do not look like the stately white male, slightly graying at the temples. They have ethnic hair, body art, and X chromosomes. (I was going to say breasts, but of course, men have those too.)
Women and people of color look around and see few role models on the faculty and even fewer in the administration. They may already feel the suspicious eyes of some of their teachers and colleagues who hear people labelled them as “DEI” admissions or hires. Those fledging docs already feel that they might not belong or that someone will realize that they are an imposter.
So-called imposter syndrome, which I write about here, is simply a very human tendency to question oneself whether one is good enough or belongs. Every human feels it, even those guys with the best credentials, white skin, and the graying temples. When a person from an under-represented group looks around and notes that he or she is the only person who looks like them in the room, it hits a bit harder.
Every person who enters the medical profession in some capacity, must study, work hard, and sacrifice their nights and weekends to get there. Witnessing illness, death, and family grief is not for faint of heart. Sometimes the disappointed and depressed young doctors think the only way out of their situation is to end their own lives. An estimated 300 - 400 doctors die by suicide every year. This is a national tragedy.
Cover photo by Joan Naidorf
When I read and reviewed Dr. Lisa Sanders’ book, Every Patient Tells a Story, I noted that the author’s note page includes the following:
“The use of pronouns when you are speaking of an individual remains problematic in writing now that we can no longer just use the generic “he.” There is no rule at this point, so in this book, I will refer to the generic doctor as she and the generic singular patient as he.” (Every Patient Tells a Story- Author’s Note)
Yes! Why not? Why not create the space in our literature and culture where the default gender of a physician is female? In addition to her books, Dr. Sanders writes the monthly Diagnosis column for the New York Times Magazine and is on the faculty at Yale University. I do not have her resume or reach, but if she could make the generic physicians in her book female, why the heck couldn’t I?
In 2020, I decided to write a book expanding on some lessons I learned from the challenging interactions I had as an emergency physician with some of my patients and their families. The title of that book is Changing How we Think About Difficult Patients: A Guide for Physicians and Healthcare Professionals. It was published by Nancy Collins, at The American Association for Physician Leadership.
I decided to follow the example of Dr. Sanders and to refer to the generic doctor as she. When I presented the finished draft of my book, the physician pronoun stayed as she/her. Some of my stories include nurses and paramedics who I also include with either male or female pronouns. Women and people who identify as women, will most certainly see themselves in the pages of my book.
My book is lesson for healthcare professionals on how to change their thoughts about some of the challenging interactions that we have with our patients or their families. Many of the beliefs we acquire about substance-users, the chronically ill, or the angry patients are just thoughts that our mentors taught us and everyone in the workplace believes. With effort and some tools that I offer, medical professionals can change their thoughts, feel more curiosity and empathy, then get better results for their patients.
If an artificial intelligence program scans my book, perhaps the gender algorithm will start to change on the gender of physicians in our society. Changes in AI and change in our society move slowly but with effort, they will move in the right direction.
