My husband, an emergency room physician, has a particular passion for managing airways. If you are comatosed with a head injury, bleeding to death from a blunt trauma to your chest or having a severe anaphylactic reaction, maybe really bad pneumonia — in other words, you cannot take care of your own airway, you’re in good hands if he’s the guy in the ER — but not because he is a man.
Indeed, a recent study suggests, female physicians are just as good at performing endotracheal intubation, a procedure in which a breathing tube is inserted through the mouth and into the trachea to protect the airway and to help a patient breathe.
Does physician gender have a significant impact on first-pass success rate of emergency endotracheal intubation? was published June 14 in the American Journal of Emergency Medicine (AJEM). The study hypothesized that female physicians are not inferior to their male counterparts in first-pass success rates.
Hold up — what? A study to establish women are not inferior to men was conducted — and published — in 2019?
If you’re like many people contributing to a chat stream on the Read app, where I saw the AJEM article, your first response might be indignance. As one woman wrote, “When in the name of all things are we going to stop acting surprised that women can perform in medicine as well as men?”
A male reader had this to say: “Of all the hypotheses that you could come up with to test, it had to be one that potentially adds division amongst medical staff? . . . What a ridiculous study.”
Reaction to the publication on other social media was fast and furious. People maliciously attacked the researchers and the publisher without pausing to ponder something very important: where the study was conducted and what the implications might be for the culture involved.
Authored by Whei Jung (a female medical student) and Joonghee Kim from the Department of emergency medicine, the study was done at Seoul National University Bundang Hospital, in South Korea.
Examining 1,154 cases of adult intubation using direct laryngoscopy, the researchers found the first-past success rates of female and male physicians were 83.6% and 84.8% respectively. Allowing for
variables like physician clinical experience, patient presentation and other difficulty indicators, researchers concluded women are as good as men at performing the procedure.
Sure, the study was published in an American journal (and one angry respondent said AJEM was complicit that a “no difference” hypotheses required study), but publication in a western journal carries a lot of accolades that can change perspectives abroad. The authors proved their point: women physicians deserve the same respect as their male counterparts. That’s something we take for granted in North America.
The knee-jerk reaction of the offended was so fierce, Kim issued an apology to readers, saying he was insensitive and admitting such a study was not required because his findings were so obvious from the beginning. He pointed out that he himself has two lovely daughters and it was never his intention to offend or insight gender related issues. He even offered to have his paper pulled.
Could the study have been better framed and presented in AJEM? Absolutely. It would have benefitted from some cultural context.
But since we’re discussing airways, what if everybody took a deep breath? What if we lowered our defensive walls, maybe did a little more reading and research, before firing off so fiercely online?
Let’s not denounce the Korean paper because we’re offended. Andrew Miller, who commented on the Read app stream, summed it up well:
“The cultural lenses most are viewing this through are largely that of western countries where this degree of sexism has subsided. Consider the possibility that the Korean culture is so strongly paternalistic in that female physicians not only experienced a subjugation by their male counterparts but also by the very patients they have sworn to treat . . . Attacking the authors for attempting to right a clearly identifiable wrong through what is arguably a most noble scientific endeavor is absurd.”
I would add arrogant. How dare we, as Westerners, demand the paper’s demise? This study is important proof of gender equality in medicine for female physicians struggling to be respected, not just in Korea, but in many parts of the world.
From 2000 to 2005, we lived in Abu Dhabi, capital of the United Arab Emirates, where women do not have the same rights as men. Emirati women needed a man’s permission to have an operation (not to mention drive and own a cellphone). When my husband treated a woman in the ER, her husband could insist upon being present. One of the reasons women were allowed to become physicians (they could not, for instance, become air traffic controllers), is because only “doctors” are allowed to examine women for specific complaints.
As I conclude this column, the Korean research has been temporarily removed from the AJEM site. Hopefully it will be back up before a female physician in Korea performing her next endotracheal intubation has to defend herself.
Shannon Linden writes a blog, magazine articles and grocery lists. Visit her at: shannonlinden.ca.