Professionalism: #Medbikini through the eyes of an aspiring medical student

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The recent furor over the article published in the Journal of Vascular Surgery (JVS) about unprofessional behavior among recent vascular surgery trainees occasioned a discussion between myself and my daughter, an exceptionally bright and perceptive young lady aged 23 who is considering a career in medicine and will be applying to medical school. She asked me about the situation when she saw it trending on Twitter, and I had to read the article to understand what the outcry was about.

It struck me as being well-intentioned but, frankly, tone-deaf, even to myself—let alone a young woman or many young women considering a career in medicine. It brought to the fore, fairly or unfairly, that ours is a world that, despite claims and data to the contrary, still harbors a parochial, antiquated and out-of-touch view about modern life, and the adaptation of our collective professions to changes in society, social mores and demographics.

We have heard plenty from graduates and currently practicing young vascular surgeons about this publication. It also would be helpful and instructive to hear the perspective of a young woman who is not yet in the field of medicine but plans to be a future physician/surgeon about what this publication communicated to her about perceptions, intentions and the lens through which she and others in her age group might be viewed.

This is not about condemning the authors, as they were, no doubt, well-meaning and well-intentioned, but rather to heighten our consciousness about the silent and not-so-silent messages we send when we are stuck in a bygone time.

The following paragraphs are those of my daughter. I offer them as a cautionary tale about how we, as a profession, need to realize how out of touch we appear. Perhaps what this shows is not a welcome mat but rather a portrait of an ascetic, judgmental hierarchy that, despite its words, communicates condescension and opprobrium toward our youngest colleagues for being open about enjoying life, albeit unintentionally so.—Niren Angle

 JVS paper delivered loud-and-clear message

Recently, a study was published in JVS, presented at the Society for Clinical Vascular Surgery (SCVS), outlining the “prevalence of unprofessional content” on social media among young vascular surgeons. Some of this “unprofessional” behavior includes “offensive comments, appearance of intoxication, inappropriate attire, or controversial social topics.”

While this sounds at first glance intriguing, it is riddled with sexism and 19th-century thinking on the definition of professionalism. It was the caricature of—with all due respect—old guys commenting on what is and isn’t appropriate in the context of “professionalism” in medicine or surgery.

It was troubling to see that it reflected a worldview largely out of touch with modern life, youth, and, frankly, communicated a condescension that is antediluvian, to say the least.

Nowadays, social media is often a social resume. When you look at someone’s Facebook, Instagram, Twitter or, more recently, TikTok, you see who the person is—or who they decide to show the world who they are. There are often photos of individuals with friends, on vacation, at home or  pets.

The authors of this paper deem photos of women in bikinis or holding an alcoholic beverage somehow unprofessional. The authors are not speaking of bikinis and alcohol in the workplace, or even passed out drunk, but rather enjoying something that most adults do in social settings. Is it supposed to be a secret to our patients that someone might wear a bikini or enjoy a cocktail? Does this reflect on their ability to care for patients?

As a young woman who is interested in pursuing a career in medicine, this is off-putting. In the past, medicine has been a male-dominated profession due to the time commitment and the stereotype that women are less capable intellectually and temperamentally. Luckily, in the past 25 years, women have matriculated medical school in increasing numbers and percentages.

In addition, women are getting married and having children while excelling in their careers. Better yet, they are not considered incapable or absentee mothers for balancing time-consuming, prominent careers and their families. This publication took us back 25 years or more.

Professionals are often thought of as well-behaved, hard-working individuals who are dedicated to their calling and who strive to excel at every turn. This does not immunize them from having a good time in their personal life, nor does it warrant enjoyment in secrecy. Unbeknownst to many, patients actually like to know their physicians are social and have human characteristics, and not automatons who talk down to them.

Of course, social media is a representation of who we are. We—men and women alike—should not take our social media presence lightly. Just as we would not show up intoxicated to a networking function, young professionals should make it clear that they are not wildly inappropriate and conduct themselves in a way that any company would be proud to have present. However, this is not what the article is criticizing.

While professional women are—and should be—held to the same high standards as men, women are targeted in this article in a way that men would never be. First of all, the researchers looked at 68% male profiles and only 33% female profiles. The problematic nature of this article is not solely due to sampling issues. The authors make some broad assertions about what is considered acceptable, without paralleling the same expectations in men.

The idea that women and men who want to be in the medical profession are disallowed from posting a picture in which they are holding an alcoholic beverage—in this article considered “potentially unprofessional”—is absurd. There is no rule that says young women (and men) have to give up their lives in order to be successful in this profession. Is it the case that, if I were to go to Napa for the weekend, I would have to stay away from wine or else my patients would think less of me? Or is it to be kept a state secret, only known to people who know the secret handshake?

Furthermore, the article asserts that a medical professional should not maintain a presence on social media depicting themselves in swimwear. This is a blatantly sexist assertion. The past few years have been about women’s empowerment. From Victoria’s Secret changing their branding to ensure that women of all body types are appreciated, to the #Medbikini trend sparked by this unfortunate paper, women should feel comfortable wearing bikinis without attracting accusations they are any less of a doctor.

As a potential female medical student, it appalls me to see that this is how some mentors might view me. Even before my foot is in the door, I have a much likelier chance of being seen as inadequately professional because I have a pictures in which I’m having drinks with friends and on vacation wearing a bikini on my Instagram.

As someone who values their social life as a method of mental health maintenance, it makes me feel as though I am not suited for a life in the medical profession if this is how we are going to treat our female physicians. Enjoying a glass of Sauvignon Blanc while wearing a bikini does not make me any less of a sufficient professional. This is 2020.

In a time of #MeToo and female empowerment, the insinuation that wearing a bikini or having a glass of wine makes me any less of a sufficient candidate for a position as a physician is distressing. Every action and inaction send messages. This paper delivered one via a megaphone. It is not just the authors but the editorial board that is deserving of ignominy. Retraction of the paper was necessary but not sufficient. There is work to be done to make our world in surgery an inviting place to inhabit for young women and men alike. We must do better.—Athena Angle

Niren Angle, MD, is a vascular surgeon and chief of staff at John Muir Health-Concord, California. Athena Angle is an aspiring medical student.

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