In 2023, data from the labor market showed that the percentage of working women had reached an all-time high. 45% of women across professions were breadwinners. In medicine, women matriculants to medical school began to outnumber men starting in 2017. Despite these welcome advancements, institutional and cultural norms have hardly kept pace. Medical education and clinical research lag similarly behind.   

As women have assumed greater responsibilities at work, somehow we have remained disproportionately responsible for childcare and household chores. Growing up in the 1990’s, my childhood pediatrician refused to speak with fathers about their children.  My parents both worked full-time and shared childcare responsibilities, yet my mother alone was burdened with the role of primary parent by the doctor’s office, school nurse, and most any adult needing to communicate with my parents about our childhood affairs.

I would like to believe that things have changed since my childhood. One would imagine for example that in medicine specifically, our fellow clinicians would recognize the importance of respecting all types of families and understand the concept of parenting as a shared responsibility.  My lived experience as a working physician parent and that of my colleagues suggests otherwise.

Recently, I was listening to one of my favorite emergency medicine podcasts. I bristled as the speaker repeatedly and reflexively referred to the generic caretaker of a pediatric patient as “Mom”, recalling my mother’s frustrating experiences as a mom, and my own as both a mother and physician.  The implicit bias of the gendered language used by the podcaster later echoed in the teaching cases I had pulled for a residency lecture that same morning.  Residents diligently worked through several pre-written clinical scenarios in Pediatric Emergency Medicine. In all of the cases, “Mom” was described as the primary historian.

It is well established that representation in medicine is critical to achieve equitable healthcare access for patients and equitable career opportunities for women physicians. “Representation” certainly includes increasing the number of women in leadership roles, but also encompasses the more nebulous goal of building institutions and culture that allow women physicians to succeed and thrive, both at work and at home. Language is a significant part of culture, and we ignore it at our peril. Gendered language in medical education and clinical practice is accompanied by underlying assumptions and common practices that undermine realization of true representation of women in medicine.

At face value, the common assumption by a pediatrician that “Mom” is the primary caregiver in a married, heterosexual couple might seem like a benign annoyance with minimal implication on gender equity in the physician workplace or in life. Gendered language in medical education may be similarly dismissed as “semantics”. However, in both cases, the very existence of this persisting bias is often reflective of pervasive and insidious currents of deeply rooted assumptions about gender, which may limit the effect of our efforts to mitigate and reduce the harm caused by gender bias. 

Use of inclusive language in medical education and teaching is one (of many) critical aspects of representation, and is emblematic of the wide-reaching cultural change needed to deliver the gender equity promised by changes evident in medical school applications and admissions data. 

Women physicians are often instinctively aware of the ways that gender bias in their medical education and career is compounded by gender bias outside the workplace in society and everyday life. Although fathers are more involved now than ever in the past, women physicians understand the depleting certitude of the “second shift” that awaits them when they return home from a grueling shift in the Emergency Department.

In married households, 32% of fathers report being a regular source of care for their children, per the US Census, and nearly one-fifth of stay-at-home parents are men. Single fathers have also become increasingly common, eight percent of households with minor children in the United States are headed by a single father. Of single-parent households, almost a quarter (24%) are headed by fathers. LGBTQ families also buck the assumptions and norms of the traditional mother-and-father dynamic. The language we use must reflect our society, and intentionally include the beautiful diversity of American family dynamics.

As an Academic Emergency Physician, I regularly prepare my residents for oral boards with clinical scenarios. Reviewing available published materials, I have noticed a glaring and ubiquitous preponderance of gendered language and associated bias. In my work as an educator, I actually created a spreadsheet of the family structure and terms used for parents in published clinical scenarios designed for graduate medical education, using all available and highly regarded books and teaching resources.

In my own (admittedly unpublished) initial review of 49 cases from commonly used oral board review textbooks and online sources, only 2 cases mentioned the father as the primary historian.  In cases where the fictional parents brought their child to the doctor together, none established the father as a primary historian, whereas many if not most specified the mother as the historian. 100% of cases that explicitly mentioned the genders of the parents featured hetero-normative couples.

In addition to the written educational materials to train Emergency Physicians, gendered language also remains prevalent across clinical education and patient care. In one example, a colleague and I reflected on the implications of using gendered terminology such as  “the mother’s kiss” procedure, particularly when equally descriptive but gender-neutral language such as the “parent’s kiss” exists.

Use of gendered language could conceivably make a father less comfortable learning and performing such a procedure. It may also bias us in how we teach the procedure and lead us to instinctively teach the mother, even when the father is also present.  Other more informal gendered language, such as “a mother’s touch” or “the mom-ometer” for tactile fever detection again implicitly relegate caregiving to women.

It is tempting to dismiss gendered language as having minimal implication on downstream patient-centered outcomes, but a quick search of the literature reveals that gender bias in medical terminology also reflects a deeper bias in our framing of clinical research and patient care. For example, there is actually literature examining the accuracy of tactile fever recognition by parents, including an abundance of studies that only included mothers. There are zero studies looking only at fathers.

Despite being a physician mother with a stay-at-home husband, and despite starting my family decades after my mother’s experience, I have frequently been treated as the “default parent”, including with regard to my children’s medical care. I hear similar sentiments echoed by other professional women. As educators of patients, students, and residents, we must be intentional and judicious in our use of language, as well as our actions and interactions with our patients.

When we forget to see the people in the room and respect their family structure and individuality, we lose them as historians and partners in their children’s care. When we create and perpetuate implicit bias in our learners, we all but assure that the cycle continues into my son’s generation and beyond.

If women do not want to be consistently treated as the default parent, and men do not want to be discounted, and if women ever hope to gain respite from gender bias at work and the “Second Shift” at home, we must create better and more inclusive narratives. As we have increased our presence in number, we as women physicians and community leaders must also increase our representation in the ways we build culture with our language, actions, and practice. 

As educators and academicians, we can write better questions. We can be thoughtful and deliberate in our choice of language when lecturing and teaching at the bedside, and we can adapt otherwise high-quality teaching materials to be inclusive. We can educate our learners to recognize and mitigate gender bias in their education and practice, and actually arm them with the tools to re-write women and men into the stories we tell and the cases we see in a way that recognizes our true complexity, potential, and shared humanity.

As we develop study materials for the new Emergency Medicine Oral Boards format, we can and should create new review materials and resources that reflect not only how far we have come and who we are as a society, but where we are headed, and who we hope to become. There is no reason we cannot do the same in our actions and initiatives across Research, Administration, and Clinical Operations, as we design studies, write department guidelines, and innovate in our departments and across the specialty. As female physicians, we are more experienced than many at flipping the script. For the sake of women and men, let’s lead the charge so that one day, Dad might get the call, and parents of all types of families can link arms and face the “Second Shift” together.