Tag Archives: medicine

Irene Cybulsky: A Stymied Surgeon Tries a New Tack

Dr. Irene Cybulsky in a surgica mask and gloves with an ambulance in the background

Debbie says:

In some ways, “The Only Woman in the Room,” Christina Frangou’s article on Dr. Irene Cybulsky in Toronto Life, is a completely predictable story. Dr. Cybulsky started medical school in 1984, and chose surgery — and then cardiovascular and thoracic surgery — as her specialty. Her progress was plagued with sexism: as Frangou says, medicine may have more and more women, but surgery is still a male field.  After her first one-year job as a cardiac surgeon, the permanent position went to a man:

Her boss gave her a reference letter emphasizing that she took good care of patients and got along well with nurses, but he sidestepped what mattered most to hiring committees: Cybulsky’s technical abilities as a surgeon. The letter burned at her. “[My patients] do well because I did a damn good operation,” she told the author Judith Finlayson for a book about women in the workforce, “but that gets lost.”

In 1995, she got the job she was looking for, and continued (are we surprised?) to be plagued by sexist assumptions and sexist jokes. For a time, the only other woman in the department was from Ghana, so Cybulsky also got to see the intersectional harassment of a Black woman surgeon. In 2009, she was promoted to head of the cardiac surgery division–the first Canadian woman ever to lead a cardiac surgery unit. She saw this as an opportunity to bring some equity — both gender equity and attention to other issues, like a general reform of how patients were referred to surgeons.

A 2021 study published in the Journal of the American Medical Association showed that male physicians in Ontario disproportionately refer to male surgeons. Another study suggested that women surgeons are less likely to receive referrals after an unexpectedly bad outcome, while the same is not true for men. When a female surgeon has a complication with a patient, the referring doctor is less likely to refer patients to any female surgeon. Women typically receive more referrals for non-operative patients and perform fewer highly remunerated surgeries. As a result, on average, women surgeons in Ontario earn less than men for the same hours worked.

Cybulsky set out to transform the system. Patients awaiting surgery would go on a centralized list, and whichever surgeon was on call would perform the operation.

… the change was logical, fair and consistent with how things worked in other surgical departments. Still, the surgeons who were most opposed couldn’t get past it. So they focused their rage on the person who’d made the change. Word of their displeasure inevitably reached Cybulsky, and she knew she’d come close to mutiny in her division. But she also knew leadership meant dealing with adversity. It wasn’t her job to be liked; it was her job to lead and to provide the best quality of care to patients. Important change didn’t happen without fallout

Again, are we surprised? No one likes having their prestige and power reduced, and professionally successful white men have a tendency to take it … personally. All the details are in the article, and they’re all pretty predictable, including that the female physician from another specialty chose to minimize or ignore any conversations about gender inequity and focused on Cybulsky’s “communication style.” In 2016, after refusing to retire gracefully, Cybulsky was fired from her position, though she was kept on as a hospital surgeon (and had a head of surgery job at a partner hospital).

For me, here’s where the story gets interesting. You might expect her to just swallow it and keep doing surgery. You might expect her to go keep bees, or open a yoga studio, or write a scathing memoir. But she became a surgeon because she likes solving problems, so she focused on this one.

She had an option available to Canadians which is not offered to U.S. citizens: the Human Rights Tribunal in Ontario, where her husband urged her to file a claim. She did that  — and she did more. She went to law school in her mid-50s.

Human Rights Tribunal hearings look very different from a court cases: they take place in conference rooms in hotels or convention centres, and go on for a few days here and there. There’s no stenographer and therefore no transcript. The hearings are the last line of defence against discrimination and harassment, and the policy is to resolve cases in a “fair, just and timely way.” Yet under Doug Ford[the right-wing premier of Ontario]’s government, the number of full-time adjudicators dropped from 22 to 11, and hearings sometimes last years. The glacial timeline would be laughable if the stakes weren’t so high.

The original adjudicator in Cybulsky’s case announced his departure after a few days of hearings, which meant they had to start over. The delay was bad news for [the hospital’s] lawyers. With each passing day, Cybulsky sat in class at law school and soaked up knowledge. Sometimes, she’d have to miss class for the hearing, so she’d read ahead in her courses. [She and her husband] had a running joke about what would finish first: the HRTO claim or law school.

Law school won. She graduated in June of 2020.

In March of 2021, the tribunal found that Cybulsky’s rights were breached three times …

“It is an act of discrimination to fail to take seriously the applicant’s allegations about the relationship between gender and perceptions about her leadership,” the adjudicator, Laurie Letheren, the vice-chair of the Human Rights Tribunal of Ontario, wrote. “Her dignity and self-worth were undermined, and those consequences are directly connected to the fact that the applicant is a woman.”

The decision also faulted the hospital for not embracing Cybulsky’s gender. “One might have expected that having the only female head of cardiac surgery in Canada would be something that a teaching hospital … would want to celebrate,” Letheren continued. “Unfortunately, this was not the applicant’s experience. The role that her gender played in her experience in the context of this male-dominated profession was ignored.”

So she’s “vindicated,” she got the small settlement she asked for, and she’s building a life as a Canadian attorney. I am really drawn to the law-school response to her situation, and deeply respectful of the choices she made. And I can’t help feeling that there are two groups of people who lost a great deal in this story: women physicians coming up through the system, who will see how hard you have to fight even after your career is damaged; and the patients who won’t receive the skill and care she brings to solving problems.


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Doing Harm Could Do More Good


Debbie says:

Maya Dusenbery’s Doing Harm was in a position to be a really important book. Dusenbery’s deep research into sexism in medicine stems from her own experience being (fairly smoothly and quickly) diagnosed with an autoimmune disorder, and then learning just how lucky she was, compared to other women in her situation.

I was excited about this book, and glad to see that Huffington Post published a fairly long essay by Dusenbery summarizing some of her findings. And then I was horrified to notice that the essay, which Dusenbery describes elsewhere as an excerpt, does not address the relationship between racism and sexism (including such important stories as the perils black women face in and after pregnancy, and the terrifying story of Jahi McMath). The table of contents and index of the book are available on Amazon; looking them over, I see that Dusenbery does mention racial bias: however, she devotes fewer than 10 pages of her 300+-page book to these issues. The index entry for racial bias is far shorter than, for example, the index entry for postural orthotic tachycardia syndrome. Without in any way reducing the importance of that specific syndrome, I have to worry about a book that focuses on it to a far greater extent than intersectionality in medical bias.

From what I can glean from the Huffington Post piece and my research on Amazon, Dusenbery’s research is good and her focus on autoimmune diseases in women is valuable.

 [Since 1993, when the FDA permitted women to be included in medical research studies], the research community has largely taken ― as one advocate put it to me ― an “add women and stir” approach: Both men and women are usually included in studies, but researchers often do not actually analyze study results to uncover potential differences between the two. When it comes to pre-clinical research, male lab rats are still firmly the norm.

Dusenbery also treats some of the psychological history, starting (no surprise!) with Freud, and the range of ways medicine can dismiss [mostly] women’s symptoms:

It’s not surprising that it’s women who especially find their symptoms dismissed in this way since the typical patient with psychogenic symptoms has always been a woman. In the ’80s, researchers offered a mnemonic aid for remembering the main symptoms of somatization disorder: “Somatization Disorder Besets Ladies and Vexes Physicians.” These days, studies have estimated that up to a third of patients in primary care, and up to two-thirds of those in specialty clinics, have “medically unexplained symptoms.” And about 70 percent of them are women.

This needs additional text telling us what percentage of these women are black, or Latina. Substantial research (such as this) shows that skin color’s effect on symptom dismissal is intense and shameful. Women of color don’t only face far more roadblocks than white women in being taken seriously; they also face higher instances of some serious auto-immune diseases. In particular, systemic lupus erythematosis is known to affect black women at two to three times the rate it affects white women (and this number only takes diagnosed cases into account). However, Dusenbery’s index entries on lupus do not mention racial bias.

Trans people, by the way, merit four brief index entries, which seem to reflect no in-depth analysis whatsoever.

Judging from the quality of the Huffington Post excerpt, and Dusenbery’s well-deserved reputation, the book is probably full of excellent information, well-presented, and worth knowing. But unless everything I can determine from the excerpt, the table of contents, the reviews published on the book’s cover, and the index is all misleading me, and substantial treatment of intersectional issues is somehow present despite all the indications, Doing Harm is ultimately too flawed by privilege and bias. Anyone up for writing the book we need?