Walking Out on the Boys. - Review - book review

Walking Out on the Boys By Frances K. Conley (Farrar Straus & Giroux, 1998. 240 pp. $24.)

In 1963, the year Frances K. Conley began medical school at Stanford University, folk artist Pete Seeger exhorted in A Letter to Eve: "If you want to have freedom, you have to have great anger Eve, go tell Adam we have to build a new garden for all God's children." His song became an anthem for women everywhere. By this time, however, it would not be an overstatement to say that Conley herself was already sealing an unconscious bargain with the devil in the overwhelmingly male world of academic medicine. In exchange for tolerating sexual harassment and gender discrimination toward her and other women in her work place, she was allowed to play at being "one of the boys."

Indeed, Conley herself ventriloquizes sexist attitudes in some dismissive early comments about other women: e.g., stereotyping some nurses as having entered their profession to "land" a physician-husband; apparently thinking herself enlightened to "find that nurses enjoy being part of the decision making;" and implying that secretaries, nurses, and wives of her fellow neurosurgeons are more appropriately "honey" than Conley. The insight and motivation necessary to fight for real respect at work were therefore long in coming for Conley, for whom it took 30 more years to recognize that she could not win equal treatment for herself or other women in medicine through her sufferance. Eventually, Conley rose to be one of the highest ranking women in academic medicine as well as her speciality of neurosurgery. Her encounters with blatant sexism, however, are the core of her book.

When she discovered the folly of her wager, however, upon realizing that the hostile attitudes and behaviors of "the boys" were choking the life out of her own human potential, passion, and talents - along with those of other women - Conley called Adam to the mat.

Walking Out on the Boys is Coney's commanding first person account of the effects of sexual harassment and gender discrimination on women in academic medicine; the callous uprooting of her own neurosurgical career which forced her to acknowledge these harms; and her ongoing attempts to cure medicine of sexism.

To dismiss Conley's painfully recognizable account of institutionalized sexism in academic medicine as "academic politics," or worse yet suggest that readers might "relish" the political "maneuvering" or "in-fighting" detailed therein -- as other reviewers of this book have done -- is to miss her point. Similarly, to characterize Conley's concrete, personalized documentation of gender discrimination in medical education and practice as "parochial," is even more perilously to risk not seeing its implications for all women and men. Such comments are examples of the very complacency from outsiders to academics that enables the social injustices Conley so compellingly documents to thrive and reproduce, unchecked by social censure or legal enforcement. Conley's point is not merely that injustices are being perpetrated by sexist individuals in medicine, causing harm to her and other individual women working therein, but that the institution of academic medicine is deeply saturated with sexist values, shaping gender discrimination and sexual harassment into accepted attitudes and behaviors. This status quo, she argues, is "maintained at almost any cost, including lying, cover-up, secrecy, and deceit when needed," through a rigidly hierarchical power structure, with serious far-reaching harms to women, enlightened men (including Conley's husband, supportive male colleagues, and young male students attempting to change this destructive culture), and society as well.

Among the practices Conley describes in detail are: ignoring or protecting repeat offenders (sometimes for decades); dismissing injustices as "personality conflicts," or applying psychiatric labels to the "difficult" or "crazy" women who dare to challenge inappropriate attitudes and behavior; and exerting any hostility or pressure necessary to drive such women out of particular institutions or out of academic medicine altogether. Indeed, one of the most chilling comments Conley relays is made by a lawyer from another academic institution, who responds to Conley's "victory" in catalyzing the termination of Stanford's unscrupulous Dean of Medicine saying he would have advised that Dean: "no matter what, don't ever let her come back on the faculty." Admittedly, Conley's broader argument is obfuscated by her slow pacing (almost two thirds into her book) in revealing her dawning realization of the implications of her own unfair treatment for others.

Apart from its compelling social justice argument, the main value of Conley's book is its remarkably well-documented expose of sexism rife at her own institution. No other book on the subject systematically translates the realities of sexism too prevalent in academic medicine, including its self-protecting and self-perpetuating strategies into a written account. The book therefore fills this gap and advances multiple important goals including: exposing and publicly censuring sexist attitudes and behaviors in medicine for a broader audience, and enabling their further study so that universities themselves, lawyers, and other concerned members of society can devise more effective deterrents and controls. This book can be highly recommended to women and men alike, especially those in (or planning to enter) academic medicine; educators and sociologists interested in addressing aspects of medicine's "hidden curriculum"; lawyers seeking to enforce civil rights; and all who may one day be patients or family members of patients, and possibly be confronted by a sexist medical culture which destroys human potential, and thus serves no woman, man, or society.

Dr. Catherine Myser is Director of Ethics and Clinical Ethics education, consulting; and research programs at the University of Vermont College of Medicine and Fletcher Allen Health Care. She has worked in numerous medical schools and hospitals in the United Sates and abroad, and was a Postdoctoral Research Fellow in the Center for Biomedical Ethics at Stanford University's School of Medicine in 1994-1995.

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