LabCoatsOnce upon a time nurses were all women in hats and white skirts and doctors were readily identifiable by their formal dress, and deep, masculine voices. Changes in demographics, fashion and the health care teams have shattered these stereotypes.  In doing so, it has become more difficult for our patients and fellow practitioners to identify the diverse members of a modern health care team.

This week we present the case of Jenny and Justin:  a couple of residents who are struggling with the assumptions of their patients and colleagues that result from their youthful looks and – in Jenny’s case – gender.

The Concept

Inspired by the Harvard Business Review Cases and led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@BoringEM), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month (yep, we’re late this month, sorry!) we will pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses will be made available for download in pdf format – feel free to use them!

If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching game to the next level.

The Case

Submitted by Dr. Amy Walsh (@docamyewalsh)

Justin Chin walked in for his overnight shift, logged into the computer, and prepared to get sign-outs from the evening team. He noticed Jenny Whitely exiting a patient room wearing her crisp, rarely used white coat and struck up a conversation.

“Hey Jenny, how’s it going?”

“Oh, fine, busy,” she muttered as she briefly look up and smiled fleetingly, barely making eye contact.

In that moment, it struck Justin just how much Jenny looked like one of the harried junior residents on Internal Medicine. Next to an enormous stack of charts and paperwork, with her hair pointing in about 3 different directions and donning a white coat, Jenny definitely seemed a bit… off.

Determined to get to the bottom of this rather abrupt change, Justin prodded further: “What’s the deal with your white coat?”


“Did you decide to switch to IM or something?” he joked.

“Oh, I’d almost forgotten I was wearing it! No… I’m still EM through and through…” she said, snapping out of her paperwork induced daze. She briefly smiled, but then the look in her eye changed, however, and her face dropped as she continued: “I’m trying something new.”

“What do you mean?”

“Well, I think I’ve been asked how old I am eight times this week, and I’ve been frustrated by being mistaken for a nurse or an RT. Then the straw that broke the camel’s back was that a patient asked me if ‘they’ were going to discharge her.”

Justin could certainly relate to her impatience with questions about age. He had heard his fair share of “You look like you’re twelve!” from patients himself. But he didn’t understand what she meant about ‘they’, so he asked, “Was she admitted or referred to another service?”

“No! Here’s the kicker…I asked her what she meant… and this 40-year-old lady asked if a doctor would finally come see her!”

Justin had never… ever… seen Jenny so riled up. Clearly this was really bothering her. He sat down in the chair next to her, and asked: “I don’t understand. Why don’t they think you’re the doctor?”

“I’m not sure.”

“And your new fashion choice is related to this… how?”

“I’m wearing the white coat to see if people take me more seriously.”

“Why don’t you just introduce yourself as Dr. Whitely?”

“I do!!” she said, clearly exasperated by his suggestion.

“Then why do they think you’re a nurse?” Justin asked, his brows furrowed in confusion.

“I don’t know for sure… but I think it’s because I’m young. And a woman.”

“Nah, I think you’re being overly sensitive!” he said, patting Jenny gently on the back. “I mean, I get the ‘How old are you?’ a lot too. You know, if the patient’s sixty-five, we’re probably younger than their kids, but this is the 21st century.  Nearly half of all med school graduates are female. I’m certain you aren’t treated differently because you’re a woman.”

“I disagree. Gender biases still exist!  Maybe you just don’t see it because you’re a guy?”

“Maybe,” Justin shrugged. He still wasn’t convinced, but she was right, maybe he didn’t share Jenny’s experiences. Who was he to question Jenny’s experience as a female doctor?

Questions for Discussion

  1. As a young person, how do you cultivate a sense of authority and respect in your patients?
  2. How do you discuss differences in gender expectations and sexism within your residency program or medical school?
  3. Is there a problem with female physicians being mistaken for nurses? If so, what are the issues that might arise from this misperception?

We look forward to hearing your thoughts over the week (November 1-8, 2013).*

*Update (November 8, 2013):  On November 8, 2013 we posted the expert & community responses to this above case. Click HERE for a link to the Expert & Community responses, which include words from:

Thanks as well to Dr. Amy Walsh (@docamyewalsh) for developing the case.

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.  Also, as always, we will generate a curated community commentary based on your participation below and on twitter.  We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

Brent Thoma, MD MA
ALiEM Associate Editor
Emergency Medicine Research Director at the University of Saskatchewan
Editor/Author at
Brent Thoma, MD MA