A Woman's Life in Medicine with Suzanne Koven, MD
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What is the main topic discussed in this episode?
At The Nocturnist, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
This episode of The Nocturnist Conversations is sponsored by Fabled. Fabled designs workwear for the modern woman in medicine. Founded by a physician, Fabled knows women in medicine deserve work apparel as thoughtful and bold as they are. Shop the collection at thisisfabled.com. The Nocturnist is made possible by the California Medical Association and the Patrick J. McGovern Foundation. I'm Emily Silverman, and you're listening to The Nocturnist Conversations. women have been excluded from the practice of medicine for much of the profession's existence. But fast forward a couple of centuries, and now women make up more than half of medical students in the United States. So can we say that the culture of medicine has finally shifted to be warm and welcoming and supportive of female physicians?
Why did women in the 1980s have to write their own maternity‑leave policies?
Not quite. My guest today, Dr. Suzanne Coven, graduated from medical school in the 80s, at a time when there were so few women in her residency program that she was asked to write up her own maternity leave policy. Her memoir is a testament to how some things have changed for women in medicine while others have remained the same. Today, Dr. Coven is a primary care physician and the inaugural writer-in-residence at the Massachusetts General Hospital. Before we spoke, I asked her to read an excerpt from her new book, Letter to a Young Female Physician, Notes from a Medical Life. Here is Suzanne.
Early on, I believed that displaying medical knowledge, the more obscure the better, would make me worthy. That belief was a useful spur to learning, but ultimately provided only superficial comfort. During my first year clinical skills course, an oncologist asked me to identify a rash. Mycosis fungoides, I blurted out, since it was one of the few rashes whose name I knew and the only one associated with cancer. My answer turned out to be correct, causing three jaws to drop at once, the oncologist, the patients, and my own. But the glow of validation lasted barely the rest of the day. A little further on in training, I thought that competence meant knowing how to do things. I eagerly performed lumbar punctures and inserted central lines and applied for specialty training in gastroenterology, a field in which I had little interest, thinking that I could endoscope my way to self-confidence.
My first few years in practice, I was sure that being a good doctor meant curing people. I felt buoyed by every cleared chest x-ray, every normalized blood pressure. Unfortunately, the converse was also true. I took cancer recurrences personally. When the emergency room paged to alert me that one of my patients had arrived there, I assumed that some error on my part must have precipitated the crisis. Now, late in my clinical career, I understand that I've been neither so weak nor so powerful. Sometimes, even after I studied my hardest and tried my best, people got sick and died anyway. How I wish I could spare you years of self-flagellation and transport you directly to this state of humility. I now understand that I should have spent less time worrying about being a fraud and more time appreciating about myself some of the things my patients appreciate most about me.
My large inventory of jokes. My knack for knowing when to butt in and when to shut up. My hugs. Every clinician has her or his own personal armamentarium as therapeutic as any drug. My dear young colleague, you are not a fraud. You are a flawed and unique human being with excellent training and an admirable sense of purpose. Your training and sense of purpose will serve you well. Your humanity will serve your patients even better.
Thank you for reading that. As you know, I loved this memoir. Thank you for sharing it with me a little bit early. I was feeling very special to have a sneak preview. And I wanted to open up this conversation by talking about the doctor origin story.
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Chapters
8 chapters
1
What is the main topic discussed in this episode?
0:00–1:09
2
Why did women in the 1980s have to write their own maternity‑leave policies?
1:09–8:51
3
What does Dr. Koven’s memoir reveal about early career imposter syndrome?
8:51–10:11
4
How did the “arranged marriage” to medicine turn into a love story for Dr. Koven?
10:11–12:46
5
What hidden sexism and racism did Dr. Koven experience during residency?
12:46–15:31
6
How does shame around dieting connect to gender expectations for female physicians?
15:31–20:07
7
Why aren’t more women in leadership despite making up the majority of med‑school classes?
20:07–23:47
8
What does it mean to be a healer versus a data‑entry specialist in modern medicine?
23:47–42:45