Women in Medicine

Podcast Transcript

Announcer:
Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart and Vascular Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Dr. Jellis:
Welcome. I'm Christine Jellis. I'm a staff cardiologist here at the Cleveland Clinic and I'm excited to have with me today one of our pediatric surgeons, Dr Tara Karamlou. Tara is a fabulous surgeon. She's also an amazing researcher, mentor to many, teacher, mother, wife. She really has the whole package going on, and I think it's a wonderful opportunity for us to sit down today and talk about some of the issues that we face as women within medicine, and specifically within surgery.

Dr. Jellis:
These are issues that make the work-life balance sometimes challenging. But I think there are some advantages about being a woman in this area as well. So today we're going to explore that, and hopefully Tara can give us some insights into what her life is like. So let's just start by looking at the challenges that you might face in the world of medicine and more specifically in the world of surgery.

Dr. Karamlou:
That's a great question, Christine. I think that as a female cardiothoracic surgeon, probably the biggest challenge in my career, and when I've talked to colleagues, they've also articulated similar challenges, is that we don't really have a peer group, a group of colleagues that we can rely on analogous to what our male counterparts have every day. And I think that we greatly underestimate the benefit of that type of peer group.

Dr. Karamlou:
It's not only helpful when you start your career and you're needing to talk through a challenging case, or maybe you had an outcome that wasn't what you expected and you just need somebody to talk to that, talk to about that experience. So I think those kinds of interactions, but also to celebrate your accomplishments and to feel good about what you're doing every day. That sense of team comradery. I think we miss that more than we think as female cardiac surgeons.

Dr. Jellis:
Certainly, we've seen the number of women going into cardiac medicine both as physicians and surgeons is increasing, but still really only a small proportion of the entire workforce. There are some organizations that are actively working to promote women being recruited to these areas. The Women in Thoracic Surgical Group is a group that comes to mind, that perhaps you could tell us more about that group and others that are actively working to promote women in the surgical areas.

Dr. Karamlou:
Yeah. The Women in Thoracic Surgery is really one of, I think the seminal organizations that has highlighted the need for women to, I think, develop their own parallel initiatives. And before I answer your question directly, I just want to address one of the concerns that I had about really becoming engaged in that organization. And that is the very fact that in some ways these women organizations exist, I think refocuses us on the gender disparity gap that is a reality.

Dr. Karamlou:
So, in other words, why do we need a Women in Thoracic Surgery organization? Why can't we just be part of the larger society of thoracic surgery organization to which all of our male counterparts belong? Having that peer group, that is an essential component of success in our field and connecting with other women who are poised to elevate you in your career and to support you in your career. I think that is the ethos of the WTS or the Women in Thoracic Surgery.

Dr. Karamlou:
So, right now Shanda Blackmon is the president of that organization. She's a general thoracic surgeon who is terrific. But it is really spearheaded by women leaders like Valerie Rusch. I don't really count myself as one of those leaders yet, but I have been on the leadership of the WTS for four years now. So hopefully as a stepping stone to really becoming more actively engaged in developing some of the initiatives that I think will help shape our specialty.

Dr. Karamlou:
I think it's a terrific organization. I think it took me a little bit of time to really warm up to the idea of joining it, to be quite frank with you. But it has been one of the most rewarding parts of my career.

Dr. Jellis:
Tell me a little bit about the current initiatives. There's some exciting podcasts and audio visual media events that are happening. And I think that our audience would be keen to hear more about that.

Dr. Karamlou:
Yeah. At the Southern Thoracic, which is a regional meeting of cardiothoracic surgeons and pediatric cardiac surgeons like myself, it's in early November. And the WTS or the Women in Thoracic Surgery, has devoted the preamble to that meeting, really a little bit of a leadership retreat for the executive of the WTS, but also as a vehicle for us to have these podcasts. So each one of us, and I think there's about six or seven presentations, is a little snippet about what resonates with you as a message to other female cardiothoracic surgeons, or, actually, I dare say, you could extend that to any female practitioner in whatever specialty.

Dr. Karamlou:
I mean, you could even be a lawyer, a business woman. It's really a challenge for women, career women, professional women to look inside themselves and to find that message that resonates with them and that they can leverage to elevate themselves. And I think that's the real idea, the concept behind these podcasts.

Dr. Karamlou:
My particular one is maintaining your female identity, which really resonated with me. And I think there's several others that are analogous and like messages. But it should be a terrific session and these should be available for people to watch, and to utilize, and to share with their female colleagues and their daughters and their grandmothers. I mean, we're all women and I think we all continue to excel in our own spheres of life. So it's going to be really cool.

Dr. Jellis:
I think you summed it up well that you said a lot of these messages are not just applicable to surgery or medicine, but it's really the broader community and women in different fields of practice, whatever that happens to be. I think we can all learn from each other and hopefully bridge some of these traditional barriers between us that I think we'll increasingly find very useful.

Dr. Karamlou:
Yeah, absolutely.

Dr. Jellis:
I think there's some good data that's come out recently to show that patients with female physicians actually do better, which I'm going to keep talking about that for years to come.

Dr. Karamlou:
Sounds amazing.

Dr. Jellis:
But I think there's some real advantages about being a female physician. And I know we talk about the challenges at times, but perhaps you could speak a little bit about the advantages, and for the young women who might be watching, to hear about what might attract them into a field of surgery and medicine in general and the positives that we can get from it.

Dr. Karamlou:
Yeah, I mean, that's a very interesting question, and a little bit of a turnabout. But I think there are a couple of things that women I think maybe do slightly better than men. One is build collaboration. I think part of the socialization of women, especially in contemporary society, is still one of the peacekeeper, of the hostess in some ways, sort of smoothing things out. I know I certainly played that role in my family. Whenever we played Monopoly and my dad was losing, it was always like, "Something isn't right here."

Dr. Karamlou:
So you always have that sense of wanting to balance things and make sure that you're being inclusive. So inclusivity, collegiality, and building collaboration I think is the first component of that. I think the other component, and I know that my male colleagues may not agree with me, but I think patients will, women have, I think more empathy and I think they have a way of viewing medicine that is in some ways more human.

Dr. Karamlou:
I know certainly as a mother, when I counsel other women either in fetal life or postnatally, I always open the discussion by saying, "As a mother, this is what I would want." And I can't tell you how many times after those initial dialogues, after all of the recovery and convalescence and acuity is over, I have had so many moms and even dads come up to me and say, "When you told me you were a mom, I just felt like I could relate to you." And I think that that is a real phenomenon. So I think that that compassion, that humanism...

Dr. Karamlou:
Sometimes we shy away from it as women because we want to seem impenetrable, like the surgeon who's indestructible. But I think that human component actually makes us much better physicians and certainly better caregivers.

Dr. Jellis:
Oh, I definitely agree, and I think additional qualities that I think we can often bring to the table are just being a good listener.

Dr. Karamlou:
Oh yeah. That's a great one, for sure.

Dr. Jellis:
I always say to my medical students, "Just sit back for a couple minutes and listen to the patients, and they'll give you most of the information if you'll give them a chance to talk." My husband would say I usually talk too much, so I have to restrain myself from that.

Dr. Karamlou:
Same as mine.

Dr. Jellis:
I think communication and listening certainly play a big role. One interesting question that I would like to ask is what advice would you give to your younger self, to someone who might be in high school or college thinking about a career in medicine and surgery, what pills of wisdom would you have benefited from not so long ago when you were in that position?

Dr. Karamlou:
Yeah, that is another I think very relevant question today when, as you say, more women are potentially going into the field. I think what I would tell women is that you can definitely... I don't want to use a cliche but have it all, but you need to be very careful about compartmentalizing your life to maximize the opportunity that you're going to be successful and reach the ceiling that you want to reach.

Dr. Karamlou:
What I mean by that is if you don't plan, if you don't organize your time, you will end up in some ways not achieving the level of success that you may want. So meeting your expectations for your career growth, but also not neglecting your responsibilities or your desires as a mom, as a wife, as a friend, as a daughter. And I think that I was not as good at that, kind of finding that equipoise.

Dr. Karamlou:
But one my mentors, who really was sort of the force that led me to pediatric cardiothoracic surgery, I went into his office and he asked me, do you want to write this chapter? And of course, I said, "Absolutely, I do," because we know you always want to accept challenges head on. But then he said, "You know, Tara, do you know what a Yes-No button is?" And I said, "No, I've never heard of a Yes-No button." And he said, "A Yes-No button," and he pulls out this thing that had a yes on one side of it, and you turned it around and it had a no on the other side of it. And he says, "You need to get better at using your Yes-No button."

Dr. Karamlou:
And I said, "Well, what do you mean by that?" And he said, "You always say yes to things," right? That's what we're told. When someone asks you to write a chapter, to write a paper, to stay late for a case, to take on this complex patient, our immediate professional response is yes. But he says, "When you are saying yes to other people, your Yes-No button, it's flipped this way. It's saying no to yourself. And it's saying no to your own personal choices and all of the things that make you whole as a person."

Dr. Karamlou:
And so he said, "Whenever you are saying yes, just keep in mind that there is a price to be leveraged, and that price is that in some ways you are coning down your personal existence and who you are." He was an amazingly successful pediatric heart surgeon, and I was just looking at him thinking, "Well, are you very good at using your Yes-No button?" But I've never forgotten that moment. And I occasionally still don't use my Yes-No button very well, but I've gotten better at it.

Dr. Karamlou:
I think that would be the message I would impart to anybody that wants to be in the best field ever, which is pediatric heart surgery. You have to keep those compromises in mind.

Dr. Jellis:
Absolutely. And I think the importance of mentorship, as you've just illustrated, is huge.

Dr. Karamlou:
Yeah, it's critical.

Dr. Jellis:
And that mentor may be someone that you feel affinity towards, that reflects you. Or it could be someone completely different who might be able to give you a different perspective on life and challenge you to do things that you wouldn't have otherwise done. I think I've had wonderful mentors along the way, some of whom have been women and continue to be women. But I also had some wonderful male mentors as well who've taught me a lot and perhaps challenged me to set my dreams higher than I would otherwise have done.

Dr. Jellis:
So I think for those young girls out there who might be thinking of a career in medicine, I think having multiple mentors is really helpful, and sometimes asking the right questions or having people that are going to give you useful tips and tricks of how to face those challenges.

Dr. Karamlou:
Yeah. I think that mentors give us advice, and people always say, Advice is what you ask for when you already know the answer, but wish you didn't, right?

Dr. Jellis:
Mm-hmm (affirmative).

Dr. Karamlou:
So I think mentorship, I think, inherent in that notion is that sometimes mentors have to really tell us the hard truth that may sometimes be difficult to hear. So I think mentorship is, as you say, absolutely critical. I think you look for mentorship wherever you can find it, but I think it's a two-way street, as you have to accept mentorship, and you have to in some ways, take that advice that you might not want to take.

Dr. Karamlou:
If somebody says, "I think you would be really good at this. You're focused on this, but I really see something special that you can contribute to this initiative." I think sometimes you may have to listen to that even if it's not what would be obvious to you from the outset?

Dr. Jellis:
Definitely. When I think about you Tara, I think about national, international leader, a little bit of mystery.

Dr. Karamlou:
Yeah, yeah, for sure.

Dr. Jellis:
A mother, wife, clinical par excellence surgeon, mentor, teacher. What else have I left out? How do you find time for yourself amongst all that? How do you maintain the essence of who you are, your femininity in a otherwise male-dominated world? How do you carve time out for yourself?

Dr. Karamlou:
Well, I think you always have to have a little bit of sparkle in your life. So even if you're wearing scrubs, I wear a little bracelet that I usually keep it hidden, but it's got a little sparkly butterfly on it. And so, I think you have to maintain a little bit of that edge and things that make you feel confident and make you feel female. I think you have to hold onto those things because I think that being a woman as we've discussed is really an asset. It's something to be treasured and something to be celebrated.

Dr. Karamlou:
But I think in today's world, especially in cardiac surgery, you need to be cognizant of the perception that others have of you. So I think sometimes while you may want to just be all out there, sometimes you have to reign things in a little bit and have that perspective on life. But I would say the most important thing is to carve out time for things that you really love.

Dr. Karamlou:
For me, it's running. I do like to shop, I have to admit. But now I shop for my daughter more so than for myself. So I rationalize it that way. If I buy a lipstick every once in a while, it's okay. So I think those things are really important, and having friends and colleagues is really critical.

Dr. Jellis:
Definitely. I think one thing here at Cleveland, we've managed to create some of those friendships that straddle different areas of medicine, and I personally find that very rewarding and hopefully this is just the beginning. Hopefully, for you girls watching out there, we'll see more of you heading into the field of medicine and perhaps specifically pediatric surgery and pediatric heart surgery in the future. But thank you, Tara, for such a wonderful conversation today.

Dr. Karamlou:
Oh, you're so welcome. This has been great.

Dr. Jellis:
Hopefully, we'll be able to do it again soon.

Dr. Karamlou:
Great. Thanks.

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