Drs. Tintinalli, Kass and Wolfe Respond to ‘Parenthood and Medicine, Each in its Season’

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Last month, Emergency Medicine News (EMN), a newsletter published by Wolters Kluwer, printed a letter to the editor that set off a firestorm. Penned by North Carolina emergency physician Geoffrey Martin, MD, the letter expressed the view that it is not within a woman’s nature to balance professional work with motherhood. One line clearly summed up the message: “Be a mom, be a wife, be a doctor, but each in its season,” writes Martin.

Readers reacted quickly and passionately, and Twitter was the first to blow up. Dozens of physicians – women and men alike – cried foul, calling it “shameful” that a professional magazine would give voice to these views. A few voices even called for a boycott of the magazine. 

EMN defended its decision to publish a controversial point of view in its letters section, calling the decision “our First Amendment obligation.” An official response from the newsletter claimed that it was the magazine’s policy to publish “all non-libelous opinions.”

Should certain unpopular opinions be censored? Does a publication have an obligation to print all viewpoints all the time? It’s not every day that an issue in emergency medicine sparks this strong of a reaction in our readers. It brought up important questions that are worth continuing to engage. 

In the spirit of open dialogue, Emergency Physicians Monthly invited Drs. Judith Tintinalli, Dara Kass and Jeannette Wolfe to respond to Dr. Martin’s letter and the issues it raised.

Have your own response? We welcome it. Send it to editor@epmonthly.com. We can’t promise that every letter will get printed, but we promise that they will be reviewed by our team of physician editors.

-The EPM Editorial Team


Judith Tintinalli, MD, MS
Parental Angst Knows No Gender

My kids and I were skiing in Park City.  I had to fly somewhere in Canada for an important ABEM meeting. Fine, I’ll miss just one day out of the week. But my teen-age daughter chose that day to ski a double-black diamond run. The allure of fresh powder, you know. My cell rang in the meeting. It was my good friend RJ. “Judy, we’re in the ED. Daniella screwed up her knee. We are all taking good care of her. She’ll be ok.” So I finished my responsibilities at the meeting, and flew back to Park City that night to spend the next few ski-less days with my daughter.   

I called Daniella today. “Do you remember that? How did you feel that I wasn’t there?”

“Just fine,” she said, “I had good ER docs and Ray Jackson was with me, and I knew you would come as soon as you could.”

I feel for Dr. Simons. I feel badly that she is a “martyr to her patients.” It’s tough to focus on clinical care when your mind and heart are elsewhere. A  kind, supportive EM family can help make a softer landing, for sure.

Dr. Simons’ pain was real and palpable. But try to think about her emotions as representing those of NOT THE PATIENT. And then think about how we, as emergency physicians, tend to slide by family and friends, focusing on the patient and sort of excluding the deep needs of a family member. Dr Simons’ story should make us sit up and pay attention to the needs of families as well as of patients. 

But change the picture. You’re a single dad, or out on a dad-only trip with your kids on a ski vacation. You have to fly to an ACEP Committee meeting. Your son (or daughter) wrecks her knee. You make sure she’s well taken care of, then arrive the next morning for hugs and kisses and lots of loving.

Does a Dad feel any different than a Mom in a situation like this? No way. The seasons change with age – your age, your children’s ages, your parents ages – but the tender feelings never go away.

Dr. Geoff Martin seems like a fine guy (based on a video on vitals.com). He seems proud to be an emergency physician. He gives food for thought when he writes “you can plan a little differently so that you can experience the richness and fulfillment [of both].” But change the words “women” or “moms” to “men” or “dads,” and you get the same angst. 

We all make choices. When we realize the pressures and choices become unbearable, time to re-calibrate. Emergency medicine provides us with a world of professional choices:  full-time, part-time, hardly-any-time, high-intensity, low-intensity. We are lucky. We are doctors. We are parents, sons, daughters, friends. We do the very best we can.


Dara Kass, MD
The Choice to Print Has Consequences

My reaction to Geoff Martin’s letter to the editor in EM News was different than most on social media. As the founder and editor-in-chief of FemInEM and a former contributor to EM News, I was far from shocked that Dr. Martin held such an opinion, or that EM News would choose to print it, for that matter. 

When the editors of EM News responded to the Twitter backlash, I was surprised. Their formal response was “…. We publish all opinions, our First Amend obligation.” Twitter responded “That’s not how the first amendment works, or what it means. Do you publish every editorial that’s submitted? Actual newspapers don’t.”

As the editor-in-chief of an online blog, I moderate and approve every comment on FemInEM. Occasionally I reject a comment. This is a not a suppression of the authors first amendment right, but an editorial choice I make to maintain the integrity of my publication. I frequently approve comments I disagree with, especially when I think they facilitate important conversations surrounding gender equity in EM.

What I do not do is provide a platform for opinions that are neither novel nor productive. I have no interest in re-litigating the issue of women working outside the home. Is it worth it? Are women happy? Is it right for society? Who will raise the kids? As far as I’m concerned these questions only amplify antiquated notions and take us a step back as a specialty.

And those editorial choices have consequences. To quote the twitter account FemmeMedStudent (@femme_med) “Students look at this stuff when choosing a field. Printing this makes females turn away bc it shows EM still gives a voice to misogynists.” To put it bluntly, our editorial choices matter.


Jeannette Wolfe, MD
Enough Divisive Potshots; Let’s Get to Work

It all started with an article about the tremendous conflict that one emergency physician felt after not being able to find last minute shift coverage and having to go to work while their frightened kid was having a medical emergency. The story underscored a struggle familiar to any person with dual citizenship in medicine and parenthood, but it posed a much deeper question. Where should the line be drawn between our responsibility to our profession and our responsibility to those whom we love? Not an easy topic to tackle and realistically the answers are complex. But as the likelihood of an unanticipated personal emergency ultimately occurring within a group of physicians is rather predictable, this question is important and legitimate to discuss. Therefore, I was quite surprised when I read an editorial comment on the piece that did not focus on suggestions as to what should trigger emergency coverage or how that coverage should be set up. Instead it implied that the whole discussion would be much less of an issue if women simply sequenced their lives such that they were either moms or doctors. If it is not apparent by now, the original piece was written by a divorced mom and the response by a male.

Alright, I’ll be honest, right now my fingers are itching to sneak in just a few unfiltered comments. But here’s the thing, this is 2017 and 50% – FIFTY PERCENT – of those of us currently practicing emergency medicine are struggling with burn out. Our specialty is in trouble, this is not the time to be divisive. In the past 20 years, quite literally the face of our specialty has changed.  We are no longer made up of a majority of white guys who could delegate “family issues” to a stay-at-home wife.

Today, our specialty is diverse in skin color, religion, politics, generation and sexual preference. In an ever-changing, increasingly complex medical world, our specialty needs to seek out and hear the opinions of these diverse members so that it can be better positioned to solve difficult problems.

EM is also varied in its members’ interests. EPs work 24-hour shifts in remote back country clinics and they do clinical research in academic labs. They do podcasts and they develop academic curriculum. There is room for people in EM regardless of their clinical work load and it is critical our culture adjusts to recognize the different needs of its members during the different stages of their lives.

EPs are heterogeneous in physician scheduling. We can work full time, part time, per diem or locum tenums. Our goal as a specialty should be to help physicians be engaged and satisfied with EM over the long term. 

EPs are diverse in their family structures. Currently, many men in EM are responsible for significant amounts of direct family and household responsibilities because they are either partnered to a high powered professional or are divorced and single parenting. EM is also chock full of females.  Approximately thirty percent of current practicing EPs and 40% of EM residents are women. We are here, we are staying and what we need to be happy is simply the same thing that the rest of our specialty needs, and that is all the stuff written above.

We are at a critical time in health care and our specialty. There is no longer room within our community for divisive potshots. Let’s get to work and let’s find unity.

ABOUT THE AUTHORS

EDITOR-IN-CHIEF
Dr. Tintinalli is currently a professor and Chair Emeritus of Emergency Medicine at the University of North Carolina. In addition to teaching in the emergency medicine department, she is an adjunct professor at the UNC Gillings School of Global Public, and a frequent lecturer in the School of Journalism and Mass Communication. Dr. Tintinalli is double boarded in emergency medicine and internal medicine. She was the founder and first president of the Council of Emergency Medicine Residency Directors. She is a former president of ABEM as well as the Association of Academic Chairs in Emergency Medicine. She is a past winner of ACEP's James Mills award as well as ACEP's National Education Award. And of course, she is the Editor-in-Chief of 7 editions of her eponymous textbook, which is arguably the best-known EM text in the world.

Dr. Kass is the founder and editor-in-chief of FemInEM.

EXECUTIVE EDITOR
Dr. Wolfe is an Associate Professor of Emergency Medicine at Tufts School of Medicine’s Baystate campus.

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