Navigating The Authority Gap as a Trans Women in Medicine

I've been thinking all week about what to talk about for Trans Awareness Week. There hasn't really been a topic that has jumped out to my mind. I've had a couple of suggestions but I haven't quite found the right way to talk about them so they'll have to wait until I do.

Being devoid of inspiration I got up at 4am last Monday to go and support my amazing friend Dr Sarah Holmes as she was completing a 24 hour 'Abbathon' running and cycling to Abba music for 24 hours. You'd think that would be

enough but she's actually completing 50 challenges before she's 50 all in support of Marie Curie, who provide care and treatment for people at the end of their lives. She does that along side being Marie Curie's Chief Medical Officer. Anyone that knows me know that to me she is my inspiration in Palliative Care: she is an incredible doctor, leader and mentor and I'm lucky to know her. So please go and sponsor her. (https://www.justgiving.com/fundraising/sarah-holmes79)

Anyway it's 5am, she's been running for 12 hours straight and I've gone in to offer some moral support and marathon brownies (see what I did there?!). She's still plodding away to the background music of Abba B-sides and we start talking about a book she's been reading called 'The Authority Gap' by Mary Ann Sieghart.

How she has the presence of mind to discuss such a complex topic at this stage I don't know but we talked about how fundamentally in life women are seen as less authoritative than men. Men will often be deferred to in a room and women ignored even when they are the senior or more highly qualified. It sounded like a thoroughly interesting book and generally if Sarah recommends something it's worth pursuing. So this week I've been listening to the audiobook version.

The second chapter discusses a subject close to home. It talks about the experiences of trans men and trans women and how their perceived authority changed following transition. There's good research showing that trans men as they are perceived more and more in their lived gender start to get listening to more, spoken over less and generally thought of as more useful. Of course trans women face the opposite they lose authority as they are perceived more of as female.

This made me reflect on a particular intersection that trans women face called transmisogyny. That is the experience of sexism and ridicule of femininity along side the particular virulence that is aimed at trans women for daring to give up male privilege. This intersection was described by Julia Sereno in Whipping Girl.

We see that throughout discourse around trans people today. Often it is trans women who are mocked for being 'men in dresses' or portrayed as a threat, alongside facing significant issues of sexism such as sexualisation, reduced income and other misogyny that cisgender women face. It's not something trans men face although they of course face their own issues.

So what's my experience been? I absolutely recognised the authority gap in medicine pre transition. Palliative care is a very female dominated specialty and so my seniors were often brilliant, highly skilled and knowledgable women (like Sarah!) but merely by being 'a man' I would often find patients directing questions at me or talking to me during consultations and having to redirect their focus to the consultant. I often had to restate things that my female colleagues had said in teaching or meetings as they hadn't been heard or dismissed. When I said them they were listened to even though they weren't my words. ( I obviously made sure my colleagues got credit too!).

How about now? I don't pass, but I am clearly a trans women and am seen as such, as I talked about here. I noticed just before I left my last job that I was getting frustrated at not being listened to, to saying something being ignored and then someone else saying the same thing 5 minutes later. I assumed it was part of the reasons why I left my last job and didn't think much of it. I didn't have 'juniors' as the community consultant so only experienced patient interactions as 1-1. I haven't worked on an inpatient unit properly since before I became a consultant so my experience was based on how I was treated pre transition.

In my new job I'm the inpatient consultant and so have a group of doctors working with me. I don't really operate a hierarchy but in reality I'm the senior

clinician on the ward. Has my experience changed? Absolutely. I'm now the one following the patients gaze to the nearest man, even though I'm clearly leading the consultation. I'm having to spend time explaining why it's ok to just go with my plan and why they don't need to discuss it with 'That nice man doctor as he seemed to know what he was talking about'.

They don't mean anything by it, it's just socialised behaviours but goodness it makes everything take just that bit longer and harder.

Whilst I was aware of the authority gap I didn't quite realise how much harder it made things.

So really this post is a shoutout to all women who have been doing more and doing better in life despite having to swim against the tide of society when men have been coasting along in its current. I've only just turned around and started swimming against it too and goodness has it given me a whole level of respect for everything you've all achieved and done.