I decided to comment on the now famous (or at least viral) Google memo as an anchor point for social media on the blog. After making its way through the social media and into the mainstream media, I don’t think that it is necessary to say much about it other than it was written by a Google software engineer James Damore who was subsequently fired for the effort. I qualify my statements by saying that I do not know this engineer or anything about the corporate culture at Google other than what was written in his long memo. I do have 33 years of experience steeped in every aspect of medical culture. That includes working for corporations that have implemented many of the initiatives discussed in the memo. My overall take is that corporate politics can be dangerous to your health, but not because of major party politics.
The Memo presents a confusing introduction. The author states that he does not believe in stereotypes but proceeds to argue from that viewpoint. He discusses the predominate liberal atmosphere at Google and what that means in terms of liberal stereotypes. He refers to himself as a classic liberal, but at the same time complains about and refers to being discriminated against as a conservative. Despite the ample qualifiers, there is an implicit suggestion that due to inherently different characteristics – it may not be possible for a substantially male population in coding to be altered in material ways and that the programs in place to do an end run around this issue are not cost effective for the company. It is a strong argument to maintain the status quo.
As a kid growing up in the 1960s, female physicians were unheard of. In the subsequent decades all of that changed drastically. When I started in medical school, about half of the class was women, but women were substantially underrepresented in largely surgical specialties. There were clear problems with the transition. I can recall rounding where there were open arguments and verbal attacks based on gender by people at the same level of training. As a medical student I was privy to the private conversations of both sides and in those days it was all about gender. But thankfully only in a few areas. I had the opportunity to train with attendings and residents who were women and who were first rate physicians and academicians. Because of the gender based undercurrent, I also felt the backlash. Being an introvert is like being a projective test for some people. I got feedback from a male resident that the female attending on one of my rotations thought that I did not like women and that was just inaccurate. I attributed it and some other attitudes from a few women I encountered to biases they may have encountered along the way. I won’t say that did not have an effect on me – but it did not adversely impact my progress on the path to being a physician.
By the time I became a resident, half of my class was women. I viewed them as colleagues. They were all clearly as bright as I was. The farther I got into psychiatry, the more remote the gender biases seemed to be. I was eventually hired into a department that was largely women. It had a collegial atmosphere. In all areas of patient care, I never doubted that the work they were doing was at the level of my work. I would not hesitate to refer people to them or consult with them in tough situations and do so even today. In psychiatry, women are well represented in professional societies, scientific meetings and publications. I have never heard a male psychiatrist utter a word about women being less skilled or professional in psychiatry. It would be taken as an absurd statement.
The brief recap of my experience of gender representation in psychiatry has its limitations. It is my experience over 30 years in the field. It is in a field that is in short supply and may be dying – rationed out of existence by the government and managed care companies. For many years, interest in psychiatry was low. The problem has never been studied to my knowledge but my speculation is that enrollment by women in both medical school and psychiatric residency programs probably averted a much greater crisis. I can’t speak to the initiatives that got the enrollment in medical schools to go higher, but whatever it was – consider it highly successful.
That does not mean it was an easy transition. Although I never personally witnessed it, I have no doubt that women and minority students were treated badly at some point in their medical training. I base this on my own experience of being treated badly. There were clearly attending physicians who were not interested in the education of medical students and were openly hostile. I was ridiculed in front of one of my teams by the attending physician when he learned that I was going into psychiatry. "You don't want to work Dawson? Psychiatrists don't work as hard as other physicians and if I needed counseling I wouldn't see a psychiatrist". All of that was presented with a congruent sneer. I held back at that time at the time, and did not tell him it would probably take years of psychoanalysis rather than a few counseling sessions.
As a kid growing up in the 1960s, female physicians were unheard of. In the subsequent decades all of that changed drastically. When I started in medical school, about half of the class was women, but women were substantially underrepresented in largely surgical specialties. There were clear problems with the transition. I can recall rounding where there were open arguments and verbal attacks based on gender by people at the same level of training. As a medical student I was privy to the private conversations of both sides and in those days it was all about gender. But thankfully only in a few areas. I had the opportunity to train with attendings and residents who were women and who were first rate physicians and academicians. Because of the gender based undercurrent, I also felt the backlash. Being an introvert is like being a projective test for some people. I got feedback from a male resident that the female attending on one of my rotations thought that I did not like women and that was just inaccurate. I attributed it and some other attitudes from a few women I encountered to biases they may have encountered along the way. I won’t say that did not have an effect on me – but it did not adversely impact my progress on the path to being a physician.
By the time I became a resident, half of my class was women. I viewed them as colleagues. They were all clearly as bright as I was. The farther I got into psychiatry, the more remote the gender biases seemed to be. I was eventually hired into a department that was largely women. It had a collegial atmosphere. In all areas of patient care, I never doubted that the work they were doing was at the level of my work. I would not hesitate to refer people to them or consult with them in tough situations and do so even today. In psychiatry, women are well represented in professional societies, scientific meetings and publications. I have never heard a male psychiatrist utter a word about women being less skilled or professional in psychiatry. It would be taken as an absurd statement.
The brief recap of my experience of gender representation in psychiatry has its limitations. It is my experience over 30 years in the field. It is in a field that is in short supply and may be dying – rationed out of existence by the government and managed care companies. For many years, interest in psychiatry was low. The problem has never been studied to my knowledge but my speculation is that enrollment by women in both medical school and psychiatric residency programs probably averted a much greater crisis. I can’t speak to the initiatives that got the enrollment in medical schools to go higher, but whatever it was – consider it highly successful.
That does not mean it was an easy transition. Although I never personally witnessed it, I have no doubt that women and minority students were treated badly at some point in their medical training. I base this on my own experience of being treated badly. There were clearly attending physicians who were not interested in the education of medical students and were openly hostile. I was ridiculed in front of one of my teams by the attending physician when he learned that I was going into psychiatry. "You don't want to work Dawson? Psychiatrists don't work as hard as other physicians and if I needed counseling I wouldn't see a psychiatrist". All of that was presented with a congruent sneer. I held back at that time at the time, and did not tell him it would probably take years of psychoanalysis rather than a few counseling sessions.
I observed in those days that the abusive cultures seemed to be localized in private institutions. I naturally gravitated to the public ones - the County Hospital and Veteran's Administration Medical Center. In these places there was a certain esprit de corps. There was a lot of work. The staff were interested in caring for very ill patients with limited resources being available. There was generally a wide sampling of specialists and everyone seemed accepting of medical students and residents as long as they pulled their own weight. I met some of the best attendings and teachers in these settings.
The corporate takeover of medicine facilitated by the federal government created a hostile and authoritarian atmosphere. Instead of being responsible for your own knowledge and how you took care of patients you were now burdened with totally subjective administrative standards. The first was the new billing and coding standards. Miss a bullet point in the document and get accused of fraudulent billing. Send that bill in the mail and get accused of racketeering and go to Leavenworth. People may find that humorous now, but I can assure you that in about 1996, every physician in my organization had to attend a seminar and that is part of what we were told. As the feds transferred their power to intimidate to managed care organizations a whole new set of rules to intimidate and control physicians was put into place. The "disruptive physician" concept was suddenly co-opted from physicians with clear personality disorders to just about anything that a physician did that somebody did not like. In some institutions the accusations did not have to be witnessed or even factual. Some institutions just adapted a "three strikes and you are out" policy. In other words, if they collect 3 unsubstantiated, unwitnessed and (according to their rules) uncontested complaints - the physician could be fired. That was a discretionary rule, I have seen physicians fired for just one complaint. By the time the corporations had taken over, these rules were equally applied regardless of gender or race. I personally know male and female physicians who were fired or who just collected a strike or two. Equal oppression by the corporation may be the ultimate sign of egalitarianism.
I am going to digress for a minute on the science of the memo, because the author seems to invoke this theme several times, even to the point of offering to send more references. This memo is not a scientific endeavor, it is a political one. In that process, even the extremes of liberalism and conservatism will be able to come up with scientific papers to support their extreme positions. Even though there is a general consensus on climate change this is an example. Not everyone agreed with Einstein's revolutionary theory and at the time his work was highly politicized based in part on his ethnicity. The process of science is not designed to be taken in a political context. The other aspect of the science of the memo has to do with measurement. Measurement in the social sciences is a very approximate matter. It requires individualized expert interpretation in a highly specific context. I have lost count of the number of professional people that I know who were told by guidance counselors that they would never make it in college. Measures of personality and intelligence have significant limitations. They are not qualitative by any means. One interesting conceptualization of the problem is Massimo Pigliucci's graph of empirical knowledge versus theoretical understanding. On this graph, theoretical understanding of social sciences is definitely lagging. Even though there is a well publicized reproducibility problem in social sciences, I consider that to be expected rather than a problem that needs to be solved. In situations where the human conscious states is the subject of analysis, it is necessary to keep in mind that we have no adequate analysis of a very large number of possible states and how they overlap between men and women. There is nothing to suggest that interracial differences at this level are significant. Everyone has a somewhat heritable biological substrate, but in the case of the brain we have an infinitely plastic and complex organ that we are just beginning to understand. It is easy to mistake the positive and negative effects of socialization for a biologically inherent trait.
My experience in the workplace, at various levels of medical and scientific endeavor has made it very clear - irrespective of socialization or biology - men and women can function interchangeably doing the same tasks. The idea that one sex is intellectually superior or has personality characteristics that can lead to inherently better performance in the workplace is just plain wrong. I certainly can't speak to the workplace or political environment at Google, but I can say that the political environment in most real workplaces these days is dominated by corporate rather than major party politics. That corporate approach opens a number of avenues for the corporation to demand specific compliant behaviors from employees with possible penalties right up to termination. Squabbling about major party politics at the water cooler pales in comparison.
I am going to digress for a minute on the science of the memo, because the author seems to invoke this theme several times, even to the point of offering to send more references. This memo is not a scientific endeavor, it is a political one. In that process, even the extremes of liberalism and conservatism will be able to come up with scientific papers to support their extreme positions. Even though there is a general consensus on climate change this is an example. Not everyone agreed with Einstein's revolutionary theory and at the time his work was highly politicized based in part on his ethnicity. The process of science is not designed to be taken in a political context. The other aspect of the science of the memo has to do with measurement. Measurement in the social sciences is a very approximate matter. It requires individualized expert interpretation in a highly specific context. I have lost count of the number of professional people that I know who were told by guidance counselors that they would never make it in college. Measures of personality and intelligence have significant limitations. They are not qualitative by any means. One interesting conceptualization of the problem is Massimo Pigliucci's graph of empirical knowledge versus theoretical understanding. On this graph, theoretical understanding of social sciences is definitely lagging. Even though there is a well publicized reproducibility problem in social sciences, I consider that to be expected rather than a problem that needs to be solved. In situations where the human conscious states is the subject of analysis, it is necessary to keep in mind that we have no adequate analysis of a very large number of possible states and how they overlap between men and women. There is nothing to suggest that interracial differences at this level are significant. Everyone has a somewhat heritable biological substrate, but in the case of the brain we have an infinitely plastic and complex organ that we are just beginning to understand. It is easy to mistake the positive and negative effects of socialization for a biologically inherent trait.
My experience in the workplace, at various levels of medical and scientific endeavor has made it very clear - irrespective of socialization or biology - men and women can function interchangeably doing the same tasks. The idea that one sex is intellectually superior or has personality characteristics that can lead to inherently better performance in the workplace is just plain wrong. I certainly can't speak to the workplace or political environment at Google, but I can say that the political environment in most real workplaces these days is dominated by corporate rather than major party politics. That corporate approach opens a number of avenues for the corporation to demand specific compliant behaviors from employees with possible penalties right up to termination. Squabbling about major party politics at the water cooler pales in comparison.
It turns out that every corporation is an "ideological echo chamber" but that ideology originates at the level of the executives and the board of directors. It is overwhelmingly focused on the best interests of the corporation and not the employees. Attempting to impact that with a generally released memo like this one is a naive mistake and it misses the mark for many reasons. The commentary from outside of the organization is predictable given the source, and of course entirely irrelevant to the intended purpose of the memo. And lastly, Damore's ideas about why men make superior software engineers is possibly accurate but I doubt it. The women I have gone to school with and worked with were very bit as good as the men in those settings. Engineers may be tempted to say that medicine is not software engineering and that is true, but for some of us there are a significant number of quantitative sciences and mathematics courses long the way.
And it was always obvious to me that we need as many women in those classes and professional schools as possible.
George Dawson, MD, DFAPA
And it was always obvious to me that we need as many women in those classes and professional schools as possible.
George Dawson, MD, DFAPA
Supplementary 1: I could not work this into the main body of the post but the social media spin on this memo has been intense. Spins saying that it has the science right and spin saying that it has the science wrong. The author having to defend himself on the issue of whether or not he supports the alt-right. He said that women aren't good at tech and he has said that there are women who are good coders at Google. The reality is that women can do what men do and at no point in our history has there been more proof of that. That is a much different issue from corporate governance or politics.
Reference:
1: James Damore. Google's Ideological Echo Chamber. July 2017.
It is available from several sites on the Internet.
It is available from several sites on the Internet.
