Dora Benedict Goldstein
The road to medical school may be traveled upon by as many women as men these days. But, until recently, the path was a rocky and lonely one for women. Indeed, it nearly petered out more than once over the past century and a half-a fact that has largely been overlooked even by the first women to enter Harvard Medical School.
"We had no idea that a preceding century of strife and anger helped us get in," said Dora Benedict Goldstein, HMS class of 1949, speaking at an Alumni Day symposium during graduation week.
The symposium provided an occasion for HMS women graduates-past and present-to reflect on their personal experiences as medical students and, more generally, on the history of women in medicine.
From the admittance of the first female, Elizabeth Blackwell, to a medical school in Geneva, N.Y. in 1847, "women [medical students] have walked a long road," said Goldstein, professor of molecular pharmacology, emeritus, and co-director of the faculty mentoring program at Stanford University School of Medicine.
During the 19th century, many women apprenticed to local doctors and had to apply to many schools before finding one that would admit them. The schools that did so were often out-of-the-mainstream, alternative institutions, such as schools for homeopathic medicine. Women that were accepted by traditional American medical schools often had to sit behind a curtain "so they would not distract the easily distracted men in the course," Goldstein said.
However, a few Victorian customs actually played to the advantage of women. Because many women patients did not feel comfortable removing their clothes in front of male doctors, they often sought out other women, creating a demand for female doctors. By 1900, 18 percent of doctors in Boston were female.
But with the turn of the century-and the falling away of such Victorian mores-the demand for women doctors ebbed. Also, changes in medical education were forcing many of the alternative medical schools that admitted women to close. "And that put women all the way back to square one," Goldstein said.
In fact, very few women entered medicine during the first few decades of this century. Women were denied entry to HMS until 1945. "No explanations were given or thought to be needed," Goldstein said, adding that at least HMS did not resort to "the small size of women's brains or the delicate nature of their physiology or moral nature. Harvard simply said it was inexpedient to admit women at this time. A gentlemen's rebuff."
HMS finally opened its doors to women in 1945, a decision motivated by the loss of young men to the war effort. The Harvard Club also opened its doors-though not the main entrance-to women. "We had to go in the club by the back door," said Goldstein.
Once she arrived at HMS, Goldstein says her life was pretty much "like any medical student": long nights spent studying muscles and bones, hours in the operating room. There were "little humiliations and annoyances" perpetrated by resentful upper classmen, but these were "trivial," Goldstein said.
But Stephanie Pincus, class of 1968, was less dismissive of the difficulties encountered by women at HMS. Pincus, who is professor and chair of the SUNY at Buffalo Department of Dermatology, told of the isolation she and her female classmates experienced at HMS. "If one considers going to medical school a ball game, we weren't even on the playing field," she said.
For some women now at HMS, the marginalization process began long before they got into medical school. Donella Green, an M.D./Ph.D. student in the class of 1998, was told by a college professor that she had gotten into HMS-"over other qualified people"-because she was a minority woman.
"Even after coming to HMS, I was not able to dismiss these comments," Green said. "I have an overriding sense that I am constantly being judged, and that my accomplishments reflect not just my own abilities, but those of my gender and my race."
--Misia Landau
Joan Goldberg
As more women become doctors and gain a voice as leaders in
the medical community, they are putting a sharper focus on
women's health. Such a focus, they say, is sorely needed.
Mortality and illness rates for adolescent girls and poor women of all ages are increasing in this country and in many others around the world due to a lack of access to health care and a lack of awareness about the health risks that women face at various stages of their lives.
"Seventy percent of interns report insufficient knowledge and training in all areas of importance in adolescent women's health," said S. Jean Emans, Harvard Medical School associate professor of pediatrics.
Emans spoke at the HMS class of 1970 symposium on women's health, held during graduation week. Members of the class of 1970 who are now involved in providing health care to women spoke on such issues as adolescent health, HIV in women, and abortion. The consensus was that there will have to be more public education and also more research on issues pertaining to women's health if the trend toward greater morbidity and mortality is to be reversed.
Parents also are in the dark about the health risks-of sexually transmitted disease, smoking, drinking, suicide-that are facing adolescent girls and young women today. "It's someone else's problem, but certainly not in my own family" is the prevailing attitude, said Emans, who is co-chief of the Department of Adolescents and Young Adults at Children's Hospital.
Perhaps most dangerous is the lack of awareness on the part of women themselves. "There's less of a realization that women are at risk for AIDS both from the woman's point of view and the health care provider's," said Joan Goldberg, HMS clinical instructor in medicine and director of the AIDS program at Harvard Community Health Plan.
In addition to a dramatic rise of AIDS in women, the incidence of other sexually transmitted diseases, pelvic inflammation, pregnancy, abortion and rape is growing, the speakers said. Suicide, homicide and accidental deaths also are increasing as causes of death in the adolescent female population.
Meanwhile, a study of a Long Island community shows that parents grossly underestimate the rates of sexual activity, drinking, drug use, and the use of weapons among their own children. "We're quite optimistic about what our own youth are doing," said Emans.
To make matters worse, the growing trend to cut health costs is leading health care providers to turn a blind eye to the risky behaviors of their adolescent female patients, Emans said. "There's a real philosophy among health care providers that if you don't ask, you don't need to do [a medical test]. If you don't ask whether adolescent girls are sexually active, you don't need to do a Pap smear."
This philosophy comes at a time that young girls are inundated by a flood of messages-piped in by MTV, television, movies, magazines and advertisements-encouraging them to engage in sexual activity. These messages may range from the blatantly sexual music videos seen on MTV to the more subtle advertisements shown in Seventeen, which depict women in bathing suits below headlines like "Dangerous but Fun."
Perhaps the hardest hit by the pervasive lack of awareness of women's health issues are adolescent poor women. They are at greater risk of becoming infected with HIV. And although they are only slightly more sexually active than average, the poor are more likely to give birth should they become pregnant.
"They don't have good family situations and anything else going on in their lives, and think having a baby is going to make things better, whereas more motivated kids are likely to have abortions," said William Bours IV, a graduate of the class of 1970 who now practices family medicine in Forest Grove, Ore.
From a health perspective, bearing a child may pose a greater risk than abortion, which is a relatively safe procedure, Bours said. "I don't think any other single medical advance has had a bigger impact [than abortion] on the health of women in this country."
The health risk of carrying out a pregnancy is tragically compounded in those cases where a woman has been infected by HIV, Goldberg said. Many of the HIV-infected women that Goldberg sees in her program are Haitian immigrants who discovered that they had HIV only after giving birth to an infected child.
"These women tend to be isolated. They lack the emotional support networks that gay men have. And they often suffer from a tremendous amount of guilt," Goldberg said.
--Misia Landau
Preclinical Teacher: Abul Abbas
Clinical Instructor: Lewis First
"Done Most for the Class": Ed Hundert
Harvard Dental Alumni Association Gold Medal: Patrick Boyle
Dr. Norman B. Nesbett Award: Patrick Boyle
Harvard Dental Alumni Association Silver Medal: Christian
Meyer
Robert B. Reed Prize: Quan Li & Hong-wei Zhao
Samdperil Health Law Essay Award: David Studdert
Uwe Brinkmann Memorial Travel Award: Mercedes Becerra Valdivia
Charles F. Wilinsky Award Fund: Elizabeth Richardson & Jyun-Yan Yang
Francois-Xavier Health & Human Rights Essay Award: Bet Molnar
Albert Schweitzer Award: Rokho Kim
Andrew Arnold, associate professor of medicine, has been awarded an outstanding investigator award given by the American Federation for Clinical Research. He was recognized for his work using genetic tools in the study of endocrine tumor pathogenesis.
Thomas Gaziano, third-year HMS student, was one of four medical students awarded a $10,000 scholarship by the Massachusetts Medical Society Scholars Program. Gaziano was recognized for his community service and volunteer work.
Peter Glickman, first-year HMS student, has been selected to participate in the American Medical Student Association Foundation's 1995 Washington Health Policy Fellowship Program. Glickman is one of 15 students who will be introduced to the health policy process.
Frederick Jakobiec, Henry Willard Williams Professor of Ophthalmology, has received the Association of American Publishers award for the outstanding medical text printed in 1994. Jakobiec, along with co-author Daniel Albert of the University Hospital and Clinics in Madison, Wis., was honored for his book, titled "Principles and Practice of Ophthalmology."
Marie Clare McCormick, HSPH professor of maternal and child health, has been elected to join the Johns Hopkins University Society of Scholars. The society honors former postdoctoral fellows and junior and visiting faculty who have distinguished themselves.
Grant Rodkey, associate clinical professor of surgery, has received the Massachusetts Medical Society's Lifetime Achievement Award. Rodkey was honored for his lasting contributions to the practice of medicine and for his contributions to the goals of the society.
Richard Schwartz, assistant professor of radiology, has received a 1995 Toshiba America/RSNA Seed Grant. The award is given to support experimental investigation of hypertensive encephalopathy in animals.
"There may be a sentence or two different," says Linda Wilcox, the ombudsperson for HMS and HSDM. "We really tried to streamline the due process."
Under the updated system, formal complaints made against faculty members, appointees and trainees will be heard by a three-member grievance panel selected by a newly approved Standing Committee on Rights and Responsibilities. Members of the committee will be chosen this summer. Complaints lodged by or against students also will be presented to the committee.
As ombudsperson, Wilcox attempts to resolve these types of issues informally. However, when this is not possible, Wilcox turns to the procedures in the guidelines. "You want people to feel that they will have a fair hearing-if they are accused or if they are accusing. And so you develop a series of guidelines to say: 'This is what you are entitled to.'"
END
"Both programs are extremely highly regarded," says Bruce Cohen, associate professor of psychiatry at McLean. "And the combination is even stronger." Cohen will be co- directing the program with John Herman, instructor in psychiatry at MGH.
In its first year, the program is planning to accept 14 residents, six less than the total currently being trained in the two individual programs. The merger, and the decrease in residency positions, reflects the fact that patients are increasingly taking their emotional problems to their primary care physicians, rather than psychiatrists. In addition, there is a national trend toward training fewer specialists.
Residents in the four-year psychiatry program will be able to divide their training time between the two facilities, drawing knowledge and experience from both the inpatient care and day clinical care offered at McLean and the emergency and outpatient psychiatric care offered at MGH. The MGH psychiatric department also provides consultations to physicians on the hospital wards.
"I can't imagine a program anywhere in the country that has the strength and the depth that this program will offer," said Herman. "[The program] has an incredibly deep [pool of] faculty, and combining the two faculties is an incredible resource . . . . It's like having the first-round draft choice for five seasons in a row."
END
Fellows: (in front) Adriane Bembry, (l to r) Eric Blackiston, Diana Vaca, Fe Punsalan, Sophia Lin, IDHM Director of Education Neysa Dillon Brown and (not pictured) Emanuel Sanchez
A walk through almost any hospital tells much the same tale.
Minority orderlies, minority nurses, and, increasingly,
minority doctors on the wards. But very few people of color
in the upper ranks of management.
"To transform health care, we must transform the leadership of our hospitals. We must make sure it's representative of our communities, and it's not that right now," said John O'Brien, chairman of the Massachusetts Hospital Association and CEO of Cambridge Hospital.
O'Brien spoke at the launching of a fellowship program that will provide an opportunity for six minority students to work as summer interns in management positions in several of Harvard Medical School's affiliated hospitals and other health organizations in New England. Many of the students' activities will be coordinated by Harvard School of Public Health.
The internship program is sponsored by the Institute for Diversity in Health Management (IDHM), an Atlanta-based organization founded in 1994, which received some of its start-up funding from the American Hospital Association. The program encourages hospital administrators to see that cultural diversity in management may be essential for the success of their institutions.
"This is not just a feel-good, altruistic, right thing to do. This is a very competitive arena we're in. If I can get a leadership team that looks like our community, that can get into the community, that's good business," said O'Brien.
The idea for the institute was born four years ago when the American College of Healthcare Executives and the National Association of Health Services Executives commissioned a study to determine the number of African Americans in upper levels of health care management.
"They discovered what we intuitively knew all along: There are very few African Americans in the upper echelons of management," said Walter Johnson III, president and CEO of IDHM.
The institute's Summer Enrichment Program will place more than 100 students from 60 universities in 12-week internships this summer. In addition, IDHM sponsors career events in high schools and colleges, financial-assistance programs, professional-placement programs, and an extensive mentoring network.
"Mentorship is a very important part of your education and training," Kathleen Atkinson, director of health policy at the Massachusetts Department of Public Health, told this year's Boston-area interns.
During their internship, each student will be mentored by a senior executive, such as a vice president, president or CEO of a hospital or health care organization. Participating Harvard institutions are Cambridge Hospital, Children's Hospital and Deaconess Hospital.
Students will accompany their preceptors in their daily activities, attending meetings and seeing firsthand what a day in health services management is about. During the course of their internships, they will visit several health care sites and complete a final project.
--Misia Landau
WEDNESDAY, JUNE 28
Randy Rosen, BWH
Anesthesia Grand Rounds:
Toxemia of Pregnancy
7 am, Anesthesia Lecture Hall, BWH
Sally Trombly
Risk Management Fdn.
Anesthesia & Critical Care Grand Rounds:
Regulations of the Mass. Board of Registration
7 am, Sherman Aud., BIH
Faculty & Residents
Plastic & Reconstructive Surgery Grand Rounds:
Morbidity and Mortality Conference
7-8 am, CRI, 2nd Fl., NEDH
Robert Leffert, MGH
Shoulder Rounds:
Case Presentations
7:30-8:30 am, Lower Amp., Clinics 1, MGH
Benjamin Sachs, BIH
Ob/Gyn Grand Rounds:
Department Update
8-9 am, Riesman Lecture Hall, BIH
Ruth Tuomala, BWH
Anesthesia Grand Rounds:
HIV Infection and Pregnancy
8 am, Anesthesia Lecture Hall, BWH
Carlo Buonomo, CHMC
Surgical Grand Rounds:
Radiographic Evaluation of Bowel Obstruction
8:15-9:15 am, Enders Aud., CHMC
Greg Robbins, MGH
Infectious Disease Conference:
Marine Infections
Margo McGehee, MGH
Bartonella Infections in AIDS
8:15 am, Bigelow 8 Conf. Rm., MGH
Glenn Steele Jr., NEDH
Surgical Grand Rounds:
Colorectal Cancer - A Model of Progress in Translational
Research
8:15 am, Joslin Aud., NEDH
Ray Frizzell
U/Alabama
Medical Grand Rounds:
CF/CFTR
Noon-1 pm, Enders Aud., CHMC
Thomas Rocco
B/WRVA
Medical Grand Rounds:
Non-Invasive Imaging of Myocardial Ischemia
Noon, A406, Bldg. 3, B/WRVA
THURSDAY, JUNE 29
William Brugge
MGH
Medical Grand Rounds:
Endoscopic Ultrasound - Toy or Tool?
8-9 am, Shriners Burns Aud., MGH
Roderic Eckenhoff
MGH
Anesthesia Lecture:
Models of Anesthetic Actions
8 am, Clinics 3, MGH
Maturin Finch
N.E. Rehab. Hospital
Medical Grand Rounds:
Post-Stroke Rehabilitation
8:15 am, Hurwitz Aud.,
MAH
Risk Management Foundation
Gynecology Grand Rounds:
Writing the Medical Record
8:30-9:30 am, Meigs Conf. Rm., Vincent 228,
MGH
David Wiebers
Mayo Clinic
Neurology Grand Rounds:
Update on the International Study of Unruptured Intracranial
Aneurysms
9-10 am, Ether Dome, Bulfinch 4, MGH
Edith Ashley, HMS & Henry Mankin, MGH
Clinicopathological Conference:
Case Records of the MGH
11 am, Ether Dome, Bulfinch 4, MGH
James Krueger Rockefeller Univ.
Skin Disease Research Center Lecture:
Psoriasis - A Disease of Epidermal Keratinocytes and
Activated T Lymphocytes
Noon-1 pm, Carrie Hall Conf. Rm., BWH
Robert Rubin
MGH
Bone Marrow Transplant Conference:
Prevention and Treatment of Infection in the BMT Recipient
Noon-1 pm, Dana 1820, DFCI
Murray Mittleman, NEDH
Newborn Epidemiology and Health Policy Conference:
Study Design Issues in Neonatal Clinical Research
1:30 pm, 5th Fl. Conf. Rm., BWH,
221 Longwood Ave.
FRIDAY, JUNE 30
In Sup Choi & Christopher Ogilvy, MGH
Cerebrovascular conference
7 am, Gray 2 Reading Room, MGH
Prakash Masand SUNY/Syracuse
Academic Conference:
Update on Newer Antipsychotics
11 am-Noon, Pierce Hall, MH
Elly Trepman
N. E. Baptist Hospital
Spaulding Grand Rounds:
Dance Medicine
11 am, Conf. Rms. 8A & 8B, SRH
WEDNESDAY, JULY 5
Edward Lowenstein, BIH
Anesthesia & Critical Care Grand Rounds:
Development of Opioid Anesthesia
7 am, Sherman Aud.,
BIH
Joanne Oh, BWH
Anesthesia Grand Rounds:
Anaphylactic and Anaphylactoid Drug Reactions
7 am, Anesthesia Lecture Hall, BWH
Gary Strichartz
BWH
Anesthesia Grand Rounds
Basic Mechanisms and Clinical Pharmacology of Local
Anesthetics
8 am, Anesthesia Lecture Hall, BWH
David Sugarbaker
BWH
Surgical Grand Rounds
8:15 am, Joslin Aud., NEDH
Fred Rosen, CHMC
Medical Grand Rounds:
Forty Years
Noon, Enders Aud., CHMC
THURSDAY, JULY 6
David Hooper, MGH
Medical Grand Rounds:
Antimicrobial Resistance and its Control
Cyrus Hopkins, MGH
Tuberculosis - Are We up to the Challenge?
8-9 am, Shriners Burns Aud., MGH
Kenneth Miller
NEMC
Clinicopathological Conference:
Case Records of the MGH
11 am, Ether Dome, Bulfinch 4, MGH
FRIDAY, JULY 7
In Sup Choi & Christopher Ogilvy, MGH
Cerebrovascular Conference
7 am, Gray 2 Reading Room, MGH
MONDAY, JULY 10
Elizabeth Gaufberg Robert Joseph &
Lisa Rechtschaffen, CH
Medical Grand Rounds:
Primary Care-?Defacto Mental Health Care
Noon, Lecture Hall, CH
TUESDAY, JULY 11
Chris Miller
Genetics Institute
GI Research Seminar:
Transcriptional Regulation Through the IDX Factor in the
Pancreas
4 pm, GI Library, Jackson 7, MGH
Neil Resnick, BWH
Division on Aging Seminar:
Principles of Differential Diagnosis in the Elderly
4:30-5:30 pm, Trustman Board Rm., ST-208, BIH
WEDNESDAY, JULY 12
John Pawlowski, HU & Philip Hess, BIH vs. Chris Quartararo &
Stuart Hough, BIH
Anesthesia & Critical Care Grand Rounds:
Grand Debate - Smooth Muscle-Who Needs It?
7 am, Sherman Aud., BIH
Gary Strichartz, BWH
Anesthesia Grand Rounds:
The Pharmacology of Neuromuscular Blocking Agents
7 am, Anesthesia Lecture Hall, BWH
Lesley Gilbertson, BWH
Anesthesia Clinical Conference:
Rational Selection of Local Anesthetics
8 am, Anesthesia Lecture Hall, BWH
Robert Greenberg
U/New Mexico
Medical Grand Rounds:
Child Rights and Child Health - An Inseparable Connection
Noon, Enders Aud., CHMC
THURSDAY, JULY 13
Robert Levin, BCH
Medical Grand Rounds:
Asymptomatic Primary Hyperparathyroidism
8:15 am, Hurwitz Aud., MAH
Alan Aisenberg
MGH
Clinicopathological Conference:
Case Records of the MGH
11 am, Ether Dome, Bulfinch 4, MGH
Linda Cowell, SRH
New Beginnings in Rehabilitation Lecture:
Rehabilitation for the Brain-Injured Patient - Beginning
Again
11:30 am-1 pm, Conf. Rms. 8A & 8B, SRH
FRIDAY, JULY 14
In Sup Choi & Christopher Ogilvy, MGH
Cerebrovascular Conference
7 am, Gray 2 Reading Room, MGH
TUESDAY, JULY 18
Louis Caplan Tufts/NEMC
Clinical Crossroads/JAMA Case Conference:
An 80-Year-Old Man With Asymptomatic Carotid Artery Disease
9:30 am, Grossman Conf. Ctr., BIH
GI Fellows
GI Grand Rounds:
Interesting Cases From the Bigelow
11 am, GI Library, Jackson 7, MGH
Ronald Tompkins Shriners Burns Inst.
GI Research Seminar:
Hepatic Tissue Engineering
4 pm, GI Library, Jackson 7, MGH
Ruth Kandel, HMS
Division on Aging Seminar:
Diagnosis and Management of Dementia
4:30-5:30 pm, Trustman Board Rm., ST-208, BIH
WEDNESDAY, JULY 19
Eric Kindwall
Med. College of Wisconsin
Anesthesia & Critical Care Grand Rounds:
Clinical Hyperbaric Medicine - A Present-Day Perspective
7 am, Sherman Aud.,
BIH
Neil Kussick, BWH
Anesthesia Grand Rounds:
Malignant Hyperthermia
7 am, Anesthesia Lecture Hall, BWH
James Philip, BWH
Kinetics of Inhalation Anesthetics
8 am, Anesthesia Lecture Hall, BWH
Members of the Staff
Medical Grand Rounds:
Clown Rounds
Noon, Enders Aud., CHMC
Susan Beluk, SRH
New Beginnings in Rehabilitation:
Strategies for Headache Management
4-5:30 pm, 1 Brookline Place, Suite 503, Brookline
THURSDAY, JULY 20
David Kagle
MAH
Medical Grand Rounds:
Pain Management
8:15 am, Hurwitz Aud., MAH
T. Bernard Kinane
MGH
Clinicopathological Conference:
Case Records of the MGH
11 am, Ether Dome, Bulfinch 4, MGH
Lalita Haines, BWH
Continuing Medical Education Conference:
OCP Management
12:15 pm, 5th Fl. Conf. Rm., ACC, 850 Boylston St., Chestnut
Hill
FRIDAY, JULY 21
In Sup Choi & Christopher Ogilvy, MGH
Cerebrovascular Conference
7 am, Gray 2 Reading Room, MGH
Monday, July 24
Shahram Khoshbin, BWH
Medical Grand Rounds:
Temporal Lobe Epilepsy - What's Old and What's New
Noon, Lecture Hall, CH
TUESDAY, JULY 25
Danielle Harari, MGH
GI Grand Rounds:
Constipation in the Elderly
11 am, GI Library, Jackson 7, MGH
Joseph Alexander, MGH
GI Research Seminar:
Molecular Pathogenesis of Human Pituitary Tumors
4 pm, GI Library, Jackson 7, MGH
Ed Marcantonio, HMS
Division on Aging Seminar:
Recognition and Treatment of Delirium
4:30-5:30 pm, Trustman Board Rm., ST-208, BIH
WEDNESDAY, JULY 26
Jeff Cooper, MGH
Anesthesia Grand Rounds:
The Anesthesia Simulator
7 am, Anesthesia Lecture Hall, BWH
Pamela Douglas, BIH
Anesthesia & Critical Care Grand Rounds:
Cardiac Fatigue - Fact or Fiction?
7 am, Sherman Aud., BIH
Steven Garfin
UC/San Diego
Clinical Crossroads/JAMA Case Conference:
A 50-Year-Old Woman With Disabling Lumbosacral Spine Disease
7:30 am, Grossman Conf. Ctr., BIH
Deborah Barron &
Roger Russell
BWH
Anesthesia Clinical Conference:
Anesthesia Simulator - Case Correlations
8 am, Anesthesia Lecture Hall, BWH
Bruce Korf
CHMC
Medical Grand Rounds:
Molecular Diagnosis of Genetic Disease
Noon, Enders Aud.,
CHMC
THURSDAY, JULY 27
David Alper
MAH
Medical Grand Rounds:
Common Foot Problems
8:15 am, Hurwitz Aud., MAH
Mark Drapkin, Newton-Wellesley Hospital
Clinicopathological Conference:
Case Records of the MGH
11 am, Ether Dome, Bulfinch 4, MGH
FRIDAY, JULY 28
In Sup Choi & Christopher Ogilvy, MGH
Cerebrovascular Conference
7 am, Gray 2 Reading Room, MGH
