Dr. Jennifer Grandis on Harsh Medicine: Why Women Can’t Get Ahead in Science & Health Care

We're better than the places that we work.

I mean, the places that we work have many fine qualities, but they're just places where we work.

And they're subjected to societal forces, to political agendas, to, you know, competing priorities.

And remember what brought you to science and medicine.

What

was the passion that you had when you were a younger person.

And if you can still tap into that passion, don't squander it.

Hello and welcome to the Dr. Kristen Lyrely Show.

I am really, really excited about this one, you guys, because today I'm sitting down with Dr. Jennifer Grandis.

She's a fellow physician.

She's a researcher.

She's a leader.

She is kind of a legend, so you're lucky.

And her career has spanned the clinic, the OR, the lab, and the halls of institutional power.

And that's what we're going to be talking about today.

She has spent decades thinking about how careers in medicine and science actually get built, who gets seen,

who gets supported and who gets left behind.

And she has a new book.

It's called Harsh Medicine.

It takes a long look at the system and where there's room for improvement, especially for women in medicine.

So we've got a lot to talk about today.

Let's get into it.

Dr. Grandis,

welcome.

Thank you, Dr. Liarley.

And let's agree that titles matter.

And when women are introduced by their first names and men are introduced as doctor,

something we should pay attention to but I'm really happy if you want to call me Jenny today and I'll call you Kristen.

I love

that.

That was something that when I was first in practice as a young doctor we were all asked who how do you want to be addressed by your patients and I think we all felt like we want to relate to our patients so we started asking them to call us by our first name but then there was a respect

difference.

And so we all quickly transition to being doctor liarly or doctor whoever.

Your

name matters.

It does.

It does.

And especially when in general what we find is that the women are viewed as touchy-feely, as warm and fuzzy, as

friends and pals.

And so it just makes everybody, sometimes even the women, more comfortable being referred to by our first names.

And as I say, you know, for you and I to call each other anything other than by our first names would be very weird.

On the other hand, if you were at a meeting and your colleague was being introduced as Dr. Smith and you were introduced as Kristen, it would be somewhat jarring to you.

And that happens

all the time and the people who do it aren't bad people.

They are not aware of two things.

Number one, what they're saying and also how it feels to the person.

And I have to say this term microaggression, which maybe we'll get into, it

It softens the aggression part.

It makes us feel like, oh, it's not like a gunshot wound.

You know, it's just micro.

On the other hand, the accumulation of all these tiny little things end up making a person feel unwelcome at the very least and sometimes completely excluded at the

worst.

Right.

And it's not just calling us by our first name or addressing us as doctors so and so, but it's also people making the assumption that we're nurses instead of doctors, which I love the nurses.

We all love our nurses, but I remember being in medical school and sitting with a colleague of mine who was another woman and somebody asking us what we were doing and we said, we are medical students and we're studying to be doctors.

And he literally said, what kind of nursing are you going to go into?

He didn't hear at all what we said.

He just saw

us.

That's what we're going to talk about.

I once I gave a talk at a university in the south and on this topic and I said there's a group of physicians and I said can you raise your hand if you've ever been mistaken for being a nurse and every woman put up their hand and the men were like oh my god and it's because it happens all the time that we tend to just

You know, if we paid attention to it, we would obsess about it.

It would get in the way of our doing our work.

But at the end of the day, but here's what I learned, Kristin.

You know, I have walked through this life as a white person.

My skin is light and I'm also privileged.

I come from a highly educated background.

My parents were upwardly mobile and that has given me power that I didn't always appreciate.

And when I did my study and I interviewed some African American women physicians, they described being confused.

for being a housekeeper.

Oh wow.

And that has never happened to me and I want to say something really important here because I have a male colleague who is Hispanic.

He's first-generation.

Not long ago we wrote a book chapter together and he in the book chapter described here at our elite academic medical center coming into his operating room and somebody

Mistaking him for the cleaning person who was supposed to change the room over now the interesting thing is that because you and I Have that experience so regularly it doesn't get in our way of doing our job But this man could not move beyond it and what I tried to

Take from that experience is number one.

This was a way we could relate to each other I mean he could understand what women were experiencing because he had been subjected to those kinds of Assumptions based on maybe his accent and the color of his skin But what it also showed me was resilience gap Which is so interesting because I do think that the more fragile we are the more insecure we are and the less we have really

grappled with those gaps in security, the more apt we are to be somewhat blind to other people's suffering because we're so overwhelmed with our own disappointments.

I was just as a Gen X mom having this conversation with my Gen Z kids yesterday about how we drank from the hose and they can't handle that.

And we're going to get more into generational differences and how that makes a difference.

But let's go back to the beginning.

When you went into medicine, when did you realize that this work was going to be bigger than just being a doctor and working in the clinic and going to the operating room?

The things that we tend to think are going to be our normal lives.

It is not just that.

It's so

much

more.

Yeah.

Thank you so much for that question.

Well,

For me, it was really internship because I graduated from medical school in 1987.

I wanted to be a surgeon.

I chose otolaryngology.

Really it was pragmatic.

I had fallen in love with surgery on my general surgery rotations as a third year medical student.

And there were very, very few women and they were miserable.

And I was not yet married.

I did not yet have children.

And I thought, oh, I really want a full life.

I want to get married.

I want to have kids.

these women look really, really unhappy and I don't want to be this way.

So let me find a different neighborhood.

And so even though there were no women in most of the surgical subspecialties, the ear, nose and throat doctors were nice guys.

And so I chose it because they were nice.

And that's still true.

That's still, I think, a very fair assessment.

But I didn't think for a minute

that my being a woman was in any way relevant until I show up for internship.

I'll never forget orientation.

It's me and 18 men.

I could not ignore the fact that I was so different from everybody else by simply virtue of where I was supposed to, you know, get changed.

It was in the nurses locker room because there were really no women surgeons at the time.

And it was, and my response to it was

To pretend it wasn't true to say, you know, I'm gonna learn I want to learn how to be a surgeon I want to fit in but I'm going to Define my boundaries really sharply so that I don't behave I'm never in a situation where I behave in a way that I don't respect and so I you know I wasn't gonna date anybody, you know that I worked at the meeting, you know, whatever little policies that I made up and I

experience their behavior towards me mostly teasing but sometimes gross and really inappropriate I just look the other way I just you know one of my favorite anecdotes as I was on ortho you know as an intern and we met every morning in the ED at 5 a.m.

we went over all the traumas that come in the night before went over the X-rays

And then we walked to the ortho floor.

And after several days, the chief resident takes me aside.

I'm the only one on the service.

And he said, what happens to you?

Every day we lose you.

And I'm like, you walk through the men's locker room.

And he said, oh, and he didn't stop.

He just expected me either to just suck it up and walk through the men's locker room, which I wouldn't.

or I was just going to be a couple minutes late because I had to figure out a different way to meet them on the floor.

So was that a horrible thing to do?

No, but it gave me the message that was really clear, is you're different.

I don't want to believe you're different.

I don't want to actually take your difference into account.

So you were led into this because, let's face it, I was a really good medical student and I'm very likable and I was able to match there.

So we're going to accept that you're here, but we're just not going to change anything that we do in order to accommodate you.

And I don't think that that has really changed substantially in many, many branches of medicine.

It's like the big gift was letting us in because guess what?

We're really smart and competent.

But when I still see department sanctioned activities before seven in the morning,

or meetings that start at, you know, five, six at night.

I think how are the people who have young children and don't have the resources to have full-time childcare help?

How do they manage this?

Yeah, so that's what it was like.

It was kind of like, oh, this is a thing, but I'm ignoring it.

It's a thing.

I can't fix it, but I cannot let it get in the way.

of learning what I need to learn.

Right?

How do I fit into the boys club?

Because the

boys

club

is

the club.

And if

I fit into it, there's no other club.

There's no other club.

That's exactly right.

That's exactly right.

So I did.

I figured out a way to fit in and was it always perfect?

Absolutely not.

And I'm so glad that there's there's a critical mass move into graduation a few weeks ago and three of the women residents have already had babies.

Like I was the first woman to have a baby in our program and it was as if

the world was ending.

Like nobody could imagine how I could do all my call, how I could operate.

I mean, and now it's just normal.

So there are really substantial differences.

Yeah, I have to say, I went through residency, you know, 15 years ago and I already had four kids under 10 as an OBGYN intern.

And so when you said the early morning meetings and figuring out the child care thing, we had to have multiple child care options because you couldn't just drop your kids off at, you know, I had to be at the hospital rounding at five in the morning.

Right.

So, and my husband had a

job.

Nothing's open.

So we needed au pairs and nannies and regular child care and before school and after school.

And it was incredibly expensive.

Most of my student loans went to child care.

And it was just so tricky keeping track of who was where and who needed to be picked up.

on top of all of the other stuff that we were doing and trying to keep up with our colleagues who didn't have any of those distractions.

Right, right, right.

And yet, it was interesting, you know, one of the women who I interviewed for my study, she described, she was in a surgical field and she described being so excited when she got pregnant because she was on her research year, she was pretty sure it wasn't going to disrupt anything clinically.

And she had enjoyed her colleagues bringing in photos of their new babies and talking about families.

She goes, oh, this is great.

Now I'm really going to fit into this aspect of our club, so to speak.

And the chairman calls her in and basically told her never to do it again.

That he did not want to hear about this pregnancy.

He did not want it to be a thing in the residency.

I don't know that anyone would have the.

to say that to a pregnant resident today.

On the other hand, the message was loud and clear.

You are not like one of us and the men can be parents and embody that in a full-throated way that you're not allowed.

think it's a different

time now because people have stood up and because there are so many more people in the field but it's still not perfect and there are still many people who are suffering and so I want to just make our way through your career because you you did it you survived you dominated you are incredible

Did you realize as you were making your way through your internship, through your residency, through the early years of your career, the research, all of your incredible accomplishments, did you realize that this was going to be where you ended up and that this was such an important priority for

you?

Yeah, never in a million years.

I mean, I have to say that I really focused on

What was the task at hand?

So I needed to learn how to be a surgeon.

I needed to learn how to be a clinician.

Then I became a parent.

I needed to be the kind of mother that I wanted to be, which meant hiring different people, figuring out child care, figuring out who this child was, what he needed from me, how did I need to modify my life and ambitions, if at all.

And then I became a scientist during residency.

I took a year off to study cancer biology because I think really two things.

Number one was I could not save the life of my head neck cancer patients with surgery alone.

And the chemotherapy and radiation was very toxic and also largely not curative.

And I thought, gosh, you know, we're.

In head and neck cancer resections, at the time, we're quite mutilating.

We would take out someone's larynx.

They had a hole in their neck for the rest of their lives, a mechanical voice.

Or we would take out their tongues.

They couldn't communicate at all.

We had scars.

So we couldn't really hide it.

We changed the way people swallowed and spoke.

And that was really essential to their nature.

And I thought, well, we have to understand the biology of this cancer if we're going to really treat it.

But we live.

in a puritanical world where if a cancer is associated with a behavior that's viewed as one under someone's control, they are blamed.

So head and neck cancer patients historically were smokers.

and drinkers.

And these were not the masters of the universe.

It's interesting now with human papillomavirus, HPV, playing such a major role.

It's now masters of the universe and famous people who are getting it.

But back in the day, it was smoking and drinking.

And like lung cancer, these people were viewed as, I think, less worthy of study.

These cancers were not as popular.

So I became a scientist.

I became a scientist to help my patient and not thinking about it.

it felt like a meritocracy.

I mean, medicine was always supposed to be a meritocracy.

We can talk endlessly about how that's not entirely true, but science felt objective.

It felt like my being a woman surgeon was always gonna be a thing, you know, in the clinic, but it wasn't gonna be a thing in science.

Nobody cared what my gender was if I had really good ideas and I got my grants funded and I did research and I wrote papers and I got published.

that would my my gender would be in material.

But I became kind of a unicorn because I was a woman who is now married with a child and I had an NIH funded laboratory and that really elevated me in terms of visibility you know kind of everywhere because it was such an unusual combination.

And as more women medical students were coming into the field, they would come to ask me advice about surgery.

And I thought, oh my God, I do so much research.

I don't have a full clinical life.

Let me understand.

So I did a study.

So we published it in 2004.

So a long time ago.

Before there was, you know, email, I sent a statistically validated questionnaire to all 504 women otolaryngologists in the country.

I matched each woman.

Wait

a minute, wait a minute, all 504?

That

was

it?

Yeah, yeah.

Sorry, I had to pass her.

Just say it, just say it, that was it.

And I matched each woman.

with two men who were their age and practiced in the same region of the country.

Because all the studies, if you recall, that have looked at women surgeons in particular had compared young women to old men because there were no, there were no old women.

And so I thought, okay, that's a flaw because everybody was able to write off essentially the salary discrepancy based on maturity, which kind of made sense.

So what I found was 20% less pay for doing, as best we could tell, the same job, which was surprising to me.

But

What I wasn't prepared for is that the women were significantly more likely to experience regret, to be divorced, to be childless, and to have experienced discrimination and harassment on the basis of gender.

So I published it and I thought, okay, I'm done.

That's not my field of study is cancer research, but I did this for the field.

moment, it felt like it made a difference.

Of course, Doximity, you know, 20 years later, writes about the pay and all the different fields, and there's still a pay gap everywhere.

And guess what?

The worst is otolaryngology.

That's 20%.

And I think, oh, my God, well, that was actually my wake up call because in in cancer research, we don't ignore significant findings.

So if a drug doesn't work, we can't keep giving that drug.

If a drug is toxic, we don't keep giving that drug.

If a pathway isn't significant, we don't get grants to study that pathway.

But it was really interesting that this work on gender differences was just a moment in time.

And I thought, oh my goodness, there's horses.

So actually, that was a wake-up call.

But still, my job was to be a role model.

I was just going to do it.

I was going to show everybody else that you could do it.

I was living a wonderful life.

And I was unprepared for what happened to me relatively later in my career.

The National Academy's report came out around the same time to show us that 46% of women in academic medicine experience sexual harassment.

So I thought, well, I'm not alone.

But I needed to understand it.

I approached it as a researcher because that was my way of healing, of really working it.

through was to understand.

Yes, and you have a big network and you were able to do that because you had built yourself up to that point where you had that perch, that vantage point to be able

to

study it.

What would you say to somebody who is early in their career, like the medical students that you had

advised,

who wants to build the kind of network that actually opens doors?

Where do they even start, especially if they are not in a traditional environment?

Yeah, that's a great, great question, Kristin.

So I get a comment, a question like this all the time.

And I'm very clear eyed that my reputation

really allowed me to survive the experience and really allowed me to do something very positive with it.

If I hadn't been so visible and respected as a physician scientist and been elected into all these elite societies that people respect, I don't think I could have done the work without it.

mitigating my professional ambitions.

Because as much as I'm really determined, you know, that this book be healing, that we can talk about it, you know, I just want to one of my mantras is we have to get comfortable about talking.

about things that are uncomfortable.

It's not comfortable for me to say I was sexually harassed and forced out of my job.

That's icky, but I'm not going to go back to that place of shame and self-doubt.

I'm going to move forward and say this is just human beings, being human beings.

Let's not let it define the ability of people to contribute in our field because our field needs clinicians and scientists.

Very much and the women who go into medicine and science are there's no evidence that we're less capable and talented than our male colleagues So when we abuse each other when we're blind to what's happening It's a problem.

So what I tell young people is your experience is real Write it down Talk to people about it.

Yes, don't pretend it isn't happening to you because it will never recover from it if you don't reckon with it

And sometimes you might be in a situation where there are more powerful people who can advocate for you.

One of the things I say is that, you know, when I grew up in one system and then later in my career moved to a different organization.

I didn't appreciate how protected I was by very powerful men.

So there were people who were jealous.

There were people who tried to hurt me.

And each and every time there was a more powerful man in the organization who defended me.

So I didn't have to really fight my own battles.

And so what I would say is we're not always equipped to fight our own battles.

And I've met too many people our age and I'm older than you are.

But even I've met women in their 40s and 50s who don't have careers anymore.

because whatever happened to them was so destructive that they didn't have a path forward.

I am so fortunate that

what happened to me in the moment felt like my career and my life were over but it was not and I was so forward but I could that could not have been true if I had been you know less accomplished and had less of a profile.

Well the numbers are stunning to know that half of women in this area

victims of sexual abuse and to know that we suffer it alone because we are afraid to talk about it.

If you can take that shame, if you can embolden yourself because you know you are far from alone and you can use

all of those feelings as coal in the engine and fire it up and actually defeat it.

That is, I think, part of the beauty of your book, Jenny, because you are using all of that energy to do something really positive, not just for you and your generation, but for the generations to come.

And looking back on your career, you've been incredibly successful.

You've gotten so many of the things that you've wanted.

just because you are brilliant and you are determined, but there have been things that you haven't gotten.

Oh,

of

course not.

What has that experience taught you?

Well, you know, it's interesting.

It has allowed me to appreciate that, number one, I have gaps in deficiencies and weaknesses like every human being, but the price that I have paid

for those gaps, those limitations of weakness, it's so different.

Like I remember a very senior person in the organization, very blunt person saying to me, gosh, there's so many men around here who are so much worse at their job than you are at yours.

Why are you being forced out and they're not?

And that's kind of how it felt like.

I love you to remember

that.

Like that was so important to you that you put in a special place in your heart.

It did, it did, because it made me, so that's the thing I wanted to say is that

even if you feel powerless to help someone who's suffering, letting them know that you see that they're suffering and you're sorry that they're suffering, even if you don't feel like you can do much about it, it actually does help.

It really does help.

So it felt to me like I was a person in a complicated world and that if I was ambitious,

and I aspire to embody these leadership positions that the qualities that I needed to have were sometimes really challenging.

I mean, you know, my favorite anecdote about myself as I was leaving Pittsburgh, again, the CEO took me out of the health system, took me out for drinks.

And he's like, you're so talented, really appreciate you.

He said, but you need to know you've been viewed as a little bit aggressive.

And I said, oh, tell me more.

So that's another piece of advice.

When someone says something to you and you're like, what the heck are they saying?

Instead of internalizing it and letting it define your confusion, ask them.

People want to talk.

So I said, tell me what you mean by that.

And he described a series of completely legitimate behaviors.

I said, huh, I wonder, because it's maybe not obvious, but I'm also, I'm not very tall.

And people have described me as petite, which, petite, petite in YouTube, right?

So I said, gosh, you know, so and so I wonder if I was a man and I had those qualities, would it be perceived as assertive and would that be a good thing?

And he's like, oh, I never thought of that.

So I think that,

when these horrible things happen to us or when someone offends us.

If you can in the moment and sometimes we're just completely disabled.

I mean, I can't tell you how many either personal experiences or anecdotes I heard from people in my study and friends and colleagues where something happens and they're just absolutely floored.

Like they don't really know what to do about it.

But if you if you can encourage the person to continue because you will learn a little bit about where they're coming from and you may have a window.

to help them understand how you heard what they said.

And they probably didn't intend to communicate what you heard.

Sometimes they did, but sometimes they didn't.

And then it's really one of these magical moments where you can see things that were always in front of you.

But for whatever reason, you have to go through life with blinders.

I mean, how many times have you walked down a street in your neighborhood and noticed something for the first time?

You know it's been there forever.

Well, guess what?

When we're overwhelmed with fatigue, with raising a family, with trying to be a clinician, a surgeon, and in my case, a scientist too, we've got to have blinders on.

We can't pay attention to all this noise because we won't be able to survive.

And then you realize, oh, oh yeah, that's there.

Well, I think I better deal with this.

I love that you approached what could be a potentially really uncomfortable conversation by inviting a question.

I think that's always a good one to keep in your hip pocket.

Tell me more about that

because

it does.

It invites that conversation.

You learn more, they learn more, and it really creates a rich conversation instead of that division and walking away from it and the fear that I think a lot of especially women, especially younger women in medicine, we just hear it and we're afraid.

We are and we don't want to burn bridges and we don't want to compromise or we don't want to be that girl, you know and and it's really hard because they're just if it's kind of like there's a script and there's so few roles for the diversity and the complexity of women and it's like no no no

we need better roles.

They're just, they're like the mean girl and then there's the, you know, the jock and you know, how about just a normal person who's just trying to do her best like

everybody else?

Right.

Well, and let's talk a little bit.

We talked about you.

Let's talk about institutions because you've also looked carefully.

You've worked in different institutions.

You've examined them.

When you look at how institutions recognize and develop talent, what are the most consistent mistakes that you

see?

Oh my

goodness.

I think that it particularly well I want to make sure this is a I'm tuned to the academic medicine environment but I don't think this is wrong for so many other fields is we really prioritize individual exceptionalism when someone is charismatic or they are really effective in an aspect that brings great value to the organization let's say

they're great at raising money from grateful patients or they do a really high volume of very important procedures that bring great revenue.

So these people are overvalued and when they are human and they behave badly, the institution has a tendency

to do the wrong thing until they're forced to do the right thing.

There's so many examples of that.

And so I do think that we are bamboozled by charismatic people, particularly if an organization is run by people who all kind of look the same, who all kind of came from a similar background.

When they see a mini-me, when they see a potential protege,

It is really hard to see them fully and understand their limitations.

And so an organization sometimes becomes blinded to what talent looks like when it comes in a different package.

I think extroverts have a huge leg up in any organization.

Surprise, surprise.

I'm an extrovert, but I'm married to an introvert.

My daughter's an introvert.

They struggle with it.

And I really, one of the great lessons I learned from my study is a woman who had had leadership positions said to me, she says, you know, I'm an introvert.

And you extroverts, if you're going to run a meeting, you have to understand that probably half of the people are introverts.

And you have to tailor the meeting for the introvert because the extrovert doesn't need your help.

They're going to take over.

You need to give us the agenda ahead of time.

You need to ask, make sure everybody has an opportunity to weigh in.

And if someone is bullying or dominating, you need to mute them because we don't really have the skills to do that.

It was it was clearly quite eye-opening.

So I do think that that is one way that

institutions which are made of people can stop and say, okay, how are we identifying talent?

How are we cultivating talent?

How are we making sure that we are seeing all of the ways that talent is manifest?

Is this how you determine which organizations are evolving versus which organizations are static?

Yeah, that's a really, really good question.

Yes, and...

What I would say is I went into my study thinking I would find institutional differences.

So I made a point, and I can't tell anybody where I did my interviews, but I interviewed at some very elite high profile places, top NIH funded institutions.

I interviewed at some middle of the country, public institutions, very low ranked in terms of US News and World Report as well as NIH.

They were the same.

Wow.

Right.

I mean, the nature of the human interactions, the experiences of the men and the women, the perceptions of the men and the women were not significantly different.

There might have been different flavors at different places, but in general, there was no significant difference.

And that was eye-opening to me.

And what I would say is that the institutions that durably change do so in response to a hero.

So a hero comes in and a hero single-handedly over the course of their let's say decade in power Changes the face of the leadership and so suddenly the leadership looks like society and it doesn't look exactly Does this

hero have to be a department chair or somebody who is leading everything or could it be a person who

was a really good question?

Yeah

I think they have to have power.

So when I saw what I call these heroes, they had the power to put people in positions of influence.

They had the power to allocate resources.

They had the capacity

to see structural inequities.

And instead of saying, oh, we're great.

We've always solved it this way.

I'm not going to try to address that because that's not going to be my agenda.

They actually were able to do it.

And when a hero came in and did that, if the organization leveraged that and crafted policies,

to embody those visions that would survive the lifetime of the leader because all leaders go.

And what tended to happen is if the institution didn't recognize that they had a unique opportunity to do something important and durable, then that opportunity left as soon as that leader resigned.

And I don't think we want to get all that political today, Kristen, but what's so interesting is I started this book

Right when there was the Me Too movement, you know, I started the study in 2018-2019 and then while I was doing the study DEI was a priority and so people spoke very openly about the institutional mechanisms and the priorities and now we're experiencing a backlash which includes demonizing these terms but what I really want to say is that it was always important and this demonization

just underscores how important it is.

And so I think we can have a different conversation about what talent looks like and what is a meritocracy.

But if we don't take into consideration all of the different ways that people can make significant contributions, we are not going to be successful, you know, ultimately.

And that's really the most disappointing thing is when we think it only comes in one flavor.

Right.

I will always get political with you anytime but not today because I'm not

gonna do that

to you.

But what I hear the saying is this is not about terms DEI or any of that.

It is about actually culture and what is the culture and what is valued

So how do we build those cultures that where people feel safe raising a concern before it becomes a crisis or where they feel like they actually are contributing to the overall sense culture of the organization where they

where they're working and living?

Yeah, that's a really great question.

So Kristen, what I'm seeing happen, and it's happening now here with one of my friends who's now in a really powerful position, is she understood that the ways that, if you will, concerns or complaints were coming in, they were very weighted.

They were very heavy.

I was trained at some point, if someone comes to you with a complaint of sexual harassment, you have to report it.

You're a mandatory reporter.

And what that essentially did is it inhibited people from coming and talking about it.

Because, and I experienced this myself, and also, so many of my interviewees said, you know, he was doing this to me, it was awful, but I had to get...

my degree, I had to get out of there.

I just needed to survive.

And going through the weighty process of reporting would have damaged me in ways that were even worse than what I was already suffering.

So I think what we need is a low touch collaboration.

of all the different offices in any complex organization, you know, whether BHR or Ombuds or Title IX or whatever it is your organization has where people can bring concerns.

And the intake is confidential, non-judgmental, just listening, and then that intake person or those people

can get advice and feedback and sort of crowdsource what the information is.

And as long as you understand when you come in that you may not be vindicated.

It could be that your concern, while very serious to you, doesn't really meet the bar of a crime.

And the punishment that you wish to be imposed is not going to happen.

But at least there can be potentially a mediated conversation between you and the person

having them misunderstanding with and hopefully you'll both come out you know a little bit better but what we end up doing is we make the process so intense and so laborious that the person who's suffering suffers more and the person who's committing the acts that are causing the suffering they're given a

big runway to get out of Dodge.

And so we call it passing the harasser.

But what really happens is before a situation can be fully adjudicated and a decision reached, the person leaves and goes to another place.

And guess what?

Surprise, surprise, it happens again.

So I think we need to do a much better job of understanding that people are people and misunderstandings are misunderstandings unless just

have a grown up, a trained grown up, taken the information about the misunderstandings at the very least, and then let them work their way through a coordinated system to try to achieve.

So let me give you an example.

Recently I was brought into a situation where I won't bore you with all the details but basically a senior mentor was bullying a junior faculty member and was not allowing her access to data that she had a legitimate right to access.

Now he had a right to access it too and what I realized and what I told the person in the organization is

You know, we don't have a policy about this.

We're not prepared for this.

So let's learn from this situation, then let's make it crystal clear, and let's make mentors and mentees, you know, apprise them of these policies and these rules.

It doesn't mean.

you know that they're always going to abide by them at least though it's written down we've thought about it there's rules and we don't leave it up to the temperamental decision of a person who may or may not be suited to supporting a young faculty member achieve their independence if you perceive that they're taking this on is going to deprive you of what you think you deserve so

are just human things but we sort of pretend everybody's gonna figure it out themselves and they don't and so what ends up happening is the powerful people remain powerful and the people who are harmed just kind of shuffle along and you know and what we found with women in academia is we all hypothesized that they would leave and they didn't they became clinician educators

So there's nothing wrong with being a clinician educator.

It's a wonderful thing.

My husband's a clinician educator.

My daughter's a clinician educator.

But people who go to MD-PhD programs, the women too, don't do that to become clinician educators.

But the overwhelming majority of women MD-PhDs later in their career stay in academia and they no longer have research programs because they don't get the resources that they need and the support that they need.

that is very interesting especially very relevant right now in light of not to get political but the current political circumstances with NIH funding and just how precious it is and how we were just getting to the point where we were ramping up with women researchers studying women issues and now it's all

It's all in peril, which is another very scary situation that we are not going to talk about right now because we need to talk about the institutional consequences.

We talked about what's happening with individuals when these unfortunate situations are going down.

But when institutions fail to see and support people, that actually has a price tag as well.

What does that cost us in care, in quality,

in trust, and just the people who leave?

Well sometimes there's great institutional shame.

So ultimately if an institution has protected someone who's committed great harm.

that institution has egg on their face when that harm goes public and we don't have to talk about any of the situations but there are many many in there in the news all the time and an institution is not really powerful enough to predict which will and which will not ultimately bring them shame so there's reputational harm which of course you know every institution wants to avoid but more important it sends a chilling effect to everybody who's watching

So if you watch something bad happening to someone and you identify with that person there, you have a lot of shared qualities, you have ambitions potentially to be into that kind of a role, and you watch and you're like, oh, okay.

Well, maybe I don't want that.

So it sort of chills the ambition of some of the more important people who really could make a contribution by showing them how difficult it is and how the fine line they'll have to walk is just impossible.

But it also makes the meritocracy myth just that.

It becomes a myth.

If we believe in truth, we believe in science, we believe in data, when we see all these forces that are nefarious, that are harming some people and propping up others, it is really demoralizing and we do this all the time and it's not just science and medicine, you know, and I'll never forget how

You know, people defend an individual because they haven't experienced the toxic behavior that another person is alleging.

And what you want to say is, can't both things be true?

You know, can't this person be a total sweetheart in the way that you've known them, but in this other capacity where you really don't have any direct observations or experience?

they can behave in ways that are really not in the best interest of all of us.

And that's a thing.

All our institutions, particularly the one I work at now, it's a public institution.

We depend on the trust of the public.

And I believe passionately in the mission of this institution to care for the underserved, to do basic discovery science.

I still believe in that.

You know, what happened to me could have happened anywhere.

I really don't believe that

the institution was uniquely culpable, but I do think that the institution's instinct to protect people in power and look the other way when something bad is happening to someone is a common instinct and ultimately doesn't serve the institution well and it harms people.

It certainly does harm people.

And we see a lot of our colleagues now in this day and age.

Burnout is at record levels.

People are very frustrated.

Providers are frustrated.

Patients are frustrated.

Healthcare is on fire.

What would you say to one of our colleagues who is on the edge, ready to walk away?

How

do

we keep them?

Because we need them.

We do.

Well, I want to say to everybody, we're better than the places that we work.

I mean, the places that we work have many fine qualities, but they're just places where we work.

And they're subjected to societal forces, to political agendas, to competing priorities.

And remember what brought you to science and medicine.

What was the passion that you had when you were a younger person?

And if you can still tap into that passion,

Don't squander it.

Maybe find a different place to embody that passion.

Maybe find a different way.

I mean, I'm winding down my lab.

I no longer do surgery, but I'll always be a surgeon scientist and I'll always care about the next generation.

And I'll always believe that a good study with a biologically plausible hypothesis, the results of which can change the way we practice medicine,

is the gold standard.

And as long as I can still feel that way, I can get over the disappointments.

You know, think of it, as a parent myself, I think there should be a time limit for how long you could blame your parents for ruining your life.

But as a child of two imperfect people, both of whom I loved and loved deeply,

I think we can understand that the people that we love and the places that we love are flawed, but we get one, from my point of view, precious life.

And the training that we go through to be the people that we are is intense, it's long, it's hard, but it makes us really uniquely skilled to provide help in a world where there are more people who need help than there are people who can provide help.

And so I feel like we're really lucky.

We can be the helpers.

We sure can, as long as we know where our North Star is and can keep coming back to that place.

And for you, you've written this book that we need to talk about.

What was the moment where you thought, I need to take all of this experience and all of this research and turn it into a book.

It could be a paper, it could be a talk, it could be an op-ed, but you wrote a book.

Yeah, crazy.

So first of all, it was a journey.

And when I did the study, I knew I had to write papers because that's what we do.

You know, we do a study, we have IRB approval, we have subjects, and I had to write about it.

And so that was fascinating.

I mean, I've always been a molecular biologist, a clinical investigator.

I'd never been a social sciences researcher, so I really appreciated the rigor and the complexities of social science research.

This was a qualitative research study.

But the papers were sort of devoid of heart and What I was haunted by Kristen I was haunted by the interviews I can still see these people whose offices I went into they allowed me into onto their campus into their office they gave me consent and I turned on a tape recorder and I recorded

their feelings, their observations, their points of view, and it was very powerful.

I mean, what I always tell people is I go, I've had the privilege of going all over the world and talking about cancer research, and it's wonderful, but it's not very emotional.

Talking about this.

emotional.

I mean when people get in touch with what they've experienced, their pain and suffering, the pain and suffering of their loved ones, their their culpability or not, how to manage that culpability or not, it was powerful.

So I thought I got to tell the stories and you can't tell a story in a scientific article.

So I was encouraged by a wonderful, wonderful friend from college.

He's an architectural historian.

He writes books because that's what people in the liberal arts do.

And so I found an agent.

I thought it took forever.

It took me six months.

And she was wonderful and supportive.

And I had a book proposal.

And it took a little while to find a publisher.

And the most frustrating reaction was, oh, we're done with that.

You know, sexism?

Oh, really?

We're done with that.

Oh, yeah, the Me Too movement.

It solved everything.

This is old news.

There's nothing here to learn.

And so it took a little while to find a publisher, but we did.

I don't think I was prepared to self-publish, although there's nothing wrong with that.

I just don't think it was really part of my agenda.

And then it just took a long time.

It took a long time to write the book in such a way that I thought people would read it or listen to it because it's an audio version as well.

Of course, I'd love people to buy it.

I'd love it to be successful, but I recognize this is an academic book.

It's an academic press, but it's written for a lay audience.

And what I hope is that when people need it, it's there for them.

You know, I don't think I would have imagined that I would ever need a book like this, but I did and I do.

And for people who don't think they need it now.

I hope they're surprised by what they can learn from it.

I mean, the most remarkable thing was that every woman I interviewed, like 54, even if they immediately said, oh, I have never had any of the experiences.

By the end of the hour, I'd heard about their experiences.

Really?

They just didn't recognize it.

Oh, they didn't.

Or they had parked it in a closed box that they weren't going to open.

But as their life unspooled, as their thoughts went to different places, as I asked the questions, we eventually got there.

And the men, this is the most important thing, because we still live in a world and we still, in our profession, the people in power are largely men.

And even the men whose wives and daughters were now in the field, and they understood this deeply from the experiences of their beloved, and they were agitated about what their wife or their daughter was going through and been through.

But even these wonderful men, when

I nudged them to pivot to their own domain, their own school, their own department, their own institute.

It was so hard.

It was so hard.

And what I want to say to everybody is, we have to find a way to talk about this without immediately assigning blame or guilt.

And a man recently said to me, a friend of mine, he said, go on your social media.

And I wonder, are you blaming me?

I thought, oh my goodness, what an interesting reaction.

I said, no more than I'm blaming me.

You know, I'm responsible for not having access to my power earlier in my career.

I saw bad things happening to people and I

I made sense of it in a way that didn't put me in a position where I needed to act.

And that's on me.

And I can have some compassion for myself because I was being, you know, abused in my own way.

I was fighting my own fights, but I didn't act to advocate for them.

And what I want to say to all of us is when we see it, let's do something about it.

At least let's just talk about with each other.

And so in that way, I blame all of us, but I don't hold

the men accountable for the experiences of the women.

I hold all of us accountable, particularly at this stage in my career, for going into a field, for valuing the field, for being passionate about it, and for allowing it to play out in ways that don't always really support our moral compass, assuming we have one.

Well, that assumes, though, that you have the ability to do that.

You know, when you are young and you are powerless and you are trying to make your way as the only woman in a room full of men, you are seen as aggressive.

You don't have options.

You need to go through the male men's locker room to get to.

It just doesn't work that way.

But I think that

we can create those tools.

We may not have them now.

And the men who have women in their lives who they get frustrated about in their personal lives but can't translate that to their professional lives, we can help them create those tools so that they can do that.

And that means that we also need to be looking to future generations.

So that's my next question for

you.

What is happening with the next generation?

Are they approaching any of this differently?

And do you feel hopeful?

I do, I do.

I mean, I had 50% of my interviewees were full professors or senior leaders because I really wanted to talk to people who I thought were in positions of accountability.

But one quarter were assisted professors.

They were young people.

And I can tell you that I was mostly, mostly really overjoyed by the perspectives of the younger men.

So one anecdote that really sticks with me,

A man comes to an institution, he's never negotiated before, and he has no idea what to ask for, so he goes in and he asks for everything in the world, and he gets it.

He's like, oh, wow, that was easy.

Blah, blah.

And then a few years later, a woman comes into the same part of the institution, and she is better than he is, and he sees that she's better than he is.

She's got more grants, more publications, and they start collaborating, and they start comparing notes.

And it turns out that her experience negotiating was completely different from his with the same person in the same organization.

And he said, oh, well, let me show you what I got.

Let me tell you about what I got.

And then armed with that information, she goes back to the person who is completely unsympathetic.

It's like, nope, you know, you agree to this, you're stuck with it.

But she was able to take that information and she was able to go somewhere else in the organization and get what she deserved.

So the fact that instead of assuming that he had this unique right,

to this benevolence and that she was somehow bad at negotiating.

I'm so tired of hearing that women are bad at negotiating.

It's like the most ridiculous thing in the world.

No, because it's not a fair fight.

There aren't these transparent rules.

How about you give everybody the same startup package?

Why don't you have a transparent mechanism that

People can see.

So anyways, I was encouraged.

There were people like that who saw, who understood, and they were absolutely willing to share.

There were some others though who were overwhelmed by the sharp elbows of their female colleagues.

And they didn't consider the possibility that that behavior was in reaction to being treated unfairly.

And I don't know what we do about that except to talk more about what we are experiencing.

Even if it's just like, hey, I had this experience today.

Have you ever experienced anything like that?

So if we're trainees in a program, Virginia faculty, go to your male buddy, go have a cup of coffee, ask for advice.

I don't know what to do.

What do you think?

Because our peers are really in a position to learn from us.

And I don't think, here's the thing I took home.

I'm not sure the women learned anything from me who I interviewed.

I learned from them.

But I can tell you, every single man I interviewed learned from me.

Just because I was asking questions that he never asked himself.

It was really extraordinary.

And never had to.

He never had to ask himself because it was all right there.

Exactly.

Exactly.

So just ask questions, asking questions, and finding ways to share your experiences.

really powerful.

I'm hearing that common theme.

We've said it a few times throughout our conversation is sharing, talking with each other, not being afraid to reach out and just collectively working together for the betterment of the entire group and you, but you had to be a lone voice at one point as you were picking people up along the way.

You've chosen to be this public voice.

It hasn't been easy.

What made you willing to do that and what has it cost you in the process?

That's a really really good question So I will never know what it cost me because I don't have a control group I'm not aware that I have been rejected For anything because of this but I am certain that this topic makes a lot of people uncomfortable and I'm okay with that because I speak about it.

I hope with genuine passion and respect

for all peoples.

I don't have an axe to grind.

I don't feel vindictive.

There's nobody I want to punish.

But what really changed for me was my daughter.

And I'm not sure she would agree with this, but when she was a first year medical student at the institution where I work, she was over one day and she described being on a neurosurgery weekend at one of the hospitals.

And all the residents were men, not unusual.

She was the only woman medical student on the service that day, and they asked her to go get them coffee.

Oh.

And she described that it felt terrible.

It felt terrible to be there to learn about the patients, but she was kind of sent off on a secretarial duty.

And she couldn't talk about it with anybody because they were grading her.

At the end of every experience, she had to hand

the attendings, you know, a piece of paper where they commented on her.

And she was pretty sure that she, if she gave them feedback about how that made her feel that she would be punished for.

And I was pretty sure she was right about that.

And I thought, oh my goodness.

And now she's a pediatrician and pediatricians are really nice.

compared to surgeons in some ways, but in some ways, but even so, you know, she has had these collective experiences of basically being ignored, you know, that the men are amplified and she is, nobody pays attention to her.

So anyways, I felt, oh my God, I didn't do this.

I didn't live the life.

I didn't go through what I went through, especially, you know, the last experience.

to not make a difference.

And I really believe that I had a unique combination of respect and a voice.

And I was at a stage in my career where there was no possibility.

Honestly, when it happened to me, I thought, it can't get any worse than this.

And it's true, there's nothing that they could ever do to me compared to how that made me feel.

And so, you know, a friend asked me not long ago when the book was coming out, when she knew the book was coming out, she says, aren't you afraid of what people will think of you when you write this book?

And I said, a little bit, but I'm more afraid of what I will think of myself if I don't.

And so that's where we are.

I mean, I'm a woman of a certain age and you have to look back over your life and think, did I do my best?

And it's never perfect.

I'm going to continue to make stumbles, but this is my version of trying to make right a world that I care very deeply about.

It does make you vulnerable.

Yeah, it does.

Yeah, but that's okay.

I think that's part of it because that's what gets you to reach out to other people and share your story and then they share their stories and then you start to build that collective power and then you start to change institutions.

Yeah, I think you're right.

I think you're right.

I hope so.

I have this vision right now of you being on staff and your daughter being a medical student and you're in Pittsburgh, so it's the pit, the Jenny Grandis version.

We love watching that show, by the way, my daughter went to medical school out here in California, but I have to tell you, we love watching the pit, my husband and I, because we both worked at that hospital.

Right?

You know, he was actually on staff at that hospital and E&T rotated at that hospital, so...

All the comments and the innuendos about the city are very, very dear to us.

And even though we both, we can all agree that there's probably no emergency room that has that much activity in 24 hours.

It is a remarkable illustration of how ill-equipped we are as human beings to show up in these situations where we need to do our job, but it comes at such a high

price.

And so in some ways I can forgive the clinicians who behave badly because they probably have all this pent up feeling about what they're experiencing and seeing every day.

On the other hand, we could do a better job of being kinder to the people who we work with.

We sure can.

Yeah.

And I have one more question for you.

And it is the motivating question.

What do you tell people question?

So you know that there are people who are watching and listening and they see a problem, but they're not sure whether or how to step forward.

What do you want them to know?

I want them to know that they are accurate in what they see when you see something.

And the question is, can you say something?

And so find a place in your life, even if it's with a family member or a friend, someone who's not in the business and just talk about it.

Having, you know, I can't tell you how valuable it has always been to me to gut check, you know, what I was going through, particularly when it is baffling and confusing and you know something's not right.

There is a lot of danger as you pointed out and I agree with you in

raising those questions in a professional environment.

The stakes feel impossibly high, but you can go home and you can write in a journal or a diary.

You can call your friend or a family member and go out for coffee.

You can say, hey, what do you think about this?

This is what happened to me.

And just the experience of saying it out loud, number one is it will take some of the

powerful shame away or the confusion and you may ultimately decide that you don't have a language to speak out but you will be comforted that it's real and you can make decisions.

I mean what I say to people all the time is you can't change other people.

If someone shows you who they are, believe them.

You're not going to change them.

But if you have the capacity, choose a place to work where you can be who you are.

And we don't remember that enough.

I mean, we sort of go to the best medical school we get into.

We have a residency match list that's all too often based on.

I don't know, geography or institutional reputation or sometimes, you know, family concerns, but at some point you get to be a big boy, big girl, you know, particularly in medicine and you get to decide where and how you practice and don't shortchange your discovery.

Ask hard questions.

Find people in that environment.

Ask what it's like for them.

Really open all the doors.

I mean, I have a

a niece who took a first job as a surgical subspecialist in a place that they wanted to live only to discover she was the only woman in the group that they had no maternity leave policy.

Oh, what?

And she got pregnant.

In the modern age?

In the modern age.

Wow.

In the modern age.

So it took her a year to leave and find another job, but she could have saved them and herself so much pain and suffering if she had

kind of opened up more doors than she opened up so Do your due diligence and don't be afraid to walk away

because

you can't to live Your life shape-shifting to make other people uncomfortable.

It comes at great personal cost

And sometimes we shoulder all that burden, but sometimes we take it out on the people that we love.

And it's really important that we get ourselves in professional situations that bring us as much joy as we can.

That's right.

We've got one life.

And if

you're spending all of your time in a miserable situation and you're not paying attention to your family because you have a terrible job that you feel committed to, that's not worth it.

And that is not what we are doing with our lives.

Jenny, Grandis, where can people find harsh medicine?

Oh,

well, it should be in every bookstore as of next...

Tuesday is the launch date, but you can order it now online.

People are getting it.

And one of the things that I learned, interestingly, is if you order from a publisher, it doesn't count towards bestseller status.

I don't know how bestseller status is determined, but it would help me and other writers if people

I'm always a fan of your local independent bookstore.

But if you feel compelled to use a website, bookshop.com, Barnes & Noble, Amazon, or other places that people can order it.

And I would love to hear from people, what do they think?

How does it make them feel?

I really would welcome hearing other stories and feedback.

And thank you so much for this opportunity to speak with you.

And I, too, am a great admirer of yours.

And look forward to your next chapter.

Thank you.

How do people find you online?

How do they reach out to you?

Oh, I have social media.

So you can always email me at my UCSF email address or my Gmail address.

Or you can follow me on TikTok, Instagram, and LinkedIn.

Listen to you sounding all Gen Z-like.

Follow me.

Subscribe, share.

My mother follows me.

My 19-year-old mother.

She was so cute.

I'm doing an event in San Francisco on Monday night at the Commonwealth Club, which feels like a very big deal to me because I never felt like I was a writer.

And so my mother has

like thousands of friends on Facebook and LinkedIn and she's like, honey, I told all my friends and everybody's so excited.

Mom's the best.

Yes, they are.

We are.

And I'm so excited for your work.

I'm so grateful to you.

Thank you for taking the time to do this today.

Friends, we've got Dr. Jennifer Grandis here.

She is the author of a new book called Harsh Medicine.

You've got to go check it out.

And you heard her.

You can follow.

You can like.

You can share.

You can subscribe on TikTok, Instagram.

She's everywhere.

So do it.

And if you enjoyed our conversation, please do the same.

Like, share, comment, and subscribe for much more.

We will see you next time.

time.