ScientificBlogger Matthew Brown had the chance to sit down with Dr. Judy Evans, a Consultant Plastic Surgeon in the UK, to talk about her award-winning Women In Medicine documentary on the BBC, her sex discrimination and victimization court case, and her life since returning to work after the trial. At the height of her career, she was suspended from her work in the UK's public health system when some of her male colleagues raised concerns about the integrity of her work. This suspension came within ten days after she gave her support to a Nigerian trainee—a black woman—who told Dr. Evans that she was the subject of racist remark from another surgeon. The lawsuit was finally settled in 2001, and since then Dr. Evans has been enjoying work in a private practice.

"One of the surgeons said to me, 'you would have to demonstrate that you would be prepared to be sterilized if you are serious about doing surgery..."

Dr. Judy Evans, performing surgery in Plymouth, UK. She talks about her BBC documentary, her sex discrimination case, and her life since then. Dr. Evans was recently elected to the Council of the Royal College of Surgeons of Edinburgh, one of the oldest surgical corporations in the world. In the College's 503 years, Dr. Evans is the fourth woman to be elected a member of this council. She's been published in the New England Journal of Medicine, and has a special interest in skin cancer and burn treatment. MB: How did you originally get into medicine? JE: "When I was at school I wanted to be a marine biologist. So I went off to Oxford, and I got a degree in zoology, and while I was doing that I became interested in research. But I was also interested in medicine. The message I kept hearing was, 'you can't be involved in any medical work, because you haven't got a medical degree.' "I'm the sort of person who, if they want to make it really difficult for me, that makes me really determined to prove them wrong. So I left my PhD place and went off to medical school in London. "While I was there I decided I didn't want to go back to research; I wanted to become a practicing doctor. At first, people were supportive and thought, 'here's this really intelligent woman who's got an Oxford degree, and we could really use her as a general practitioner.' "But I said, 'actually, I'm rather attracted to surgery.' "And they started to treat me as if I had a psychiatric condition! I was unable to get a job in the UK training as a basic intern, so I had to travel--to Hong Kong. That was easier than doing battle with the men who were trying to discourage me from doing surgery. "One of the surgeons in London said to me, 'you would have to demonstrate that you would be prepared to be sterilized if you are serious about doing surgery. It's an all encompassing life. You don't have time to go and do ridiculous things like taking care of babies. "I got up and walked out of the room and said I didn't want to have to work for anyone who hadn't had to prove himself by having a vasectomy. Of course I got to the door and thought to myself, 'what do I do if he says he has!' "He hadn't. And I ended up working in Hong Kong. "During the time I was there, I met my husband. He was developing his career as a urologist, and he needed to be back in the UK for further training. So he left, and eventually I followed him back, and very soon after that we got married and I had my first child. "After returning from practicing in Hong Kong, I still knew wanted to do surgery.

"...I'm sure. And I don't see any reason why I can't do it."

"People were saying 'are you sure? You know, you've got the baby,' (as if it's the sort of thing you'd forget). "My answer was, 'Yes. I'm sure. And I don't see any reason why I can't do it." MB: Can you give us an idea of the sort of controversy that led up to the tribunal hearing for sex discrimination in 1999? JE: "Up until that point, everything had been very successful for me. I had been a consultant for seven years, and that was probably the most satisfying career point in my life. Things were going well. "Although I had experienced sexist behavior before, the men I worked with there had never exhibited any sexist behavior to me whatsoever. They were incredibly supportive, and the whole of our department was more like a family—we'd even look after our colleagues' kids. "Right at that time, the BBC were chasing after me for a documentary on women who had been successful in the NHS. Of four women, I was chosen to represent hospital surgery and in-hospital medicine. "It was a pretty huge thing for the BBC, but I was actually very naive. I thought this documentary would be a one-day wonder, and that everybody would have forgotten about it by the time I got back to work (I took a short break over the summer). "That wasn't the case. It was an amazingly successful documentary. The people who did it won awards for it. It was just incredible. "I still get patients who will say to me, 'I wrote your name down when I saw the documentary, and I've kept it since then…you're the only person I would have operating on me!' "During the time that I was away over the summer, a new surgeon came in. He was a good technical surgeon, but he had a big problem with women. "He made the whole of the rest of the department feel threatened by me, which had never happened before: 'we don't want to be in a unit that is only famous because it has women in it,' he would say. He started a really stupid, sort of childish thing where they started to call me nicknames—that 'bloody woman is coming down the corridor.' "The whole unit which had been so friendly just disintegrated into an 'us and them.' There were people being pushed into one team or another. "I just didn't see this huge change coming, and I didn't take defensive action. "Suddenly one day I was called in and they started telling me that I was incompetent! "They were so clever about it. One of the junior doctors said 'I think it would be a good idea if all the consultants gave us a lecture on the things that they had learned from their own mistakes'—a very clever way to get me to be completely open about every one of my mistakes as a surgeon. "Over fourteen years, every surgeon who's busy operating on a thousand cases per year has mistakes, and I opened up about mine so that people could learn from them. "Instead, they actually took detailed notes of these patients and put them together into a horrendous dossier which they then presented to the management. "Right at that time, a Nigerian trainee came to me—since I was her Women In Surgery rep—to tell me that one of the consultants had been blatantly racist against her. She asked me what she should do. "I told her that if she made an official racist complaint, it would be very hard for her. But I told her that if that's what she wanted to do, I would stand fully behind her. "The next day, she came back with a written complaint, and said 'let's go for it.' So I backed her. "Within ten days of that event, I was suspended and accused of incompetence. "It was very obvious to everybody who had been open minded and reasonable for the previous years, that this was a way for the new regime to get rid of me because at that time I was very popular and quite famous from the BBC documentary, and I was threatening their ability to have a private practice—they hadn't yet actually established a loyal patient following. "I spent nearly two years not working for the NHS. They informally suspended me--in the UK we call it being 'put on gardening leave.' But in the case of an informal suspension, the private hospital said, 'unless you're formally suspended, we're quite happy for you to continue working for us.' "So I was actually in quite a bizarre situation; all these inquiries were going on, and people were trying to figure out if I was actually incompetent or not, while all the private patients were still coming to see me. So instead of having to do my private work after doing my government work, I was suddenly free to do my private work during the day, and go home in the evenings! "Which of course made these men even more determined to get rid of me. "Eventually, I got a lawyer, and I took the case to a tribunal. They did everything they could to try to make me give up, including having retired doctors coming to my house to talk to my husband about it when they knew I wasn't there. At the time, my husband had been retired for nine years with very advanced Parkinson's disease. "There were people who had not been to see him in nine years suddenly turning up on the doorstep and saying, 'oh, it's so lovely to have tea with you, Gerald! How are you?...By the way what are we going to do about your wife? We've got to get her to shut up and back down or there will be the most awful crisis.' "He told them that they obviously didn't know his wife. "Finally, we went to the tribunal and after a long process, we settled. I walked out of there with my pension at the age of 50, and the freedom to continue private practice. Which felt very important for me to do...because I needed to show the them that their actions had actually done nothing good and had just given me the freedom to allow me to earn money, and have them see that I was earning money, while they were slaving away working for the government. "What I've lost by having to leave at 50 was the opportunity to become a professor. I've always had this idea that the pinnacle of my career would have been to be the first woman professor of plastic surgery in the UK. But that won't happen now. "At least I've had a much less stressful life by being in private practice rather than in the NHS for the last few years. MB: What has it been like since the court case, seeing some of the same doctors you took to court? "I see them every day. But I was just absolutely determined that no matter what was going on in my soul, they would see me going down the corridor smiling at them and being polite and all those sorts of things. It hurt them a lot that they haven't managed to get rid of me. MB: Why is it that, even with so many women graduating from medical school, there are still so few women at the top of the profession? "Entirely because of prejudice. "I still get junior doctors coming to me and saying, 'we've been around for three or four years, and you're the first person who's ever spoken to us in a positive way about continuing a career in surgery.' "I've done projects with my colleagues where we've gone into schools, for example, and we meet up with the girls who are applying to medical school. At that stage they're obviously not committed to medicine or surgery, but they know they want to be doctors. So we talk to them and we show them how incredibly good they could be at it. We tell these girls, 'we're surgeons, you can do it too.' "They seem to be put off at different stages. They start off really determined to be surgeons, but it seems the more and more men they talk to, the less and less they want to be surgeons.

"'re the first person who's ever spoken to us in a positive way about continuing a career in surgery."

MB: You've been through some incredibly hard battles, some of these things just because you are a woman... JE:"No, I think they happened because I was a successful woman. Nobody is that bothered by a woman who does all the jobs that no one else want to do, or a woman that isn't in any way threatening. MB: How has this experience left you feeling? "It left me in some ways lacking confidence, in some ways looking over my shoulder waiting for the next stab wound. But I made an absolute decision at the beginning that I would not tolerate myself becoming bitter. "So every time I caught myself being bitter, I just made a decision to stop. "I have tried to look at the positives that have come out of my rather unplanned career path, and I tried to make it feel like a small part of life, and the big issues--like my husband and children-- were still the most important things in life. MB: Having been through all this, what is your advice? JE: "When I turned up for my surgeon's exam seven months pregnant, the first question I was asked was 'what makes you think you have the right to present yourself, looking like that?' "I actually let the examiner upset me. He was very aggressive, and I became flustered. I failed an exam which I shouldn't have failed. "Now I tell women that when they go for the exam, the exam will be fair, there won't be any bias against them, they've just got to be as good as everybody else. There's no longer any prejudice against women in the exams, partly because I'm an examiner, and I simply won't tolerate it.

"...what makes you think you have the right to present yourself, looking like that?"

"What we need is for those women to then go on to committees to help in planning the future of medicine to be able to prevent even more discrimination of women. Some of the battles were fought by women fighting for suffrage, some were fought by my generation, and there are still more battles to be fought by women in medical school now. "We have to make surgical training something that is desirable and friendly towards women, and there's a lot of work that needs to be done before it can just be regarded as the norm for women to be surgeons. "In terms of something you can start doing today, one of the reasons that I was able to take on the claims against me with confidence is that somewhere along the line, somebody told me that the path would be hard for a woman--especially a successful woman. A group of us young women doctors were told that if we wanted to protect ourselves from some attack in the future, we should document what we did all the way through in a log. We kept the most fantastic diaries. "So when people were accusing me of something like not being at work, I could show that the reason I wasn't at work on Monday, was because I was representing the hospital interviewing junior doctors in the regional headquarters. "So I would also give that advice to trainees. Just have a big diary, and keep it forever. Write down that on Tuesday morning, you came into work at 8 o'clock, you did this, this, and this, and you left at 9 o'clock in the evening. "It sounds a terrible thing to have to do, but if you're in the habit of writing a little diary every day and just filing it away at the end of each year, it can be very useful in non-confrontational settings, as well as settings in which it can be career-saving. Those may seem like extraordinary measures now, but we're getting closer to reaching a critical mass. For other Interviews of Women In Science from Matthew Brown, click here.