Op-Ed: Is ‘Upspeak’ a Problem for Women in Medicine?


A few weeks ago, I was delighted when KevinMD accepted an opinion piece I’d submitted. But I withdrew it just before publication because, on reflection, I realized that I’d been wrong.

While sheltering in place during the COVID-19 pandemic, I’ve become an avid consumer of medical podcasts, such as those presented by JAMA and the New England Journal of Medicine. The opinion piece I withdrew criticized women researchers who, despite being prominent enough to be included in these podcasts, still kept turning statements into questions — a mannerism known as upspeak or uptalk.

“We did this study? And it had 6,000 patients?” That sort of thing.

In my original essay, I interpreted that mannerism as a fear of coming on too strong. Perhaps, I speculated, these women experts were afraid that straightforward declarative sentences might not sound “feminine” enough.

It reminded me of a time in the 1970s when I was the only woman student in a graduate statistics course taught in the mathematics department. On the second day of class, the middle-aged male professor took me aside and said that from now on, I’d have to sit in the back of the room and not speak. He went on to explain that some graduate students in that department were men from outside the United States who felt uncomfortable, and indeed outraged, at finding themselves in class with a woman.

That professor was proud of having brokered a compromise that he viewed as a favor to me since what those men really wanted was to have me removed from the class — not an inconceivable outcome at the time. Back then, it didn’t seem particularly outrageous to demand that a woman who “invaded” a domain still widely regarded as inherently male must appease those who didn’t want her there, even if that reduced her to invisibility and silence.

As a veteran of several such experiences, I initially interpreted the uptalk of women experts on those medical podcasts as placatory, suggesting second-class citizenship. I wanted to grab them by their white coats and snarl, “Doctor, you were the lead author on that study. You know as much about it as anyone on the planet. That cutesy way of speaking is fine for high school girls and contestants on The Bachelor, but it doesn’t do justice to the expert you’ve become.”

“Now let me ask you a question,” I wanted to add. “Would a male principal investigator say, ‘We did this study? And it had 6,000 patients?'”

But after I’d submitted the essay, I realized with a shock that the answer to that question is actually yes. As I listened to a wider range of podcasts, I heard quite a few male experts, particularly younger men, unselfconsciously turning statements into questions. A little investigation quickly revealed that a mannerism originally associated with women is, indeed, in the process of transitioning from gender to generation.

Having thought more about it, I now suggest that upspeak may not be a bad thing, particularly with respect to communication in medicine.

Only a few years ago, oncologists used to insist, with great confidence, that chemotherapy regimens had to be much longer than they are now. With equal confidence, physicians urged anyone with even minor cardiac abnormalities to take antibiotics before dental appointments — a practice now largely discontinued.

In themselves, such changes do not reflect badly on the medical profession. On the contrary, if new information didn’t lead to improvements in care, anesthesia might very well be administered with a bottle of booze and a rock.

What is a problem is the normalization of the overconfidence with which physicians, among others, have traditionally spoken. Research shows that confidence is commonly mistaken for competence and accuracy, not only by professionals themselves but also by their patients and clients. Humans value certainty, or the appearance of certainty, even in situations in which little can be known for sure and much depends on chance.

But the cost of overconfidence can be high. Experts familiar with COVID-19 research, for instance, are expressing concern that the medical profession risks losing public trust if researchers keep making one confident declaration after another, only to be contradicted by further evidence.

And so, I wonder. On the one hand, many of us chafe every time the president says “Deborah and Dr. Fauci” rather than “Dr. Birx and Dr. Fauci” or “Deborah and Tony.”

From that perspective, it doesn’t help when women experts speak with rising inflections that may sound little-girlish, giving the impression that calling them by their first names would be the most natural thing in the world.

On the other hand, although the habit of speaking confidently in the face of uncertainty is still widely considered an asset, it’s demonstrably a source of error.

From that perspective, particularly as younger men and women become comfortable with a more tentative manner of speech, perhaps it may evolve into something more than just a mannerism.

Rather than urging women to adopt speech patterns traditionally associated with men, perhaps we should consider whether the habitual use of those rising inflections, those statements-as-questions, might come to signify honest doubt and frank humility. If so, what has been viewed as a self-deprecating error on the part of women professionals might, in the end, prove to be one of their greatest contributions.

Joan DelFattore, PhD, is a writer and professor emerita of English and legal studies at the University of Delaware. She holds an MS in clinical psychology from Penn State University. This post appeared on KevinMD.

Last Updated July 30, 2020

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