In the final moments of the December Democratic Presidential Debate, the moderators asked the candidates to either offer a gift or ask for forgiveness. Whether we like it or not, a stark gender divide emerged.

Every single man offered a gift, while both women on the stage—Senators Warren and Klobuchar—chose the other option. And despite their vast differences in political ideology, both women essentially apologized for the same thing: being themselves.

The question as to why women feel obligated to apologize for taking up space has never mattered more than it does right now, during the 2020 Presidential election season.  And this dynamic, reinforced by a daily double standard, affects more than just our Presidential candidates.

When women physicians give formal presentations to physician colleagues, they are introduced by their proper titles—including Doctor or Physician—49% of the time. Whereas male physicians lecturing in the same setting are introduced properly more than 97% of the time.   In the previous column, I shared research about gender discrimination women surgeons face, but as you might imagine, this phenomenon extends beyond those boundaries to impact the fields of medicine, education, law, and even politics.

Throughout their lives, women are encouraged to be accommodating and agreeable, while men are taught to be assertive and stand their ground. Girls internalize societal messages early on to be thinner and smaller; young women are praised for compromising in their emotional relationships; and even though women’s voices are rarely heard as loudly as men’s, women often learn the hard way that they fare better when they remain silent. By the time they enter adulthood, it is no wonder that women quite literally feel the need to apologize for who they are.

For me, the double standard hit hard early on in my training. During my third year of medical school, an attending physician informed my male colleague and me that the only time he would take direction from a woman was if she said “it is time to sit down for dinner.” I was so stunned (and humiliated) that when he questioned me about a patient a few moments later, my answer was practically incoherent. At the end of that rotation, the attending scored me low in “professionalism,” writing, “she did not wear enough makeup to the clinic.” For reasons that remain unclear, my male colleague was not graded on his makeup or provided feedback at all on his appearance.

Medical training is hierarchical by design, which makes challenging authority difficult. During my fourth year of medical school, a supervising intern of mine did not realize that our patient suffered a heart attack overnight. When I presented the patient to the healthcare team the following morning, that intern called me “an emotional towel head” for dramatizing the patient’s condition in his opinion. No one commented about his behavior, despite the fact the patient had indeed had a heart attack. Later, the physician supervising the whole team pulled me aside to excuse the behavior because the intern was “struggling.” The attending admonished me not to “outshine” him. Since my grade depended on my silence, I acquiesced.

Ironically, research indicates patients treated by female physicians had significantly lower mortality rates and hospital readmission rates compared with those cared for by male physicians within the same hospital. However, studies reveal female physicians face higher levels of scrutiny in the workplace than male physicians. One study found that male physicians who disagreed with the patient, set the agenda and asked questions were perceived as nondominant, whereas female physicians who did the same were seen as more dominant. Other studies support this finding, revealing that female physicians have significantly less favorable online reviews than male physicians. The words most frequently used to describe female physicians include “judgmental,” “rude,” and “unfriendly” while males are evaluated less on their personal traits and more on their competence.

Which brings us back to a different Presidential election season.

In 1984, Walter Mondale ran against incumbent President Ronald Reagan. When Mondale chose Rep. Geraldine Ferraro as his running mate, the decision did not seem extraordinary because it never occurred to me having a female on the ticket would affect his chance of winning. (Unfortunately, another female candidate would not achieve this same feat for almost 25 years.) Reagan won by a landslide, winning the electoral vote in every state except Minnesota (Mondale’s home.) In fact, Reagan won 525 of 538 electoral votes, the highest total ever awarded to a presidential candidate in history. Looking back now, I wonder how much of that resounding victory was due to the fact a woman ran on the opposing ticket? And I question if our country has truly changed since then?

First, we must stop judging women by their demeanor, personality traits or “makeup application” skills. Only when we see women as assertive instead of aggressive, dazzling instead of dominant, and enlightening instead of emotional, will women be able to take their place in the sun. At the same time, we must understand how motherhood increases the value of women in the workplace rather than detracting from it. Without exploring deeply ingrained beliefs about gender, little progress will be made toward the gender equality we need up on that Presidential stage.