Book Review: May 2023

"Letter to a Young Female Physician: Thoughts on Life and Work" by Dr. Suzanne Koven

Dr. Suzanne Koven begins her essay collection, “Letter to a Young Female Physician: Thoughts on Life and Work”, as one might expect – with a letter.[1] As she watches a crop of incoming interns write letters to their future selves, she reflects on her own career: the pressures she faced to prove herself, to value her skills, and to serve her patients well. This was in 2017, and it seems anecdotally that the call for reflection has come earlier and earlier in medical training in recent years. As a medical student (still a year away from intern orientation), I’ve participated in innumerable letter-writing exercises just like the one that inspired Dr. Koven. In this book, Dr. KoveN shows us why these reflections are so important. Dr. Koven describes a background caught between the arts and the sciences. As the daughter of an orthopedic surgeon, surrounded from an early age by men who practiced medicine, she always had an idea of the role of the doctor. Whether she saw herself in that role is a bit more complicated – in her book, she details the struggles that she felt in her early science courses, that science felt “unnatural” to her, despite her earning good grades. She attended Yale for college, where she studied English Literature. She then went on to Johns Hopkins for medical school and residency in primary care internal medicine, after which she joined Harvard Medical School and Massachusetts General Hospital where she is now Writer-in-Residence.[2]

From this background, it’s easy to see the beginnings of her exploration and confrontation of her identity. We are invited to witness her early admiration for her father’s role as a doctor, her challenges and successes in pre-medical classes, her first interactions with patients as a trainee, all the way through her established career, the illnesses of her family members, and her experience during the COVID-19 pandemic. Her accounts are not only about medicine – for instance, she further unfolds in front of our eyes a lifetime of dieting and worry over her body image, compounded by the attitude of “fixing” toward bodies that medicine instills in us. In detailing the evolution of her identity as a physician practicing “humanistic” medicine, as well as her identity as a female physician, Dr. Koven (and the reader by extension) repeatedly confronts the pressure to justify herself not only to those around her, but also to herself. This pressure lies at the heart of the phenomenon many of us know as “imposter syndrome.” She points out her imposter syndrome by name early on, and this feeling remains an undercurrent in her reflections throughout. Imposter syndrome runs rampant among surgical trainees, with some surveys indicating three-quarters of surgical residents experience “significant” imposter syndrome.[3] Risk factors for imposter syndrome are controversial – some studies have shown female sex to be associated with increased rates of the phenomenon, while others have shown it to be similarly pervasive across lines of gender, sex, race, level of training, and even licensing exam scores.[4] This preoccupation is to the detriment of the patients that we treat. Dr. Koven encapsulates the way that imposter syndrome warps priorities and motivations in medicine with her early anxieties over memorizing course material in medical school. She worried, in order of implied ascending severity, “that I would miss something. That I would kill someone. That I would look foolish.” Taking humanity away from ourselves invariably risks robbing our patients of their humanity as well. So, Dr. Koven lays a blueprint for how understanding and accepting our own identities allows us to treat our patients with the same empathy (and to value doing so). Our internal tendencies become external actions. As a student with so many personal written reflections under my belt, largely due to the expansion of narrative medicine into the routine medical school curriculum, this book gives me something to aspire to: using whatever skills of reflection I have developed for myself to ultimately care for others and hopefully, to help my colleagues care for others too.

I can end this review no better than Dr. Koven ends her letter to us all: “ are not a fraud. You are a flawed and unique human being, with excellent training and an admirable sense of purpose. Your training and sense of purpose will serve you well. Your humanity will serve your patients even better.”


[1] Koven, S. (2022). Letter to a Young Female Physician: Thoughts on Life and Work. W.W. Norton and Company.
[2] Fogel, H. (2018) Why Storytelling Matters in Medicine: An Interview with Dr. Suzanne Koven. Harvard Health Policy Review.
[3] Bhama, A. R., Ritz, E. M., Anand, R. J., Auyang, E. D., Lipman, J., Greenberg, J. A., & Kapadia, M. R. (2021). Imposter syndrome in surgical trainees: Clance Imposter Phenomenon Scale assessment in general surgery residents. Journal of the American College of Surgeons, 233(5), 633-638.
[4] Medline, A., Grissom, H., Guissé, N. F., Kravets, V., Hobson, S., Samora, J. B., & Schenker, M. (2022). From self-efficacy to imposter syndrome: The intrapersonal traits of surgeons. JAAOS Global Research & Reviews, 6(4), e22.

About the Reviewer: Jennifer Kunes

Jennifer Kunes is a rising fourth year MD candidate at Columbia Vagelos College of Physicians and Surgeons. She grew up just outside of Boston and attended Harvard University for her undergraduate education, studying Biomedical Engineering with a minor in English literature. She held wide-ranging roles as an adviser, teaching fellow, and coxswain on the Men’s Heavyweight Rowing team. She then spent a research year at Brigham and Women’s Hospital, studying focused ultrasound neuromodulation and three-dimensional bioprinting. At Columbia, Jennie has served as a Health Education Co-Chair for the school’s largest student run clinic, co-chair of the Orthopedic Surgery Interest Group and the Whipple Surgical Society, class Wellness Representative, and co-chair and founder of Columbia Medical Center’s student liaison group for Sexual Violence Response.

With AWS, she has focused on trauma-informed care, specialty resource guides, and a new podcast helping students succeed in their surgery rotations. In her free time, Jennie is teaching herself leatherworking and shoemaking through YouTube videos and enjoys spoiling her cats, Moose and Fox.

Share this post:

Comments on "Book Review: May 2023"

Comments 0-5 of 0

Please login to comment