Lady Doctors and Their Feminine Charms

Researchers at the University of Montreal recently reported that female physicians consistently outperformed their male counterparts when it came to providing high-quality care to elderly patients with diabetes. The study was extremely specific in its focus – it evaluated doctors’ level of compliance with three particular guidelines for long-term diabetes treatment – and fairly nuanced in its findings, attempting to account for factors like the ages of the physicians in question. It concluded that female doctors were more likely than male doctors to schedule regular eye exams, insist on frequent check-ups, and prescribe the combination of medications recommended by the Canadian Diabetes Association.

downloadDespite the rather limited scope of the study, though, its findings prompted oversimplified and sensationalized media headlines. Time, for example, reported that “women make better doctors than men,” and Jezebel spun the findings into a purposefully hyperbolic assertion that “lady doctors are outperforming men on pretty much everything.” Now, don’t get me wrong: I definitely want female physicians to get the credit they deserve. The fact that they excel at patient care certainly merits our attention, especially since they remain comparatively underpaid; in fact, a different study of physicians, undertaken in the United States, found that this income gap has increased over the last two decades and exists even when researchers adjust for area of specialization, type of practice, and number of hours worked.

At the same time, I am troubled by the tendency to use narrowly constructed studies as evidence for huge claims about women being “better than men” (or vice versa!) at something as complex and multi-faceted as being a doctor. Moreover, I am skeptical about the attempts to explain these conclusions, which often fall back on traditional perceptions of masculinity and femininity. Reporters (and online commenters) suggest that women doctors provide better long-term patient care because they take the time to listen and follow up, because they are more sensitive and empathetic; in contrast, men provide lower-quality care because they are too hurried and cold and ambitious to devote that kind of time and energy to each individual patient.

Elizabeth Blackwell, nineteenth-century "lady doctor"
Elizabeth Blackwell, nineteenth-century “lady doctor”

When I read these articles, I can’t help but think of my own research and that of other historians who looked at pioneering nineteenth-century women doctors. Many of these female physicians argued that their distinctive feminine characteristics qualified them for work in medicine. This idea was first articulated in Sympathy and Science, in which historian Regina Morantz-Sanchez examined, among others, Elizabeth Blackwell, the first woman to earn a regular medical degree in the United States. Blackwell suggested that women should enter medicine because their feminine compassion would make them excellent healers and because their strong sense of morality would benefit the medical profession. These arguments opened doors for many women, but it never led to anything approaching equality. Ideas about distinctive gendered traits could always be used – and were, in fact, used – to channel women into general practice or into specialties like obstetrics, gynecology, and pediatrics, and it is no coincidence that these fields came to be undervalued compared to male-dominated specialties like surgery and radiology. It’s 2013, and this phenomenon still exists. Is it helping anyone to suggest that women physicians are better than male physicians because they spend extra time with their patients, being all sensitive and compassionate and caring?

Is there something in that logic that feels like a back-handed compliment? I’m reminded of the recent news stories on a completely different topic – the government shutdown. Women, it seems, took leadership roles in re-opening the U.S. government; senators like John McCain and Mark Pryor both pointed out the crucial roles women played in the process. And again, I think women deserve that credit! I’m not trying to take it from them. But the prevailing tone of that credit bothered me, as did the explanations for why women succeeded. There was something unbelievably patronizing in Pryor’s statement that “the truth is, women in the Senate is a good thing. We’re all just glad they allowed us to tag along so we could see how it’s done.” And there was something incredibly essentializing in the idea that female leaders accomplished this monumental task because they were better at compromise and because they could rely on the female networks they’d built, which one of them, Minnesota Senator Amy Klobuchar, described as “strong friendships of trust.”

It’s worth thinking about, isn’t it? The potential problems involved in attributing women’s accomplishments to supposedly gendered traits like compassion, empathy, compromise, and friendship-building? Does that kind of credit ultimately help anyone? Can’t we make statements about what works well in particular situations — more time spent per patient, a willingness to compromise — without suggesting that one gender or another has a particular claim to that tendency? Ultimately, I fail to see how it’s especially productive to set these things up as competitions between the sexes in the first place. I would prefer to see discussions of what makes an effective physician or politician without the old-fashioned gender descriptors.

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David Harley

Among younger physicians, the “Doctor Knows Best” attitude has been in decline. University graduate patients do not like the assumption that they know nothing, and must be addressedc in babyish euphemisms. People from different cultures, even those from Europe, have different expectations and explanatory systems. The difference can be seen within the same joint practice.

The medical humanities have looked at narratives for quite a while. Some have understood this in terms of a rhetorical negotiation whereby the patient’s story, illness,and expectations for treatment, is made compatible with the doctors narrative of using clinical symptoms, diagnosis of disease, therapeutics, and the hope of prognosis. Our work is not often read by medical students, but I have found that it is read by professors.

We do not have to suppose any innate characteristics to recognize that many women have to develop relevant skills in everyday life. Linguists have noted that, in casual conversation, men are far more likely to interrupt women. We can see this in universities too, in classes , and among professors, where men often regard the types of topic of interest to women are devalued and it is regarded as surprising when a woman becomes expert in a “real topic” or man becomes interested in a “women’s subject.” [Those men mostly interrupt too.] A complaint or assertion of authority by a senior male professor is regarded as an exercise of leadership, whereas the same from a senior woman is described as whining, uncollegial conduct, or passsive aggression. The men who assess women for tenure are more likely to value the grades on student questionnaire that relate to being organized than those which concern approachability and helpfulness.

Thus, the extent to which male physicians develop listening skills must depend on the dynamics of their own families, the advice of professors, and the model of the senior hospital practitioners to whom they are apprenticed. At home and at school, women are perforce likely to develop listening skills..They are brought up to care attentively to children and siblings. Nothing innate about that.

One has only to compare and contrast the world of specialist surgeons, such as trauma wards. The physicians and nurses listen, but the surgeons talk over the heads of their patients to their group of acolytes. They talk over the heads of patients metaphorically too, using the language of their trade and speaking of probabilities and statiistics of success in ways that are incomprehensible and alarming to patients.

Surgeons are accustomed to seeing patients as anaesthetized bodies. The whole tone of the surgical suite is a boys’ club, and women surgeons have spoken of how they had to become honorary men, They must tolerate the laddish jokes and treatment of nurses and secretaries. They must be umarried, not limited by the needs of childcare, and therefore able to willing to work all hours, while the surgeons go out for their round of golf. Much the same rites of initiation are reported as happening in scientific laboratories.

Women can be gynaecological physicians and nurse practitioners, but it is men who perform the hysterectomies.

Mali Kurac (@malikurac)

Perhaps it’s more about the specialization rather then gender. Rather than simply seeing it as women doctors tending to specialize in family orientated medicine while men tend towards specializing in surgery, etc., perhaps the role influences behaviour. So, a woman doctor going in to surgery has to become tough, focussed, and abrupt.

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