Medcetera

Gender Bias + Ignorance = DANGEROUS Patients?

Oh well, just read this post, and had to come write about it before sitting down to studyduty_calls for the night. The issue the author raises on the blog is a VERY important one, but dilutes it with her abject ignorance.

The basic premise of the post is the right to choose physicians of a particular gender. That right has always been there. No one is stopping anyone from seeing a particular doctor or forcing them to go to “male gynecologists”.

The laughable thing is this: the author starts off on such a bitter note about doctors (I am not going to state why I think this might have been the case, since that would be speculative and not evidence based), that it invalidates all the (ridiculous) arguments she forwards thereafter. My good friend Deb has done a systematic analysis of her post, but I am going to take it a step further.

So, how does it feel when you end up in a hospital for delivery and the gynecologist about to examine you is a male? Yes, you read it right- a male gynecologist? Or how it would be to consult a male radiologist for a mammogram? A male radiologist  who examines female genitalia? Though female gynecologists are aplenty, women often find themselves in tough corners when it comes to taking medical help in extreme cases.

This is an extremely ignorant and biased view for several reasons. First, the overt tone of hostility and surprise at “male gynecologist” is extremely derogatory. She works on the assumption that a male physician examining a female patient is always a sexual thing. That is extremely naïve and if anyone tries to hide it behind the façade of conservative orthodoxy, let me rephrase and reclassify it for them: Gender biased BIGOTRY! Secondly, the fact that gets lost in the absolute trash logic is the matter of socio-cultural significance. Patients should have a choice in the matter of seeing a doctor. And doctors should have the right to choose their patients (OMG! A doctor refusing to see patients? Now is there another igno-rant on that somewhere round the corner?). But these matters should not be considered in case of an emergency.

Consider this: you are a female, and you go into a cardiac arrest in the middle of a busy street. I am a MALE doctor, who happens to witness you go into a slump and finds you lying pulseless. Now, would anyone object if I gave you chest compressions to save your life? Thank God the November 2010 BLS/ACLS guidelines have done away with mouth-to-mouths or there was another perversion charge I would have to ward off!

The assumption that doctors “get off” on the sex of their patients is not just ridiculous, it is extremely ignorant and discriminatory. I agree there are charges of sexual harassment against doctors, but would it be logical to lump all of us in the same class?

India is not a country that has limited medical aid and so why should the women compromise?

SERIOUSLY? This shows the author has no idea of the medical dynamics of the country. In a crude manner of speaking, 75% of the doctors serve 25% of the patients in India. Breaking it down, it means the urban/rural divide in medical healthcare is so gaping, that the powers that be are considering forcing us into compulsory rural rotations post-MBBS. Somehow, I find it a little unnerving that someone who has so little idea about the medical situation in the country would dare forward such a preposterous and insulting post.

You can all it medical ethics, professionalism or anything under the sun, but a MALE IS A MALE!

I must say I never thought that males were anything but males… it would be “perverted” to do so! In an age where sexual and gender based discrimination is not just frowned upon, but actively discouraged, I find it highly ironic that the author sticks to the typical stereotypes painting males as the sexual predators. And I am sure, every profession has its share of perverted men and women, so get off our case already.

I think it would be presumptuous to assume that ALL the sexual perverts go to medical school for an average of ten years to earn their rights to be a MALE (IS A MALE IS A MALE) Gynecologist so that they can get off on their weird fantasies.

Of course, the case is otherwise too. It might be unnerving for a few men too, when being asked to cough out and at times a prostate examination by a female doctor also has the same effect.

Real life incident from our surgery posting: one of my co-interns was a VERY attractive girl, and we were in the ER as Surgery interns. There was a massive deluge of cases and we were all up to our neck deep, wading through them, trying to clear out the ER as fast as possible. Just as I had got done with my share of the cases and was stepping out for a bite (after almost being on call in the ER for 8 hours at a stretch, without a break), my colleague came up to me with a rather sheepish expression on her face. She wanted me to examine her one patient and she promised that if I did not ask anymore questions, she would pay for lunch next day. The prospect of a free meal is always welcoming for the overworked and underpaid intern, so I jumped at it. When I went to see her patient, it turned out that he had an inguinal hernia and when my colleague was examining him, he had, well, a bit of an incident, that left both the doctor and the patient a little red in the face and hot in the ears. In case you do not realize what an inguinal hernia examination involves, here is an example:

hernia_exam

But does that mean we should move for a law to have all female medical students barred from studying surgery? I know that’s stupid, right? Well, not to our blogging crusader for gender… umm… inequality:

And will the Government bring a bill to say- ” Women doctors for women and male doctors for men“??? That is a million dollar question.

I am answering it: NO! Now where do I sign up to get those million dollars lady?

The blogger goes on to say:

Again, i am not trying to say here that every doctor on the block is sex- starved, unable to control their libido.

Right. All she is saying is:

…but a MALE IS A MALE!

AND

You must look at the way they handle their stethoscopes when they check women!

AND

How many of you know the unfair advantage doctors take on such unlucky women?

AND

…their sexual apparatus goes on an overdrive, sensing helpless victims.

I could go on, but then I risk ending up quoting all of her nonsense article!

A typical example of her disconnectedness from the reality of the situation:

There are Government hospitals and primary health centers that have a single male/ female doctor taking care of everything starting from a delivery to mammogram. Probably that might be the reason why most rural women shun these hospitals.

Most PHCs would be so relieved to have mammography services, that they would not give a damn about the gender of the doctor doing the business. The assertion that gender bias is what is keeping rural women away from the hospitals also paints in my eyes the image of a city-dwelling, arm-chair warming, pseudo-intellectual who likes to spend time imagining themselves to be crusaders against all things icky when they get some time off from being boardroom parasites.

Sexual Boundary Violations ( SBVs) have burgeoned at an alarming rate in India-  which include unnecessary physical examinations, inappropriate touching, sexual jokes with patient, sexual touch and finally there are cases of sexual intercourse too…

Unfortunately, when a patient comes to see a doctor, there is bound to be some form of embarrassment involved. Her assumption that aal-iz-well if the doctor and the patient are of the same sex is ridiculous. The blogger does not realize that sexual boundary violations will occur EVEN if the doctor and patient are of the same sex. Gender really has nothing to do with boundary violations.

And as for sexual jokes and innuendo, I would ask her to thank us. Doctors are more restrained today than they were a decade ago when it comes to such acts. Read The House of God, lady, and you shall realize that we are angels. The strong reaction to anything perceived as a sexual overture towards a patient or using a joke or acronym (e.g. TTFO: told to fuck off; PRATTFO: Patient reassured and TTFO; FLK: Funny looking kid; etc. check THIS for more examples or the references quoted below, especially the ones by the fantastic Dr. Fox) has rendered the art of medical slang into a vestigial organ, dying a slow but sure death. Rejoice…

Anyways, one thing that irked me no ends about her post was the fact that the blogger reduced the whole thing to a sexual  mish mash but never considered the fact that there are people who go for people of the same sex. What would she advocate if the patient or (GOD FORBID!!!) the doctor happened to be gay? In that case would not her stand on the male-for-male and female-for-female (yeah, news flash, females can be gay too!) bill be counterproductive for the purpose of sexual policing? I guess these doctors or patients would then have to declare their sexuality in a form so that they get an adequately asexual clinical examination.

However, the real problem would be with bisexual people. First, they would have to make a law to prevent them from studying Medicine unless they changed their sexual orientation. And second, all patients who declared themselves to be bisexual would be turned away from hospitals that did not have un-sexed doctors (now would our blogging crusader not call THAT an oxymoron?). Now THAT is an ideal world! Aaaah… no more icky touching down there!

Its not like that patients do not have a choice in choosing their physician. They do, and as a litigation fearing doctor, I encourage them to. Even if for the wrong reasons, as a patient, you have the right to choose your physician on the basis of your personal preference or prejudice. However, when one bases their personal grudges and takes it out in the public forum in the form of an odious blog post, I feel compelled to dispel the myths.

Most doctors work off the best years of their lives in underpaid, less than hospitable situations to get to where they are at. Insinuations such as the ones the author has levelled have diluted the main issues that she should have focused on instead. Getting more female doctors in the business. And training male doctors in such a manner that the female patients do not feel violated following an encounter with them.

The right to choose your doctor is not my point of debate. The point I am trying to make is that, gender difference in doctor-patient relationship is a reality. The issues arising thereof cannot be solved by carpet bombing doctors with more legislative burden, but by creating a medical education system that teaches doctors, males and females, the issues regarding sexual and personal boundaries. By creating more opportunities for females to reach the higher levels of studying (creating more reservations for females is yet another symptomatic management strategy that will not work out in the long run) we have to ensure that the skewed gender ratio is adjusted. By creating incentives for the doctors to go back to villages to work for the people there we have to ensure medical care for all…

Doctors are so much in the public eye, it becomes a knee jerk reaction to blame the whole profession for the follies of a few.

References:

1. Adam T. Fox, Michael Fertleman, Pauline Cahill, and Roger D. Palmer (2003). “Medical slang in British hospitals”. Ethics and Behaviour 13 (2): 173–189. doi:10.1207/S15327019EB1302_04

2. Adam T. Fox, Pauline Cahill, and Michael Fertleman (2002). “Medical slang” (PDF). British Medical Journal 324 (179): 179S. doi:10.1136/bmj.324.7350.S179

3. Paul S. McDonald (2002-08-24). “Slang in clinical practice” . British Medical Journal 325 (7361): 444. doi:10.1136/bmj.325.7361.444/a . PMC 1123955 . PMID 12193372

4. Peter B. Hukill, A. L. H., and James L. Jackson (May 1961). “The Spoken Language of Medicine: Argot, Slang, Cant”. American Speech (American Speech, Vol. 36, No. 2) 36 (2): 145–151.doi:10.2307/453853 . JSTOR 453853

31 thoughts on “Gender Bias + Ignorance = DANGEROUS Patients?”

    3. I could not agree more with you on this! You have hit the nail on the head. I was especially irked by the way she has gone about making such assumptions simply based on personal bias. These are the kind of people who end up responsible for the hatred that the GLBT commubity face in my country.

      Unfortunately, I tried to initiate a conversation with the blogger in question over her comments thread but she did not allow my comments to go through. That speaks a lot about her narrow mindedness over this issue!

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  2. Fantastic takedown Pranab da, she comes out looking real bad. I have posted a link to your post over at her blog.

    She admits being called discriminatory bigot as a sign of success. Fits the definition of a troll perfectly :).

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    1. Well, my purpose is not to paint her in a dark color. The issue she has raised is indeed very pressing, but it is lost in the maze of her confused bigotry. She has no strong data to support her views, and is throwing her commenters’ support in my face. It is an accepted fact that gender difference in the face of the “intimacy” of a proper physical examination is very irksome. Instead of stating how to deal with that from the patient’s perspectives, she goes off on a rant!

      I do not think she is a troll. I think my description of her as a “discriminatory bigot” irked her and she responded in kind.

      I do not intend to malign her in any way. This is not supposed to be a personal attack on her to make her come off badly. This is just a critical take down of her opinions, which, honestly, suck!

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    2. I think you you are being too modest to her Pranab da, it will only irritate her more :). It will not fit into her worldview of male docs.

      I call her a troll as I think the whole point of her post was to take a potshot at male docs and get a rise out of us. You don’t write such a post and then expect not to be called gender biased. I think you are absolutely right in calling her a discriminatory bigot as that is what her post makes her out to be.

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    3. Well, she succeeded in irking both of us enough to get a response. Techknowdoc also has left a diplomatic response on her blog, but I am sure he does not want to “take sides” in this battles. I have been reading his blog for quite some time now and he is way too chilled out to encourage in such a pointless debate. Unfortunately, I am not, and when I want to take someone down, I do it.

      She may not be a troll, but as I said, some poorly informed person with an inflated sense of worth in fending her stand on what she perceives to be correct.

      The most unfortunate fact is that she is a VERY popular blogger, and gets more eyeballs than any of us. She could have started a balanced dialogue and tried to get us to discuss how we could foster an environment where female patients did not feel violated after getting a physical examination from a male doctor (and vice versa). Yet, she chose to not do that and instead channeled her chauvinistic rage in the post and took a populist stand with no practical implications whatsoever except for some blog hits, attention and gallery-wowing.

      I still stand by my assertion that she is not a troll, but someone who is just inadequately informed and highly opinionated. A very deadly combination, if you ask me!

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  6. The reality remains that given a choice, most women will prefer to be examined by women doctors; but when there is no choice, most women will not mind being examined by a male doctor. This applies to males also. Such biases run deep, reflecting centuries of thought evolution and are extremely difficult to counter. The biases do get reinforced whenever there are ugly incidents involving doctors.
    So as a practical measure, as a service provider it always pays to assure your patients that they will be well taken care of by verbal and non-verbal measures. Having a chaperon around certainly helps, makes the examination settings more professional and much much reduces the allegations and actual occurrence of molestation. But somehow, many doctors don’t follow the basic protocols.

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    1. Not denying the fact at all… a properly conducted physical examination is intensely embarrassing. However, if you read the article I am criticizing, you will notice the strong gender bias it propagates. It dances around the main issue and beats the bushes with hackneyed logic, yet never addresses how to solve the issue…

      No wait, she does: she says that there should be a law to prevent male docs from seeing female patients. Of course, that is a very reasonable thing to do!

      She does not seem to believe in chaperones either!

      I strongly object to the kind of venom she spews. She takes an important issue, and turns it into a populist agenda for some cheap publicity by taking pot shots at MALE (IS A MALE IS A MALE) doctors!

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  7. Dirty minds envision and then some of them hatch dirty scenarios and dirty stories, get self satisfycing results, feel proud, and some like you and I keep on defending our position of Reality of the Time, Nature and Natural Justice as our worthy commentator Dr, Pranab Chatterjee has. Thanx doctor for your lovely presentation in the form of this writing. Congratulations and may the Almighty Nature keep you fit and healthy to work for the Truth no matter what results get achieved. To struggle for Truth is our doing, results though are not in one’s hands, and lament not if results are not achieved. Dr Suresh Vatsyayann …freegp@gmail.com and internet site http://www.freegp. net, nz

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  8. Well Pranab, she seems so out of sync with reality that one can only wish her good luck. Hope she never suffers a fracture or needs a surgery.

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    1. Alex, she has had kids, has been dealing with the docs of the opposite gender and has been hating on them all her life, and if the commenters on the post are any indication AT ALL, then heck, she is NOT the only person who believes in this unreal, bullshit philosophy!!!

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  9. Pranab, I recognise that you come from a rather different culture than I do and that cultural sensitivies need to be recognised.

    Having said that – everyone should get a grip! A Doctor is a Doctor and I will personally (as will most Australians) see whatever gender Doctor happens to be the best available in the particular field. I can assure you that if the best proctologist was a female, that is where my husband would be going!

    My children were delivered by a male, I’ve had surgery performed by a male surgeon. My hysterectomy was performed by a female, simply because I chose her as the best at the time for what I needed, definitely not because she was female.

    If that same person was discriminated against in other ways, I’ll bet that person would raise a fuss. Yet THAT person is encouraging gender discrimination. Not on in 2011. Anywhere.

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    1. Thanks for the perspective! This is EXACTLY what I have been thinking. Cultural considerations apart, the whole idea is motivated with ignorance, which infuriates me. These are the kind of people who make laws against homosexuality. These are the people who look down on the basis of skin color or last names (in India that is indicative of the caste and social status of a person). These are the people who propagate hatred in the garb of social good.

      And the worst thing is these people form the majority and since the Indian political system is a spineless organism, if the clamor is loud enough (God knows these people know how to be loud and vocal!), these kinds of laws maybe passed.

      A detailed physical examination is bound to create some uncomfortable moments for the patients, but that is irrespective of the gender of the patient or the doctor!

      Thanks for the unbiased words. So much hate was pouring in on this issue, I started doubting if I was thinking straight!

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  10. All I have to say to this is that I totally agree with your opinion and that I am 22 years old, female, and my doctor that I had the last 22 years was a man and I was never treated in an unrespectful way.
    Oh, I just had this thought too: What happens when the examining female doc is also a lesbian? Will she be banned from helping people ever again?

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    1. Thanks for taking the trouble to read and comment on the post. By the reasoning that prompted me to post this, yes, if the examining physician was a lesbian, she should be banned from treating all female patients, and if the patients herself is one, then she should be banned from being examined by all female doctors. How is THAT!

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  11. This is a topic worth reading and writing about because the real issue often gets confused and misidentified. I’ve worked as a caregiver to dementia patients, a medical assistant, and an x-ray/MRI tech, and I’m male. I’ve assisted in surgeries of both genders and performed a lot of invasive procedures like catheter insertions. What the blogger was expressing was fear, not facts. Many people fear medical procedures, and to a degree they have reason to because many procedures cause short-term discomfort. Shots can hurt, finger sticks sting, mammograms hurt, and a flex-sigmoidoscopy can put you right out of your mind. It’s not going to hurt less if performed by someone of your own gender, but if the patient is also embarrassed by their own fearfulness or feels violated by a practitioner’s comfort dealing with bodies in ways that may seem immodest it makes everything worse.

    There are strategies to help put patients more at ease, but the first and most effective step is to always ask the patient’s permission (if they are conscious). This reassures them they are in control, and can make choices according to their own comfort level. With experience, practitioners learn to recognize when a patient is fearful even if they don’t say so. In those cases, if a person of one gender is the only one qualified to perform the procedure they can get an assistant of the same gender as the patient to help reassure them.

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    1. CONTROL!
      Very well said Mikey! The thing is, in my short stint as a doctor, I have found that a lot of patients act out, be vile and plain old ruthless with us healthcare workers because they are scared of the situation they are in, and being able to commandeer the environment gives them a sense of control over what is happening.

      The lady in the original post is also experiencing something similar. She has no control over the prognosis of the deal she is in, so by regulating genders and such stuff, she is trying to command her environs to change.

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    1. All I intend is to weed out the ignorance, and there is no personal vendetta in this agenda of mine! Thanks for dropping by to comment. Cheers!

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  14. This was an extremely well written and thoughtful response. I’ve just now joined this site and didn’t read the original article and you did address the issue of gender-specific thinking. During my clinical years in Medical school, I certainly had quite a few reactions from male patients, either: I don’t want her to examine me, or I want HER to examine me. As you pointed out, the evolution in thinking of Doctors as Doctors hasn’t happened yet, even in the 21st century.

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