Masculinity in Medicine

Gendering of Medicine:

How have typically masculine and feminine medical practices changed because of the increase of female doctors and male nurses?

One of the most interesting aspects of how medicine as a profession has been gendered is its evolution from a largely feminine to a masculine system of practice. In early times, women performed many of the functions now relegated to conventional, scientific medicine, such as childbirth and administering home folk remedies. The cliche of an 'old wives' tale' suggests the early feminization of medicinal practices. Yet because these bits of wisdom were based upon received tradition and personal experience, they were often imprecise. Only after medicine became standardized in its empirical practice did the profession gain respect and became regarded as 'masculine,' to the point that it became unusual for a woman to dream of becoming a doctor. Today, this is changing, and more women are becoming physicians. Once again, medical practices are being evaluated, and now the profession is attempting to incorporate more 'feminine' values into its assumptions. Nursing, too, has come 'full circle.' Men served as nurses during the 19th century, such as Walt Whitman during the Civil War. Today, the nursing shortage and downturn in the labor market has propelled many men to explore nursing as a career option

One recent interview with a neurosurgeon revealed that the common, negative concept of a doctor, particularly a surgeon today is someone who is masculine, egotistical, and arrogant. But even in the positive concepts of medicine in the modern era, according to Robert Nye, are based in masculine ideologies of honor. "In the professional and academic associations that flourished after 1800, honor codes served as a basis for male social relations and as guides for intraprofessional etiquette.

" Nye states that the professionalization of medicine was literally the creation of an 'old boy's club.' "Scientists and medical professionals and other members of the 'liberal' professions were no different from the general run of middle-class man in wanting to join groups of men like themselves who were interested in the same kinds of things.

" This made it difficult for women to enter the profession and feel comfortable amongst their male colleagues.

More than twenty years ago, women entering the field of the health sciences as nurses showed distinct patterns in their employment patterns. One 1984 study found that while women entering the 'traditional feminine health therapy' professions such as nursing showed no significant differences in their responses to the Bem Sex Role Inventory or the Attitudes toward Women Scale compared with a control group, female students in the health sciences "were more likely than other students to have traditional mothers who were not employed and to come from large families. Health science students also hoped to have more children. Thus, while there is some evidence that therapists are more feminine than other professional women, this seems to be much less true than in the past.

The 1984 study also found that the career paths followed by women tended to have distinct trajectories, depending on the personality characteristics and personal aspirations of the women in question. Women who were more focused upon upwardly mobile or vertical (V) advancement in a traditional fashion as well as those who aspired to lateral (L ) advancement (to another department, for example), tended to have higher masculinity scores than nurses who merely aspired to remaining within their current profession in a stationary (S) fashion. This suggested that masculine achievement, amongst groups of female nurses was still less accepted amongst certain groups of nurses, particularly those who might want to start families, although even in 1984, there was already evidence of change.

Amongst medical students, a 1980 study hypothesized that female medical students were more likely to have liberal attitudes towards gender roles, as choosing medicine is still considered a relatively unconventional career path for women. They were found to manifest greater assumptions of "equality in physicians' relationships with patients," to emphasize "the social and psychological dimensions of patient care," to chose the field of medicine "to help people rather than for entrepreneurial reasons, to be more open to "political and economic change in the medical profession and to advocate "change in the treatment of women physicians and women patients.

" in terms of painting an emotional portrait of physicians entering medical school, the hypotheses of the study were all supported.

The 1984 study of nurses and the 1980 study of male and female physicians, however, took place in the context of the immediate aftermath of the second wave of the feminist movement in the 1970s, when "only 10% of U.S. doctors were women. Today women account for one-third of the physician workforce. In U.S. medical schools, they make up half the class.

" but there is already a backlash to these increasing numbers. Some people, however, have criticized the increase of women in the profession, stating that they have changed the traditional orientation of doctors' emphasis on self-service. A recent study in the peer-reviewed British Medical Journal found that "study after study has found women doctors tend to work 20% to 25% fewer hours than their male counterparts," primarily because of family demands and argued that as "society still expects women rather than men to reduce work commitments to look after children and not to return to full-time work until the children are older…in the absence of a profound change in our society in terms of responsibility for childcare, we need to take a balanced approach to recruitment.

" My interview subject did not give an opinion on this issue specifically, but did observe that female physicians tended to be more present in less time-demanding specialties, like family practice and dermatology, rather than surgery, which might also account for the statistical discrepancy.

Advocates of the current professional gender balance, however, would state that female physicians bring overlooked values to the profession, such as compassion, which were once not part of the medical 'boys club.' This is not simply true in the fields of gynecology: male physicians still tend to undervalue female symptoms, in all areas of medicine. In fact, in one observational, cross-sectional trial, evaluating 1857 CHF (congestive heart failure) patients the study found "underuse of evidence-based drug treatment -- only half of the patients were being treated with sufficient doses of an ACE inhibitor and only every fourth patient was receiving the recommended dose of beta blocker.

" This was primarily the result of female patients being less "frequently treated with guideline-recommended medications such as ACE inhibitors, angiotensin-receptor blockers (ARBs) or beta-blockers" or being given lower doses of these drugs by male physicians.

Amongst prescriptions by female physicians: "use of beta blockers was more frequent in males than in female patients, but dosage was not different. In contrast, male physicians favored male patients for both prescriptions and dosage.