Research has shown that women are often given short shrift in the physician's office and are often on the receiving end of paternalism, their symptoms and suffering being dismissed as minor or imaginary. Feminists decry paternalism toward women in all its forms, firmly believing that women and men are intellectually equal and that they should be given equal treatment and respect. Feminists are also concerned that the health-care system tends to medicalize many normal female bodily processes, viewing them as aberrations that need to be treated rather than celebrated. In addition, feminists note that there are often subtle differences between the sexes in how various diseases and illnesses present and how they are best treated, yet these differences are not always taken into account during diagnosis and treatment. Feminists are also concerned that many clinical trials do not take into account the different physiological reactions of women and men to drugs and treatments, sometimes leaving women with treatments that are insufficient or inappropriate. Although progress has been made in most of these areas, much work is yet to be done.
Keywords Clinical Trial; Feminism; Gender; Gender Identity; Gender Inequality; Gender Stereotype; Hypochondriasis; Paternalism; Reinforcement; Reproductive Technology; Sex; Sexism; Sexual Discrimination; Socialization; Society
Sociology of Health
Going to a new physician can be a rather frustrating and intimidating process in general, requiring patients to reiterate a family medical history, establish insurance credentials, and the like. Women, however, often view these visits to be particularly off-putting, especially when a man (or even a woman) in a white coat walks in and says something like, "Hi, Susie. I'm Dr. Smith." Many women accept such paternalism, however, rather than snapping back a reply such as, "Hi, Bob. I'm Ms. Jones," in an attempt to set the course of the following conversation as a dialogue between adults rather than between an all-knowing expert and an ignorant supplicant. Unfortunately, despite all the 21st-century rhetoric regarding patient advocacy in general and a patient being his or her own advocate in particular, many physicians still maintain a paternalistic attitude, a holdover, perhaps, from the kindly-doctor medical shows of the mid- to late twentieth century. Although such an attitude is not universal, feminists note that it is all too frequent. They also note that frequently women's symptoms are dismissed as hypochondriasis, resulting in wrong diagnoses and insufficient or improper treatment.
Sexism and sexual discrimination in the health-care system and medical community is a well-documented phenomenon in the literature. Wyndham, for example, cites several studies that reveal sexual discrimination in the way women are treated by their physicians (1983). One study found that when patients presented with chest pain, low back pain, fatigue, dizziness, or headache, the male patients' symptoms were taken more seriously than were the female patients' symptoms. A study performed by the American Pain Society found that women not only make up the majority of pain patients studied but also tend to suffer from chronic pain longer than men. In addition, they tend to receive different treatment from men, who were typically given painkillers for their pain, whereas women were more likely to receive other treatments, including tranquilizers, shock treatments, or even, in one case, a proposed lobotomy. Wyndham concludes that physicians tend to view men's pain as "real" but women's pain as imaginary, a symptom of hypochondriasis or some other mental disorder. It is important to note, of course, that not all physicians treat women this way, and it is also important to note that sexism is not only limited to male physicians. Female physicians can also be sexist in their treatment of female patients.
Feminists view sexism in a medical practice as a reflection of sexism in the society at large. They also note that medical schools often teach sexist attitudes and ideas and reinforce them. Lewin, for example, relates the story of a female physician who was in a gross anatomy class in which the instructor told the class to cut off the breasts of the female cadavers and discard them (1992). Although such an action may have made the subsequent procedures easier to perform, it also gave students the impression that women's breasts were unimportant, an attitude that might be carried over in later years into the treatment of breast cancer. Wyndham also notes that medical school instructors continue to make sexist remarks regarding female patients, attitudes that are often learned by medical students along with lessons on anatomy and health.
One of the reasons for sexism and paternalism in the medical profession is socialized ideas regarding gender that are still at least partially supported by society. Failure to realize this can lead to sexism, sexual discrimination, and gender inequality. Social scientists note that there is a difference between gender and sex. Failure to make this distinction in the health-care setting can lead to a lower standard of care for women.
Sex refers the biological aspects of being either female or male. Genetically, females are identified by having two X chromosomes and males by having an X and a Y chromosome. In addition, sex can typically be determined from either primary or secondary sexual characteristics. Primary sexual characteristics comprise the female or male reproductive organs (i.e., the vagina, ovaries, and uterus for females and the penis, testes, and scrotum for males). Secondary sexual characteristics comprise the superficial differences between the sexes that occur with puberty (e.g., breast development and hip broadening for women and facial hair and voice deepening for men).
Gender, on the other hand, refers to the psychological, social, cultural, and behavioral characteristics associated with being female or male. It is largely a learned characteristic based on one's gender identity and learned gender role. Gender is a society's interpretation of the cultural meaning of biological sex. These interpretations often give rise to gender stereotypes, or culturally defined patterns of expected attitudes and behavior that are considered appropriate for one gender but not the other. These stereotypes are typically simplistic and based not on the characteristics or aptitudes of the individual but on overgeneralized perceptions of one gender or the other. For example, in the medical profession, one common stereotype, at least traditionally, has been that women are more subject to "imaginary" symptoms and illnesses than are men. This has resulted in the misdiagnosis of many patients who were believed to have psychological symptoms rather than physical ones. As a result of such gender bias, women may be consigned to suffer for years from an ailment before finding a physician who can see beyond her gender and diagnose and treat the underlying problem.
Clinical Drug Trials
Another problem that has been widely noted is the use of only male test subjects in clinical drug trials. Putatively, men are used because they are not at risk of becoming pregnant during the study, and therefore it is only the individual and not an unborn child who may be harmed by an untested drug, but in practice this means that any differences between how men and women react to the drug being tested remain unknown. For example, earlier studies have found that the prophylactic use of aspirin may help prevent a heart attack in men. However, since women were not included in the study, it was impossible to say whether or not the same held true for the use of aspirin by women. The Women's Health Study, sponsored by Brigham and Women's Hospital, was designed to redress this major shortcoming of the initial study (http://clinicaltrials.gov/ct/show/NCT00000479). Results published in 2005 indicated that, "surprisingly, aspirin's impact on [heart attacks] in women was quite different than that previously reported in men" (Ridker & Beller, 2005, p. 2). While the prophylactic use of aspirin did appear to reduce women's risk of stroke, it had no significant effect on their risk of a heart attack, thus illustrating the necessity of performing drug trials on both women and men.
It is also important to note that women and men may exhibit different symptoms for the same medical condition. For example, it is becoming increasingly widely recognized that women do not present with the same symptoms for a heart attack as do men (e.g., Pashkow & Libov, 1993). When physicians are looking for the symptoms experienced by males for a disorder, they are more likely to dismiss the symptoms of women as imaginary or...
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