Surviving in Scrubs

To what extent do women still represent the Second Sex in Medicine?

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This is a guest post by Dr Ellen MacIver.

Women, Simone de Beauvoir famously concluded, represent ‘The Second Sex’ in the dualism of men and women. 1 Many might believe that this is an outdated representation … that such substantial progress has been made, that this simply cannot be the case in professional fields such as medicine. I chose to explore women’s experiences in a piece of work entitled ‘To What Extent Do Women still represent the Second Sex in Medicine?’. The purpose was to open up a conversation and to explore the role of the female physician through popular culture representations and contemporary research. This blog post will summarise the key findings and hopefully help to open up the important discussion already being generated by Surviving in Scrubs.

In order to view the female physician’s role from a different perspective, feminist theories relating to sex and gender were reviewed. The works of Simone de Beauvoir, Luce Irigaray, and more contemporary theories by Judith Butler and Rosi Bradotti, were utilised to examine issues relating to the role of women in medicine. The predominant themes that came from post-structural feminist analysis of the contemporary literature and two key literary narratives were: the dominance of heteronormative gender roles, the ‘maternity issue’ and internalised gender biases. ‘Letter to a Young Female Physician’ by Dr Suzanne Koven and ‘Memoirs of a Woman Doctor’ by Dr Nawal El Saadawi were chosen as key
sources representing very different cultural and narrative forms, both written by female physicians. 2

El Saadawi was a pioneering Egyptian feminist physician, who overcame significant barriers to become a doctor in the 1950s. An outspoken and controversial figure she spent her life fighting against the oppression of women. 3 Although the novel is fictional, it was based on many of her own experiences. Letter to a Young Female Physician consists of 24 separate essays focusing on Koven’s experiences of sexism, discrimination, and imposter syndrome. Koven admits she was ‘oblivious’ to sexism in medicine, that this was because it is as ‘ubiquitous as air’. 4 She acknowledges that it is not just overt sexual harassment that constitutes sexism, but the subliminal prejudices and implicit biases which are interwoven into the discourse of medicine that are also incredibly harmful and problematic. Both texts are well worth reading and generate meaningful discussion relating to women’s roles as physicians, and the barriers that are still to be overcome.

Why does this matter? Despite women now accounting for over 77% of the entire workforce of the NHS, they are still experiencing discrimination and harassment relating to their gender. 5 Women are still treated with ‘less importance’ – an issue that has been highlighted
in key reports such as ‘Women Doctors: Making a Difference’ and the Royal College of Physicians ‘Women and Medicine: The Future’. 6,7 There are still key differences relating to entry to medical school, speciality choices and working hours, between genders. Gendered stereotypes regarding heteronormative gender roles are still present, not just within the medical profession, but within society as a whole. 75% of the female physicians in the BMA Sexism in Medicine report described instances in which they had been assumed to be less senior by patients/patient’s families, compared with only 2% of the male respondents. 8 Female clinicians also reported their competency was questioned more frequently by patients and they were assumed to be less capable. Many of the examples highlighted by Koven and El Saadawi are still a feature reported by many female doctors today. A stark reminder that we have not made as much progress in medicine as some would believe.

The reality remains that women are very much still ‘The Second Sex’ both within the medical workplace and in the clinical encounter between doctors and patients. Women are experiencing sexual harassment in the workplace, structural sexism in the format of poor
maternity policies, discrimination in their roles as mothers, a gender pay gap, and gender biases enacted on them by colleagues and patients. Change can only occur through opening up the discussion relating to women’s experiences and recognition that sexism in medicine
is not a distant memory, rather that doctors are facing sexual harassment on a daily basis. Subliminal prejudices, small acts of omission, or challenges to authority, can also all have a huge impact.

I’ll finish with a quote from ‘Memoirs of a Woman Doctor’ in the hope that, in opening up these conversations and challenging these issues, women can one day enter medicine with the confident step of belonging:

I stood in the courtyard of the faculty of medicine, looking about me. Hundreds of eyes directed sharp questioning glances at me. I looked squarely back at them. Why should I lower my eyes when they looked at me, bow my head while they were lifting theirs, stumble along while they walked with a proud and confident step? I was the same as them, or better. I drew myself up to my full height. I’d forgotten about my breasts and their weight on my chest had vanished. I felt light, as if I could move
as easily and freely as I wanted. I had charted my way in life, the way of the mind.

References

  1. Simone de Beauvoir, The Second Sex, 23 edn (London: Vintage Books, 2011).
  2. Nawāl El Saadāwī, Memoirs of a Woman Doctor, 3 edn (London: Saqi, 2019).
  3. Sarah Smith, ‘Nawal El Saadawi Obituary’, The Guardian, (2021) [accessed 10/08/22].
  4. Suzanne Koven, Letter to a Young Female Physician: Notes from a Medical Life, (London: W. W. Norton & Company, 2021).
  5. NHS Digital, ‘Narrowing of Nhs Gender Divide but Men Still the Majority in Senior Roles’, (2018) [accessed 26/8/22 ].
  6. Baroness Deech, ‘Women Doctors: Making a Difference’, in Report of the Chair of National Working Group on Women in Medicine, (Department of Health, 2009).
  7. Royal College of Physicians, ‘Women and Medicine: The Future. Summary of Findings from the Royal College of Physicians Research’, (2009).
  8. British Medical Association, ‘Sexism in Medicine’, (London, 2021).