Time - Man of the Year/Time_Man_of_the_Year_Compact_Publishing_3YX-Disc-1_Compact_Publishing_1993.iso/moy/060192/0601130.000

Text File | 1992-09-10 | 7KB | 138 lines

                                                                                HEALTH, Page 76

They Just Don't Understand


A maverick gynecologist argues that male physicians are poorly
equipped to care for female patients

By ANASTASIA TOUFEXIS


    For many women, seeing a gynecologist easily outranks
visiting the dentist as their least favorite doctor's
appointment. A dentist sometimes dispenses pain; a gynecologist
too often delivers humiliation. Not only must women lie
submissively in stirrups; they frequently must also endure the
abasing attitudes of their doctors -- 80% of whom are men. Only
the most radical feminists so far have suggested that women
doctors alone should be treating women patients. Now, in a
heretical stance sure to outrage the medical profession, a male
gynecologist is propounding that view. "Men have no business
being gynecologists," declares Dr. John Smith. "The role
properly belongs to women. They are the only sex truly able to
understand, empathize with and appropriately relate to women in
the already difficult doctor-patient relationship."

    That is just one of the grenades Smith lobs in his new
book, Women and Doctors: A Physician's Explosive Account of
Women's Medical Treatment -- and Mistreatment -- in America
Today (Atlantic Monthly Press; $20.95). Male domination of the
medical profession has bred a host of abuses, says Smith, 49,
a medical maverick who upset colleagues by starting the first
HMO in Colorado Springs, Colo., and now acts as a consultant on
national health policy. Research on heart disease and cancer,
as well as on the benefits of various therapies, has centered
almost exclusively on men. "We've got a body of knowledge that
doesn't apply to women," laments Smith. More than 600,000
hysterectomies are performed in the U.S. each year, half of them
unjustified, in Smith's opinion. "That's over $1 billion in
physician fees alone," notes Smith, who contends that doctors
are overpaid and undersupervised. "No wonder they don't have a
lot of motivation to develop alternative treatments to the
excuses used for hysterectomies."

    Sexism, ranging from outright abuse to subtle debasement,
is pervasive in the profession. Smith recalls a colleague who
invited him to do an exam on a patient under the false guise of
a consultation because "she has a body you won't believe."
Another physician, whenever faced with an "emotional" female
patient, would draw in his notes a stick figure with a lightning
bolt going into its head and write down a nonsensical diagnosis
of "zigzybiasis," signifying "This patient is crazy." A
pediatrician habitually marked his notes with a smiley face when
a young patient had a good-looking mother.

    To be sure, most male physicians are good people who are
certain that they act in their patients' best interest. They
are, however, a product of the values of the male-dominated
culture. "The good ole boy called Bubba who becomes a
gynecologist is simply Dr. Bubba," says Smith. Moreover, he
maintains that a strong subconscious motivation for many men who
choose gynecology as a specialty is the "need to be in a
powerful and controlling relationship with women."

    Whatever sexist attitudes men carry into medical school,
they are intensified within the fraternity of physicians. "It's
amazing how isolated doctors are," says Smith. "Training doesn't
root out their biases and insensitivities. Instead, a
subculture envelops them and reinforces each other's stereotypes
of patients." A common mnemonic used in medical school to help
identify women who develop gallstones is "fat, 40, with four
kids." Says the author: "It took forever for me to see slender,
unmarried women as candidates for gallbladder disease."
Prejudiced and mistaken notions also can govern the treatment
offered to black women, lesbians and those with a history of
venereal disease. For example, says Smith, a doctor quickly
diagnosed in a young, married black woman chronic pelvic
inflammatory disease -- an ailment that results from previous
venereal infection -- though nothing in her history supported
such a judgment. Actually, her symptoms and history perfectly
matched a diagnosis of endometriosis, a different condition.

    As a result of such attitudes, he argues, women are better
off with women doctors. Smith concedes that female physicians
can be every bit as domineering and money grubbing as their
male colleagues and that medical training may drain sensitivity
out of some of them, but "as basic material, they have the best
opportunity for empathy. And at the least, they understand the
female body better than any man could."

    Smith knows that his stance is more polemical than
practical; no one truly expects men to abandon the gynecological
field. Nor should they, as many women patients will attest. That
would be the equivalent of saying only male doctors should
minister to men and Doogie Howsers to children -- and solely the
boys at that. What makes far more sense is Smith's call for a
radical restructuring of women's health care. Among his
proposals: overhauling medical education so that male doctors
understand what it means to be a woman.

    By that he means nothing as simple or gimmicky as having
men climb into the stirrups, a tactic that is being tried in a
few medical schools. "What I'm talking about is a rigorous
exposure to the female perspective on life and males, how
vulnerable they feel in the world, not just in the doctor's
office," explains Smith. "A woman's specialist needs to go
beyond anatomy, beyond having babies and periods. He or she
needs to be an expert in female sexuality, social interaction,
cultural values, anxieties and fears, the total psychological
makeup of being a woman." They would also be trained in how such
ailments as heart disease and cancer differ in women and men.

    Smith believes that the new woman's specialist should
concentrate almost exclusively on preventive and primary care.
"The ideal setup would be female clinics, overseen by doctors
but staffed by nurses and other non-M.D. professionals," he
says. Routine prenatal and pregnancy care, now the purview of
the gynecologist-obstetrician, would be handled by midwhile
high-risk pregnancies and deliveries would be assigned to the
appropriate specialists.

    How is this change going to come about? Well, don't count
on physicians. "We've got an entrenched older establishment
that doesn't see the need for change," Smith observes. "Younger
physicians are more likely to favor it but less likely to be
politically active." Women are going to have to prod doctors
into giving them better care. Smith suggests that women approach
their gynecologists "the way you do car dealers and insurance
salesmen." Ask questions, he says, and take notes. Your doctor
may mark down such assertive action in his medical records. But
as a measure of respect, it beats a smiley face every time.