Speaker addresses gender in medicine

Dr. Susan Phillips presented some thought-provoking information during a presentation entitled, "Is Evidence Enough? Gender in Medical Research, Practice and Education," as part of a Northern Ontario School of Medicine (NOSM) symposium series. 

The lecture at NOSM's east campus on Jan. 21 was broadcast across the North via teleconference.

Phillips' studies on gender have been widely recognized and published in international medical journals. She has spoken at the World Health Organization, the Swedish Research Council and in other countries throughout Europe, North America and in Australia. She was the recipient of the College of Family Physicians of Canada's Equity and Diversity Award for 2009-2010.

Phillips is a family physician and a professor at Queen's University in both the School of Medicine and in Community Health and Epidemiology. Her experience as a family doctor in Sioux Lookout, Toronto, and Kingston has provided a window to observe how social circumstances shape health.

Her presentation touched on gender as a social determinant of health. She also used specific examples of how gender stereotypes and inequalities can affect morbidity and mortality, and how knowledge of such can improve medical practice and teaching.

Phillips defined gender as not specifically being male or female, but the role that men and women take on in society.


Effect on health

Gender can have a direct effect on health. For instance, men are greater risk takers than women, thereby shortening their lives in ways that women don't. Phillips' 2006 study about why women outlive men showed that risk-taking behaviours were the cause of a shorter lifespan in males.

"It is not about heart disease and that the male heart succumbs 10 years earlier than the female heart," she said. "It is about homicides, suicides and injuries - risk-taking behaviour."

Another example of a direct effect of gender on health is seen in countries where women are less likely to receive access to health care. The gender roles that come with being female increases their risk of disease.

Phillips cautioned against perceiving the study of sex differences as equivalent to studying gender. "We must identify sex differences when they are significant, but not magnify them when they are of no clinical importance," she said.

"In evidence-based medicine, doctors have to know who their patients are and the world in which they live. Being sensitive to gender is important in that process because gender is central to who a person is and to the roles and life functions of that person.

"Knowing the person is central to all branches of medicine, not just family medicine," she said.

A 2006 study focused on educating teenagers about safe sex and contraception because teenaged girls continue to get pregnant without wanting to. The study found that teenagers failed to practice safe sex, not due to lack of information, but because they believed they should experience the stereotypical "romance of the moment." Putting on a condom would ruin that spontaneity.

"All of the information in the world won't change the behaviour because behaviour is in the gender roles," Phillips said.


Hidden curriculum

She also spoke about the roles of teachers and education in the medical profession, as well as the hidden curriculum.

"How the preceptor interacts with students and patients teaches more than the information bites we give," she said.

A hidden curriculum may consist of the amount of time allotted to a certain subject and whether or not it is tested. Teaching human anatomy as normal in terms of the male body and the female body as different, smaller than, or missing a part, implies that differences in women are abnormal. Even in cardiology, women are presented as "atypical" from men.

"I think we pathologize women and we normalize pathological behaviour in men," Phillips said.

Placing fatigue in a schedule of lectures with gynecology and obstetrics implies it is a female problem. Homosexuality is no longer a diagnosis, but menopause is.   

Phillips' research has influenced some teachings in medical schools. Her 1993 study on sexual harassment of female physicians by patients showed that more than 75 per cent of female doctors had been sexually harassed by patients and that when they were harassed, they behaved like abused women, questioning whether or not they were at fault. The study prompted discussion about physician safety and denial of care to a patient who may behave in a dangerous or threatening way.

Phillips wrote a paper on the stereotypes embedded in problem-based learning scenarios used in medical schools.

"All the women were losers in the cases and were all defined in terms of their families," she said. "All the men went out to work. The women had abuser boyfriends, and were all depressed and poor. Aboriginals had tuberculosis and the gay man had HIV." After her paper, the university changed the cases.


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