Gender culture: historic disparities in healthcare

ABIGAIL GIORDANO – Culture is a process that is relative to time and place, and different cultural beliefs often impact medical practices. America has a very binary view of gender that even delineates certain occupations as male or female such as pediatrics and nursing, which are seen as feminine fields , while cardiology and orthopedics are majority male. On the patient side, patriarchy can be seen through the exclusion of female anatomy in older textbooks, and many anatomical roots are being argued as demeaning to women patients in medicine. Recently, the word “pudendum,” referring to a woman’s external genitalia important for obstetrics and diagnosing pelvic pain, coming from the Latin root pudere “to be ashamed,” was taken out of the 2019 version of the Terminologia Anatomica (NYTimes Gross). Furthermore, the word hymen, which persists in medical textbooks and is commonly taught in  sex-education classes, shares the same root as Hymen, the Greek god of marriage. Lastly, Dr. Young, a public health researcher, noted the first anatomy textbooks included drawn diagrams of skeletons in which the female one had wider hips and smaller craniums to solidify women in the motherhood role. Women have consistently been seen as reproductive bodies, while their reproductive and endocrine systems are neglected in scientific research . The persistence of these anatomical words and imagery show the delegitimization of  women’s  anatomy. 

The lack of research is exemplified in several nationwide clinical trials on aging and heart disease, which include over 30,000 men and zero women due to concerns of reproductive side-effects of taking aspirin, claiming that women’s hormones can change the results of metabolizing the drug (Guardian Interview). Without women in the study, how is it generalizable? And how could the FDA approve new medicine to be given to women patients? Furthermore, Dr. Young explains the lasting historical significance of “hysteria” to diagnose women’s problems, particularly mental disorders, menstrual symptoms, and unresponsiveness to treatment. Additional misdiagnoses and mysteries include diseases that appear differently in women than in men, such as ADHD and depression. 

A step in the right direction could be the addition of sociology on the MCAT. The importance of this is the inclusivity and awareness that the discipline brings to future doctors. Understanding lived experiences of different upbringings, schooling, family life, global context and more could move care towards a more holistic and personalized approach. Furthermore, there has been an increasing trend of women in medical school, with 2019 being the first year that women were the majority, according to the Association of American Medical Colleges . Along with gender diversity, race diversity in medical school has also increased: Hispanic, Latino, or of Spanish origin grew 6.3%, the number of Black American students rose 3.2%, and American Indian or Alaska Native matriculants rose 5.5% (AAMC). 

Furthermore, highlighted during the taxing COVID-19 pandemic, America’s medical industry is under fire for disparities involving intersections of women of color, gender non-confoming (GNC) and LGBTQ+ patients. A 2017 Center for American Progress study showed that nearly one in 10 LGBTQ+ individuals reported that a healthcare professional refused to see them in the prior year, which the respondents attributed to discrimination of their actual or perceived sexual orientation (Gillespie, 2022). Inadequate access to professional help leads some into self-medicating and illicit drug use, leading to more chronic side effects in the future. Importantly summed up in Paine’s 2018, “Embodied Disruption” study of LGBTQ+ experiences at doctors’ offices: “Medicine is a key social institution through which social categories are constructed, produced, and reified—as well as (potentially) challenged and redefined… When it comes to defining bodies and the social categories into which they are sorted, medicine remains one of the most powerful and influential institutions shaping our cultural definitions of sex, gender, and sexuality.”

Overall, medical professionals need to realize the power they have with the knowledge they give their patients and the recommendations that patients follow. Many patients can be seen in a vulnerable position, not only with pain, but with the fear of not being treated equally as LGBTQ+, women, and women of color. Addressing stigmas of discrimination and implicit biases that doctors hold could change the culture of medicine and empower marginalized groups.

Copy Editor – Cate Riser

Photography Source – https://healthcommunity.nature.com/posts/sex-and-gender-differences-and-biases-in-artificial-intelligence-for-biomedicine-and-healthcare-86a668f9-d6b4-4946-8003-136ad9cc2898