COVER

Women treating women

Men are now just half the class in medical schools

MARK NICHOLS January 12 1998
COVER

Women treating women

Men are now just half the class in medical schools

MARK NICHOLS January 12 1998

Women treating women

Men are now just half the class in medical schools

MARK NICHOLS

Among women who have confronted life-threatening illnesses, horror stories abound of unfeeling behavior by male doctors. After breaking the news to a woman that she has cancer, a physician abruptly leaves his office and sends in a nurse when his patient bursts into tears; a doctor, ignoring a breast cancer patient’s request that he wait for her husband to arrive before delivering his prognosis, bluntly tells her that she will be dead within two years. (Besides being insensitive, the doctor was wrong—his patient had a bone marrow transplant and is alive and well 27 months later.) Behavior of that kind may be on its way towards extinction. For one thing, medical students—as well as older physicians on refresher courses—are being instructed in so-called patient-centred communication, a style of doctoring aimed at creating a physician-patient relationship based not or paternalism but on partnership. And women are flocking to med ical schools in ever-increasing numbers—a trend that is likely tc benefit other women since studies show that female physicians tend to spend more time than male doctors do with their patients.

Despite the changes under way, gender-related problems stil surface with disturbing frequency in the traditionally male domain of medicine. Colleges of physicians and surgeons across the country frequently have to intervene—and hand out harsh penalties— when male physicians take sexual advantage of female patients, And although the Playboy centerfolds that sometimes festooned medical classrooms are a thing of the past, the medical establishment has been slow to promote women to senior positions. Manj women say sexism still embedded in the system makes it difficult for women to get ahead. For one thing, says Wilfreda Thurston who directs a gender equity office at the University of Calgary’s faculty of medicine, ‘You may be considered not serious about your career if you have two or three children.”

Still, while pointing to subtle biases in the system, women doctors insist they encounter little overt harassment or discrimination. Or the other hand, there is evidence that harassment—of both sexes— is a problem in Canadian medical schools, where women now make up about half the enrolment. Harassment charges, says Thurston, sometimes arise over inappropriate language in classrooms, or “relationships that have gone bad between students and faculty members, or physicians in teaching roles.” And according to a survey of 186 male and female doctors in residency training programs at McMaster University in Hamilton during the 1993-1994 academic year, 12.9 per cent of the women said they were the victims of unwanted sexual contact. However, more men (11 per cent) than women (6.5 per cent) said they received explicit sexual propositions. But far more women (89.1 per cent) than men (61.1 per cent) said they experienced discrimination on the basis of gender, with 70 per cent of the women saying they were discriminated against by male supervising physicians. “There’s still harassment and sexism and small inequities directed towards women,” says May Cohen, a professor in McMaster’s medical school and a veteran campaigner in women’s health.

Women who pursue careers in medical research also appear likely to encounter disheartening obstacles. A 1996 study by the Canadian Association for Women in Science looked at the experiences of female scientists in health sciences research and found that, after graduating from university with science degrees in nearly equal numbers with men, they tended to form an ever-smaller proportion of the ranks at each rung on the career ladder— to the point that only about 20 per cent of career scientists are women. Rachel McKenna, director of the transplant immunology laboratory at Winnipeg’s Health Sciences Centre, who helped carry out the study, notes that although the funding agencies that can make or break scientists’ careers by backing their projects “claim to be more welcoming to women than in the past, we don’t see that happening.”

One of the major problems facing women in medical research, says McKenna, is childbearing: when women take time off for babies, the flow of research papers is interrupted.

“You’re judged in short time frames,” says McKenna. Beyond that, she suspects there is systemic bias at work. “In subtle ways, I think the evaluation system is still based on the oldfashioned model” of a male doctor with a wife who is a homemaker, she says, “and this discriminates against women.”

If female doctors and researchers still face barriers, the profession is starting to respond to the demands of female patients for a less authoritarian style of medicine. Studies have shown that women usually are more interested than men in detailed information about their illnesses—and they want a larger say in deciding on their medical treatment. As a result, since 1992 the College of Family Physicians of Canada has made doctors’ familiarity with patient-centred communication a condition of licensing. Moira Stewart, an epidemiologist at the University of Western Ontario in London, is working with breast cancer survivors and other groups of patients in a study aimed at increasing physicians’ sensitivity to patients’ needs. One thing her research has shown, says Stewart, is that when doctors have to deliver bad news about breast cancer, patients want the message to emphasize the chances of survival—“because this gives them the strength to hope and fight.” More generally, says Barbara Wiktorowicz, executive director of Winnipeg’s Women’s Health Clinic, women want to “participate in their treatment, rather than having doctors just tell them things. They don’t want doctors on a pedestal.” With more women becoming doctors and the demands of female patients being listened to, the pedestal of authoritarian male rule may finally be crumbling. □

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Dr. Steven Narod is a veteran warrior in the crusade to conquer breast cancer. In 1994 and 1995, his Montreal laboratory was part of an international effort that identified the two genes—BRCA1 and BRCA2—believed to cause about four per cent of breast cancers in women. Now a senior scientist at the University of Toronto’s Centre for Research in Women’s Health, Narod is engaged in wide-ranging studies aimed at finding ways of saving lives by screening women for the genes. As a first step, Narod's team has assembled information on more than

700 women in Canada and the United States who inherited one of the genes, half of whom have already had breast cancer. Of those who have had the disease, a third have been treated with the drug tamoxifen following surgery, and Narod plans to monitor them for 10 years to see whether the treatment helps prevent recurrence. If it does, says Narod, then it may be possible to stave off breast cancer by giving the drug to women who carry one of the potentially deadly genes before the disease has a chance to strike.

Narod’s program is part of a surge in research into women’s diseases that has occurred in recent years. At the three-yearold Toronto centre, director Heather Maclean presides over studies costing more than $7 million a year into female health problems ranging from breast cancer and osteoporosis to tobacco addiction and violence against women. At the national level, the biggest offensive is being waged against breast cancer, thanks to the Toronto-based Canadian Breast Cancer Research Initiative, which since 1993 has funnelled $31 million into 116 research projects. “Have we beaten breast cancer?” asks the program’s research program director Marilyn Schneider. "No, we haven’t. But by learning more about the genetic mechanisms of the disease, scientists can now identify potential targets for interrupting the breast cancer process.”

In Ottawa, officials at the federally backed Medical Research Council—which helps fund the breast cancer initiative—estimate that grants for research into women’s health rose during the past decade by $9.6 million to nearly $19.1 million (among grants totalling $156 million overall). Even so, some fund-raisers say obtaining money for research into women’s health can still be an uphill battle. "People’s eyes don’t glaze over as much as they used to when you talk about women’s health,” says Dr. Knox Ritchie, a gynecologist who is chairman of the small, Torontobased Genesis Research Foundation, which funds studies in women’s health. “But at the corporate level it’s still a hard sell.”