Book Review

Women in Medical Education: An anthology of experience

N Engl J Med 1997; 336:1111April 10, 1997

Article

Women in Medical Education: An anthology of experience
Edited by Delese Wear. 183 pp. Albany, N.Y., State University of New York Press, 1996. $20.95. ISBN: 0-7914-3088-X

These essays were written in response to a request by Delese Wear, the editor, for each contributor to provide “a personal narrative about her feminism . . . and to describe how she enacts her feminism in medical school or university settings and in her life outside medicine.” In the foreword, Frances Conley sounds a rousing battle cry. The 15 essayists have had direct contact with medicine as students, teachers, or administrators, and all of them demonstrate talent and determination in the pursuit of their careers. The contributors include physicians and scholars with interests in medical practice as well as literature and medicine, medical history, medical anthropology, medical ethics, and psychosocial aspects of medicine. Each essayist describes her role in the setting of conflicts and frustrations that she ascribes to the fact of womanhood.

Although feminism is the topic, there is no single definition of the term. In one of the essays, Wear and Janet Bickel describe four overlapping types of feminism: liberal, androgynous, multilayered, and radical. The aim of all four is to dissolve sexual inequality, but the second type would also dissolve sex differences; the third would also reform all oppression related to race, social class, and sexual orientation; and the last would dismantle any patriarchal dimension of society but support sex differences and perhaps separatism. The individual authors do not, however, define clearly the goals of feminism to which they aspire.

A recurring theme is that women are victims of a patriarchy in medicine. The fact that most studies and standard values are directed toward males is cited. Some of the authors suggest that men may not have the warmth and social skills that women have. Struggles in coping with the demands of pregnancy and parenthood are described, along with the difficulty a physician has in being accepted as an equal if working on a part-time schedule. The general complaint is that men do not consider women in medicine the equal of men. These male offenders include not only other physicians but also classmates and even patients; one writer complains of being mistaken for a nurse by a male patient. However, many of the authors do admit that some of their best supporters are male doctors. Leah Dickstein states that women have been encouraged to pursue careers in primary care and not aim for the more prestigious medical or surgical subspecialties, but she does not document who has given this advice; on the other hand, Beth Alexander complains that her male mentors tried to dissuade her from pursuing a career in family medicine. There is concern that women in medical school and in training are more reticent, less apt to speak out, and less apt to question than men — a problem in earlier education as well.

There is also the theme that the female physician must struggle not to become a man, caricatured as a physician overdevoted to work, aggressive, somewhat insensitive to the psychosocial needs of patients or other staff, accustomed to using only the masculine pronouns, unconscious of the fact that female physicians are his equals, and so forth. Deborah Jones claims that patriarchy and androcentrism make it impossible for women to rise to the top and that one “cannot rely on those women who have risen to top positions by internalizing patriarchal leadership models to carry the banner of feminism.” Perhaps. That depends.

Jane F. Desforges, M.D.
New England Medical Center, Boston, MA 02111