“A widespread lack of medical knowledge about women’s health is buoyed by a society that makes a taboo of women discussing their problems, especially those to do with reproductive organs.”
Modern healthcare systems have undergone colossal advancement and development in the last century. From quicker and more accurate diagnoses to personalised care and better patient outcomes, it came as a surprise to long-term endometriosis sufferer and author of this book, Gabrielle Jackson, that very little has changed in the perception, identification and treatment of women’s illnesses by medical professionals. Evidence supports that medical students and specialists alike subconsciously regurgitate covert sexist and misogynistic assumptions about female patients—assumptions that have bled into the field (no pun intended) since the Father of Modern Medicine, Hippocrates [c. 460 - c. 370 BC] and the compilation of the Hippocratic corpus.
Medical culture
The highly masculinised culture of the medical field (in both research and workplace settings) has meant clinical studies on pathologies and drug efficacy have historically and exclusively been conducted on the male of a species (rodents, humans). The results of these male-centric studies have been generalised to both genders with a disregard of physiological and anatomical differences between the two. This generalisation has in turn contributed to the ongoing pain and suffering of women, who have either been completely misdiagnosed in the first instance, or have been diagnosed correctly but proffered suboptimal treatment options. For example, when both men and women presented with the same symptoms for heart disease but added a stressful life event to the mix, the final diagnosis for both genders was vastly different. Women were sent home with a diagnosis of mere anxiety whereas the mention of a stressful life event for men served in corroborating his diagnosis of heart disease. The results showed 56% of medical students/residents gave their male patients a diagnosis of heart disease, compared with only 15% for female patients. There are many striking examples like this in the book. She also talks about how female-centred illnesses are severely under-researched:
“Women’s symptoms are not taken seriously because medicine doesn’t know as much about their bodies and health problems. And medicine doesn’t know as much about their bodies and health problems because it doesn’t take their symptoms seriously.”
“PubMed has almost five times as many clinical trials on male sexual pleasure as it has on female sexual pain. And why? Because we live in a culture that sees female pain as normal and male pleasure as a right.”
Now to touch upon workplace culture. Jackson highlights rampant bullying culture (and sexual assault) in medicine, particularly between senior and junior members of staff: “A third of medical trainees experience sexual harassment internationally.” Harassment seldom goes reported due to the hierarchal nature of the field, as for some, progression can be contingent on networking and recommendations from seniors. It unfortunately seems as though women are trapped in a cycle of abuse despite the esteem and respect their careers demand. Depression, anxiety and suicide rates are also high amongst medical professionals including women, which affects patient care.
“In the US, doctors commit suicide at rates higher than any other profession.”
Healthcare systems - Australia, UK, and US
Jackson’s personal anecdotes about her experience with the Australian healthcare system were both harrowing and enlightening. I have an understanding of the UK and US healthcare systems (I work for the former) but I knew next to nothing about the functioning of the Australian healthcare system until I read this book. Australia’s public healthcare system is akin to the UK’s National Healthcare Service (NHS) in that it can be accessed freely or at tax-funded reduced rate via Medicare (which, alongside Medicaid, is also an option for disadvantaged citizens in the US). Australia also provides a private healthcare service that runs in tandem with the public system, much like the UK. The US, however, has no universal healthcare programme. It functions largely via private sector businesses and has an insurance/payment-based healthcare model, with employers funding their employees healthcare as a employment benefit.
Despite the fact that Western healthcare services are the best in the world, they can be highly reductionist—body parts are treated as separate, independent entities from the body and mind at large. This reductionist approach is based on Descartes’ idea of dualism, that the mind and body are two separate entities. It could be argued that due to this approach, illnesses (especially chronic ones) are simply managed as opposed to treated. This differs from Eastern and holistic medicinal approaches that look at the body and mind together as a whole, to determine the best course of treatment.
“Strangely or not, the best predictor of a woman’s sexual wellbeing is her overall wellbeing, which is why those issues—stress, mood, relationships—are not peripheral, it’s because they’re determining factors in whether or not she’s experiencing whatever you want to call sexual wellbeing.”
However, this is understandably a lengthy process. If you live in the UK, you already know how difficult it is to get a GP appointment, and having a surgical procedure is harder still. Most NHS Trusts’ waiting lists for surgical and medical services have become heavily inflated due to COVID-19 and this is exemplified by the rising rate of 52-week breaches across the board.
Healthcare and minorities
As an affluent Western White woman, Jackson acknowledges her privilege. She knows that her experience with healthcare and medical professionals may not be the same as minorities and women of colour. Whether it’s poor prior experience of the healthcare system or cultural/financial factors, people of colour are less likely to receive successful treatment/patient outcomes as their white counterparts.
“It has long been suspected that people of colour are treated negatively by doctors partly because of prejudiced misconceptions about biological differences between black and white people.”
“Another 2016 study found that a substantial number of white medical students and registrars believed false stereotypes that black people have a thicker skin than white people, the nerve endings are less sensitive, and that their blood coagulates more quickly than white peoples.”
This doesn’t go to say that all medical professionals across the board will allow biases to dictate how they perceive women and people of colour. Indeed, Jackson mentions those doctors and specialists that have helped her manage her endometriosis and other surgeries and she is ever grateful to them. What this book does do is give an explanation as to why some individuals may have a poor experience within the field, and it is largely due to historic practices and culture.
Conclusion
It would be dishonest to write this book off as a self-pitying feminist work. As a woman of colour (and faith) with a background in science and healthcare (if you couldn’t tell from my rambling review thus far) this work has been both liberating and empowering. There were a couple of bits I didn’t necessarily agree with, however this is due to my personal religious beliefs. My faith shapes my worldview and beliefs on gender and sexuality. To be specific, my points of contention are regarding Jackson’s remarks about female masturbation as a necessity and a healthy way to explore one’s body/sexuality. This apparently combats the patriarchal society that perceives women’s self-pleasure as dirty. That’s an interesting endeavour to advocate considering pornography addition is on the rise with women and pornography in general objectifies women (and men), leading to masturbation addiction and increased rates of infertility. I also disagree with her hailing the 1960/70s sexual revolution which perceived increased sexual agency/freedom [i.e out of wedlock] a woman’s “right” and something that should be encouraged. That being said, she does criticise the movement due to the rise of sexual assault and harassment: “[...]the truth of the sexual revolution: it freed men to feel comfortable with their fantasies of sexual dominance without uprooting the culture that shames women and people of all genders and lower social classes both for enjoying sex and for speaking out about sexual violence.”
I highly recommend giving this a read, especially if you work in healthcare.
“It’s everything from our cultural backgrounds, which haven’t been pro-women; it’s the fact that women’s pain is pain you can’t see; the fact that our society in general doesn’t listen to women; it’s the fact that pain symptoms are described [by women] in ways that men don’t appreciate; it’s the non-prioritising of issues of importance to women, and that covers the undervaluing of gynaecology compared to other specialities”
4/5 ⭐️⭐️⭐️⭐️