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Avoiding Male Doctors Is Not Discrimination. It May Be Risk Aversion.

Updated: Sep 26, 2023


By Chloe Nazra Lee, MD, MPH - MedPageToday - 24.09.2023 - [USA]

"Whenever a woman speaks up, someone will tell her to be quiet," a therapist working at our local domestic violence center said to me last week. "I've had people tell me that my job is based on man-hating."


Somehow, I am wholly unsurprised by this comment. Dismayed, yes; surprised, absolutely not.


Sadly, it is an attitude that persists not only in our society, but also in our field. It is an attitude that I would like to challenge and that I call on my colleagues to challenge with the following statement: acknowledging and discussing gender-based violence in medicine is not "man-hating."


A Doximity Op-Med piece published a year ago on the barriers that men face in ob/gyn raised some very valid issues, particularly the feeling of "not belonging" that drives many men away from the specialty. I appreciated the author's vulnerability in sharing his experience, and I can certainly relate to the isolating experience of feeling "othered."


What I did not appreciate were the comments, in which several physicians lamented, "reverse discrimination...the new normal!" in the ob/gyn's office; compared a female patient's preference for a female physician to racism; and called for women to "stand up for the rights of men, just as in the past men stood up for the rights of women." (Sidebar: exactly whom do you think blocked women from having fundamental rights in the first place?)


I then noticed that some physicians, in response to others voicing their concerns about male violence and sexual trauma forming the basis for patients' hesitation to be examined by male physicians, accused those expressing their concerns of "living in the past." I find this dismissive reply arrogant and deliberately obtuse. This response also fails to acknowledge that sexual trauma can be inflicted on patients both outside and inside the clinic.


Firstly, I would like to address the false equivalency with racism. I have never known a physician to leverage their minority status to abuse a patient. The same cannot be said for male physicians using their status as male physicians to take advantage of patients.


To cite a recent and chilling case, former ob/gyn Robert Hadden, MD, sexually abused countless female patients over a 20-plus year period during his tenure at Columbia University Irving Medical Center under the guise of performing necessary medical exams. After years of sexual misconduct, Hadden was finally sentenced in July on federal charges and Columbia settled with his victims for $165 million. Given the egregiousness of Hadden's sexual misconduct and the duration over which it occurred, despite alleged institutional knowledge of the misconduct, can we really be surprised when patients are reluctant to engage with male physicians in such a vulnerable setting as the ob/gyn's office?


Hadden is not alone. Larry Nassar, DO, another former physician and sexual predator, notoriously used his status as a male physician to abuse multiple young women under the pretence of performing medical exams. He evaded accountability for years, and by the time he faced any consequences, he had irrevocably harmed countless patients.


I myself reported what I believed, in good faith, to be a colleague's troubling pattern of sexual misconduct in the clinical environment. Despite the administration voicing their fears about this individual and their stated agreement with my concerns, he moved on to the next level of medical training with no real sanctions.


Another male medical student wrote an op-ed on his interest in ob/gyn and noted a disturbing response from male colleagues: "I want to talk about a reaction I've received -- exclusively from men -- that I am choosing this career as, in their words, a 'smart choice' that allows me 'to look at vaginas all day.'" I applaud this man for his honesty. This is a real and highly perturbing issue in medicine right now: there are male providers who openly sexualize their female patients while they are most exposed. This is unacceptable and repugnant.


Hence my second rebuttal to the comments in the opinion piece I cited earlier: women's hesitancy around male physicians, particularly in ob/gyn, can hardly be described as "living in the past." Sexual misconduct in medicine and the subsequent institutional cover-up (in some cases) is very much alive and well.


To be clear: I am not arguing that men should not become ob/gyns. But I am asking for a little empathy and understanding as a woman, over the defensiveness and accusations of "male-bashing" that I regularly encounter. As a physician, I know that there are wonderful and ethical male physicians. But as a patient, I am risk-averse. I know that it takes years for a perpetrator in medicine to be held accountable, if ever, and I do not want to put myself in a position in which I might be harmed. As such, I prefer female ob/gyns for myself. I imagine many other female patients feel similarly.


Put another way: if you present me with 1,000 glasses of lemonade and you tell me that one of them is urine, I will not drink any of them.


Avoidance of male providers is not discrimination; it is a matter of self-defense rooted in a very real problem of sexual and physical violence that is often perpetrated by men who have historically escaped culpability for their destructive actions. It is a matter of patient safety, which should always be our first priority.


I entreat my male colleagues not to be defensive when encountering this hesitation, but to try to understand it with compassion, without taking it as a personal attack. We want men in medicine, and especially in ob/gyn, who are ethical, who will hold themselves to the highest professional standards, and who will create an environment of safety for us, while advocating for us by addressing harms where they see them.


If you have been affected by any of the issues raised in this article, you can contact Dignity4Patients, whose helpline is open Monday to Thursday 10am to 4pm.

 
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