Sexism and the ob-gyn Do women fare better with female doctors? Authors says yes


June 15, 1993|By Linda Roach Monroe | Linda Roach Monroe,Knight-Ridder News Service

If a woman is taking care of her health, every couple of years she puts on a paper gown and lies down on a padded table with her feet in stirrups.

But that isn't the worst of the indignities she might suffer at the hands of a gynecologist, warns Dr. John M. Smith, author of the controversial book "Women and Doctors" (Dell Publishing, $12.95 paperback).

The physician also might be ogling her body to comment on it later to colleagues. He might touch her inappropriately while she's anesthetized for surgery. Or he may just subject her to an arrogant, patronizing attitude that demands unquestioning submission, Dr. Smith says in his book.

The solution, he believes, is for women to see women gynecologists instead of men.

"Male gynecologists don't talk about women the way women talk about women. They don't talk about your lives, your bodies, your culture, your experiences, your causes," says Dr. Smith, a retired gynecologist from Colorado Springs.

"They talk about your parts. And they talk about them almost with a pride of ownership -- the way men talk about a race car. A lot of pride in understanding how these things work, and a feeling of powerfulness in the ability to manipulate these things and make them all better."

A board-certified gynecologist who practiced in Alaska and Colorado for 12 years, Dr. Smith in 1979 helped found an HMO, which has since been sold, and works now as a consultant on medical-legal issues. He has been on tour to promote the book's paperback edition.

Dr. Smith's hard-edged criticism of male gynecologists has made him a maverick among the largely male ranks of gynecologic physicians in this country.

In a 1992 statement when the hardback was first published, the American College of Obstetricians and Gynecologists said: "Most (male and female ob-gyns) are dedicated physicians attempting to provide the best possible care to all patients based on science and social concerns."

"Our key point is that gender doesn't guarantee compassion," said Penny Murphy, spokeswoman for the organization.

Furthermore, Ms. Murphy noted, the male-dominated profession is changing quickly: Women are 24 percent of practicing, board-certified gynecologists in this country, but about half the medical residents being trained in the field are women. Among young ob-gyns, 50 percent already are women.

But Dr. Smith says his conversations with women confirm his contentions about their treatment by males.

"As I mentioned in the book, I've seen doctors walk into operating rooms and take a peek at women," Dr. Smith said in an interview. "And since the book, I've had a number of women tell me that it happened to them. The doctor thought they were asleep and they weren't."

What did the women do about it? "Nothing. They pretended to be asleep in all cases."

This reaction speaks volumes about how controlling a role gynecologists play in interactions with patients, Dr. Smith said. An imbalance of power is a problem with all physicians, not just gynecologists, he said.

"The basic relationship is all wrong, and that's what needs to change. Doctors need to be taken off their pedestal," Dr. Smith said.

"The problem is partly sexism, and part of it is the undercurrent of American medicine. It's become more arrogant, and very hands-on manipulative -- not engaging patients in their own decisions, but telling them what's going to happen."

Gynecologists hide behind their mantle of authority and knowledge to convince women that a hysterectomy is of little consequence, Dr. Smith said. (The American College of Obstetricians and Gynecologists also complained that Dr. Smith overstated the numbers of hysterectomies and Caesarean deliveries.)

"It's very common for doctors to say specifically, 'Your uterus bleeds, cramps, gets cancer and has babies. And now you're over the hill and you don't want to do any of those things, so just let me take it out and everything will be better,' " he said.

That makes about as much sense as removing a man's testicles after he's fathered as many children as he wants, Dr. Smith says.

And even if a woman questions the doctor, he said, her concerns are frequently dismissed.

"A woman will say she's heard that a hysterectomy changes sexuality, that it changes orgasm. And the doctor will say, 'You'll never notice it.' That's the ultimate, I think, in arrogance and patronization," he said.

While not defending bad doctoring, others in the field object to Dr. Smith's sweeping generalizations about women vs. men.

"I happen to think that being a gifted physician is gender-independent," said Dr. Yolangel Hernandez-Suarez, an

assistant professor of obstetrics and gynecology at the University of Miami. "I don't think that a female physician, just by the fact that she is female, will be more technically adept, have sounder judgment or even be more empathic."

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