Intended for healthcare professionals

Feature Christmas 2019: Fight the Power

Time’s up for he and him as the default pronouns for doctors

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6565 (Published 16 December 2019) Cite this as: BMJ 2019;367:l6565
  1. Elizabeth Loder
  1. Correspondence to E Loder eloder{at}bmj.com

Most doctors are or will be women—our language should reflect that reality

“Hello, I’m Dr Quigley. My pronouns are he/him. How would you like to be addressed?”1

“Welcome to our meeting. Before we begin, we’d like to go around and share our names and personal pronouns.”2

Increasingly, doctors and patients are expected to share pronoun preferences. Do you want he/him/his, she/her/hers, they/them/theirs, the non-gendered ze/hir/hirs, or something else? The gender neutral pronoun revolution is well under way. Despite this, the vocabulary used to describe doctors remains stubbornly masculine. Most people default to generic masculine pronouns to describe a doctor whose gender is unknown.

A patient recently greeted me by saying, “The new medical assistant thinks you’re a man! The assistant said, ‘When you see Dr Loder, be sure to tell him about your new medications.’ ‘Dr Loder is a woman,’ I said, but a few minutes later it was the same thing again: ‘When you see Dr Loder, make sure he sees your blood pressure reading.’”

I’d be outraged—except that I’ve done the same thing many times. Last week, for example, a patient told me his cardiologist had some questions about a treatment I had recommended. “I’ll give him a call,” I said. “Her,” corrected the patient. The medical assistant and I can defend our choice of “him” and “he” on the grounds that most doctors are men, so that “he” is more likely to be correct than “she” when referring to an unknown doctor. Not for long, though. Soon, most doctors in the US, the UK, and Europe will be women; this is already the case in many countries.3

But medicine is not leading the way in gender equity. Gender discrimination and harassment are serious and pervasive issues in academic and clinical medicine.4 Language reflects and is part of the problem.5 The stereotype that doctors are men persists at a time when almost half of physicians are female—and it has been internalised by women physicians like me—so it’s a problem that needs to be fixed. How to do this? It would help to retire “he,” “him,” and “his” as the default pronouns for doctors and make a deliberate switch to “she,” “her,” and “hers.” Pronouns are in flux, and it’s possible that “they,” “them,” and “theirs” will become standard. Until that happens, I have a proposal: when in doubt, and the gender of the doctor is unknown, let’s use female pronouns to send a message and open minds.

How will people react? That’s the point. The pronouns we use betray our biases. They also shape our view of the world and what’s possible. Pronouns are chosen unconsciously for a reason. Some languages, such as Hungarian or Finnish, don’t have gendered pronouns. But for those who speak English, it’s often necessary to choose a pronoun for a doctor whose gender we do not know. Until recently, it was considered perfectly fine to use a gender specific pronoun for men and say it included everyone, yet proposing the reverse sometimes elicits charges of sexism.

“Degendering” with “they,” “them,” and “theirs” or alternatives isn’t the solution—not yet, anyway. Instead, women deserve and need a chance to own the default pronoun, at least for a while, because many people take words literally. When the pronoun used is mostly “he,” our fast thinking mental picture is of a man. If we have an opportunity to think more carefully, some of us will realise this includes women, but many will not. This is the basis for the well known riddle about a father and son who are in a terrible accident. The father is killed and the son is taken to the hospital for emergency surgery, but the surgeon enters the room and says, “I can’t operate—that boy is my son.”6 When asked who the surgeon might be, a surprising number of people can’t imagine that the surgeon might be the boy’s mother.

Disruptive use of female pronouns can help. When someone says, “I went to the doctor today,” consider replying with “What did she say?” You’ll get some startled looks. That’s how you know your educational point has been received—and there’s evidence from Sweden that changing pronouns can change the way people think.7

Using female pronouns for doctors would force everyone, on a regular basis, to remember that women can be doctors. Soon the default use of female pronouns will make sense for the same reason we’ve defaulted to male pronouns: it will be the best reflection of reality and the new gender makeup of the physician workforce. Furthermore, in situations where most doctors are male (surgical subspecialties, for example), it’s then even more desirable to use a default pronoun of “she” to expand people’s ideas of who can be a doctor.

Female pronouns and women can be powerful if we work to make them so. When people stop looking surprised, and when the riddle about the woman surgeon loses its power to perplex, then it might be time to advocate for genderless pronouns. In the meantime, let’s assume that doctors are women until we know otherwise. I’ll go first. About that doctor of yours: I’ll give her a call.

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