Intended for healthcare professionals

Rapid response to:

Head To Head

Are there too many female medical graduates? No

BMJ 2008; 336 doi: (Published 03 April 2008) Cite this as: BMJ 2008;336:749

Rapid Response:

Is this really the 21st century?

I am flabbergasted that anybody in this day and age might think that there are too many women entering medicine. Are there too many men entering nursing or teaching? What does it matter what gender of human is performing a job if they do it ably?

I began my medical training 21 years ago, in the US. Even that recently, the role of the physician was more strictly defined than it is now: physicians elicited a history, performed a physical exam, arrived at a diagnosis and prescribed treatment for it. I remember watching a female pulmonologist at work at that time, and thinking to myself that she was sure acting like a man; she was personable and very smart, but there was little warmth in the interactions, and no give-and-take. Back then, to be a successful woman physician, particularly in academia, you had to be "tougher" than the men.

Things are different now - the physician-patient relationship is on average less patriarchal and less unequal, and I like to think that this is a consequence of the increasing numbers of women entering the field. Female physician are less authoritarian than men; they see themselves more as highly informed facilitators of the medical process; they develop more collaborative relationships with their patients, which result in more complete information sharing by the patient, better patient education, a plan of care more acceptable to the patient, and better outcomes.

The time I invest in educating patients about their condition improves their self-care abilities and well-being; I certainly note that more of my patients come to me stating that they took effective first line care measures (e.g. nasal irrigation at onset of a cold or sinus symptoms), but that these had failed and they thought it might be time for an antibiotic.

Incidentally, another great bugaboo of medicine has been "sharing;" telling patients anything about oneself has been considered anathema. I can tell you from experience that limited disclosure can help patients feel that they are understood, which is an important part of the therapeutic relationship.

The "therapeutic relationship" (a "safe" place for patients to air their concerns and receive responsive advice) is another concept unheard of in the "bad ol' days" of, "Me Doctor/God, you patient, do what I say." Look at the April 3rd BMJ article on the components of the placebo effect: "assessment and observation, a therapeutic ritual (placebo treatment), and a supportive patient-practitioner relationship" - make the assessment and observation component accepting and comprehensive, remove the placebo part of the prescription and you have an effective physician-patient relationship!

Although I cannot argue that the changes in medicine enumerated above have been due solely to its increasingly feminine face (certainly the US' Family Medicine specialty has encouraged evolution of a healthier physician-patient relationship), as a female physician I want to claim credit for the hard work I have done exploring my professional role and re -defining it in a way that is more comfortable for me and my patients, and more effective to boot.

I challenge the medical establishments in both the UK and the US to work to eliminate even the faintest air of controversy surrounding the changing demographics of medical students and practicing physicians. Do not look at me and see a "female physician;" I am a physician, and a damn good one, because I listen to and respect my patients, and take care to act in their best interest. There are more pressing aspects of medicine - such as the trend toward running more and more patients through 5-minute office visits in an assembly line atmosphere - that need to be addressed instead. Listen to the women; they will help you fix the situation.

Competing interests: None declared

Competing interests: No competing interests

09 April 2008
Iris P. Gonzalez, M.D.
Director Student Health Services
Washburn University Topeka KS USA