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A wall between genders in medicine

It's 2 p.m. I am spending the afternoon in a mammography clinic, as part of an effort by my medical training program to ensure that all residents develop a familiarity with breast cancer and the breast exam. Michelle, the nurse who runs the clinic, tells me that the first patient has arrived. "Let me just check with her and make sure it's okay for you to come in, too," Michelle says before entering the room.

I wait.

A discussion follows; I can hear only bits and pieces of the conversation. Mostly, I hear Michelle's responses. "Yes, that's right . . . male physician . . . wants to learn . . . no, no need to explain . . . I understand . . . that's completely okay."

Michelle emerges. Apologetically, she tells me that the patient prefers to be seen by her alone. I assure her that this is not a problem and ask her to pass this along to the patient.

But is this really not a problem? For male medical students and young physicians, adequate training in women's health seems increasingly hard to come by, in large measure because many female patients prefer to be seen by women and only by women.

In medical school, for example, male medical students traditionally have a much more difficult time receiving permission to observe pelvic and breast exams so they can learn how to do them proficiently.

Even now, as an intern, I see relatively few female patients in my weekly clinic, since many women specifically request to see female doctors. Consequently, I have probably done fewer Pap smears in seven months than some of my female colleagues do in a typical afternoon.

Not surprisingly, as a result of these sorts of experiences, fewer male medical students than ever are choosing to go into obstetrics and gynecology _ mostly because of concerns that they will have trouble building a practice when they graduate. And almost no men are choosing to go into women's health, which is generally considered to be a specialty offering care for women and by women.

Perhaps this is only fair. After all, for generations, women were excluded from medicine entirely, and even today, there are many areas that still seem to be male bastions. As an example, there's a corridor in my hospital that features pictures of each of the chief residents in cardiothoracic surgery for the past 30 years, including such luminaries as Tennessee Sen. Bill Frist. Remarkably, there is not a single picture of a woman, prompting many to dub this display, "the wall of shame."

Yet this may also highlight a major difference between the experience of women in some areas of surgery, and of men in OB-GYN and women's health: the absence of female cardiothoracic surgeons is typically perceived as worrisome, while the absence of men in women's health is generally looked upon as an affirmation of the accomplishments of women, a sign of emancipation, progress and power.

The difficulty, though, is that if we are to take the goals of diversity seriously, we would believe that it is important to have a plurality of perspectives, important to give as many different people as possible the opportunity to think about important problems.

The fact that men are turning away from OB-GYN and women's health means that about half the doctors who might otherwise spend their careers thinking about ovarian or breast cancer, or about difficulties with labor, or about uterine bleeding, are instead encouraged to turn their attention elsewhere.

The strength of women's health as a medical discipline will likely rely on its ability to recruit the best clinicians and investigators available. If female patients consistently decline to see male physicians, and exclude male medical students, the discipline is more likely to become marginalized, its worthy goals less likely to be realized. And this would be a loss for us all.

David A. Shaywitz is a medical intern in Boston.

Washington Post