Editor's Note
Vive la Difference
“The patient is a 55-year-old Caucasian female…” So starts a typical medical history, a ritualistic form that succinctly describes the important demographic details of age, race, and sex. Yet are these details important? Or do they steer physicians into a diagnostic vortex, blinding them to possibilities? How crucial to making a diagnosis is it that a patient is 55 or white or female? Leaving age and race for another time, this month’s Minnesota Medicine explores women’s health and the medical ramifications of la difference.
Anatomy, physiology, and pathology argue for the significance of the difference. Aside from obvious distinctions in the genitourinary system, most of the body’s organs have gender-based variations. The physiological sway of androgen and estrogen extends far beyond secondary sexual characteristics. And diseases distant from ovaries and testicles exhibit male or female predominance. Being a girl or a boy clearly makes a difference when you go to the doctor.
So what’s the debate about? It’s a debate that swirls in the crosscurrents of male-dominated medical practice, skewed medical research, and seismic cultural change. For the first century of allopathic medical practice in the United States, women with medical problems were generally examined by men, diagnosed by men, and treated by men. Medical studies were designed and orchestrated by male researchers. In the latter decades of the 20th century, as women left the home and entered the workplace, medicine and society changed. Today, half of matriculating medical students are women, and they go on to practice in virtually every specialty. In addition, medical research has recognized some of its previous flaws and is redefining peculiarly female aspects of common diseases such as heart disease (see “A Woman’s Heart,” p. 20). Thus, in 2005, la difference seems to be thriving in medical practice, and patients and doctors are recognizing it.
Yet, there is something that makes me a bit uneasy about some of this. As a practicing internist, I like to think that I can look at all patients with impartial compassion, understanding that age, race, and gender are important but not allowing those demographics to drive entirely how I think about or treat their problems. When female patients ask me to recommend a female physician, I do it—but not without a faint twinge of remorse that I didn’t address their concerns.
Women’s health somehow does get snagged by the palpable tensions still straining in our society over gender issues. Harvard University President Lawrence Summers recently infuriated attendees at a conference on women and minorities in science and engineering when he suggested that innate differences between the sexes could explain why fewer women succeed in science and engineering. How do we decide which differences between the sexes are real and important, and are not unfair generalizations?
In the end, it’s all about generalizations and stereotypes. Science is supposed to lead us to rational generalizations based on objective evidence, and physicians, as scientists, are supposed to apply those truths to the people walking through their doors.
We ought to be able to navigate the shoals of bias and false conclusions, apply our science, and still appreciate la difference.
Charles R. Meyer, M.D., editor in chief Dr. Meyer can be reached at cmeyer1@fairview.org.