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17 Jun 2019

A storm erupted recently over a column in The Weekend Australian magazine, which questioned why men would choose to be obstetricians and gynaecologists.

The column, penned by regular contributor, Nikki Gemmell, highlighted her own experiences (four midwife-led births) and those of some unnamed acquaintances, citing experiences such as: “They hate women, and like to see them in pain.”, “He gave me stitches without even asking me – he was so … invasive,”, “It was just too … voyeuristic.”, and “I reckon it’s all about power.”

Ms Gemmell led off her thesis, titled Is it really a job for a man?, by invoking the records of disgraced and discredited doctors, Graeme ‘the Butcher of Bega’ Reeves and Emil Gayed. That set the tone.

The response to the column was swift and comprehensive – from male and female doctors, and from patients.

Australian Medicine has compiled some of those responses.

 

Caroline Stirling, patient, Sydney

Having read Nikki Gemmell’s column in The Weekend Australian, I feel compelled to respond as the general tenor of her questions is one that infers we should be suspicious of the motives/legitimacy of male obstetricians. While her opinion is irrelevant to me because I know better, I am concerned that other readers who are yet to reach a stage in their lives where they require the involvement of an obstetrician will shut themselves off to what could be their best options because they are basing their choice on gender, rather than the more relevant criteria of skill, experience, and general competency.

I am also concerned that the morale of the many dedicated and hardworking male obstetricians could be diminished by her loaded 'questions' as to why they would be working in the area at all.

So, a little about me. I have two children, now 10 and 8. During my first pregnancy, I received all my antenatal care through a female midwife at a public hospital. In my second pregnancy, I was under the care of a male obstetrician who came highly recommended from a friend.

My second pregnancy was a complicated one as it was identified fairly early on that I had a condition called placenta percreta. This meant there were significant risks for both myself and my baby, both throughout the pregnancy and the birth. I consider myself extremely fortunate to have been under the care of such an experienced, skilled, compassionate, and caring doctor. If I hadn't been, the consequences could have been dire.

In the face of having to make many difficult decisions to ensure the best chances of having a good outcome ( including survival) for both myself and my son, the male doctor was forthcoming with the information I needed to understand what was happening, he was patient in answering my many questions, and genuinely compassionate and kind. I have no doubt he was at times under great stress but at no time did I feel that transmitted to me. At all times I felt that I could completely trust him and rely on him to look after me and my baby.

I often reflect back now on what a precarious position I was in, and how amazing it was to have a doctor who would check in on me and reassure me that everything that could be done was being done to get me to the end of the pregnancy safely. This included a few hospital admissions either side of the actual birth (which involved my doctor coordinating a team of other doctors to perform surgery while I was under a general anaesthetic for more than a few hours), many bedside chats, but also texts messages to see how I was doing.

It is no small thing to possess the unique qualities and skills that my doctor had to help get me through that difficult period, to be able to both manage and meet my medical needs, as well as be emotionally present and bring a sense of calm and control to my challenging situation. If I had to go through it all again, I would choose him again in a heartbeat.

Does a good oncologist need to have suffered from cancer? Does a good pharmacist need to have tried taking the drug they are dispensing? In my view, it is a ridiculous and offensive proposition to suggest that women have something over men, or have something 'extra' to bring to the table when it comes to being a good obstetrician. All good doctors undergo many, many years of study and learning through practice. No gender has a monopoly on the human traits and skills of demonstrating empathy and genuine care.

 

Caroline’s male obstetrician (name withheld), Sydney

What upsets me is that I am not judged by how I provide care for my patients, but by my gender and choice of medical specialty. If I behave badly or unprofessionally or not in the interests of my patients, I am more than willing to be held accountable for any failings. I just want to be assessed (judged?) on the merit or otherwise of the work I do, not my gender. This is a basic tenet of gender equality.

 

Dr Tony Bartone, AMA President, General Practitioner, via Twitter

Is it really a job for a man? Most disappointing so-called piece of "journalism", ill-informed opinion/lazy observation. 30+ years as a GP and thousands of mothers/women with nothing but equal praise and admiration for their male or female O&G #womenshealth

 

A/Prof Gino Pecoraro, Obstetrician & Gynaecologist, AMA Board Chair, via Twitter

This article is offensive, misandrist and homophobic. An insult to the many male gynaecologists and the women who are looked after by them. I have penned a complaint to the Australian Press Council.

 

Dr Jill Tomlinson, Plastic, Reconstructive & Hand surgeon, via Twitter

Doctors routinely ask questions and perform patient examinations. Patients may make grossly incorrect assumptions about the reasons behind the questions or examinations.

For example, a woman may incorrectly assume that her obstetrician shouldn’t ask about her post-birth sex life and may deem such questions to be “voyeuristic”.

As a non-obstetrician, I consider that an obstetrician who is asking a woman about her gynaecological function at a 6-week check-up is doing his/her job. Questions about sexual activity are a normal part of a gynaecological history. If we don’t understand why obstetricians and other healthcare professionals ask certain questions, we might make assumptions and be “appalled”.

An alternative response is to ask the healthcare professional why the question is being asked and how it is relevant to your care. Writing in @australian that such questions are "voyeuristic" might lead other women to fear, incorrectly, that their obstetrician asked inappropriate questions about their gynaecological function.

A woman may believe that a private obstetrician should examine her perineum, vagina, and cervix. But if the obstetrician doesn’t have a clinical reason for the examination then he/she would wish to avoid doing an unnecessary intimate examination. Because if a doctor performs an unwarranted intimate examination, then he/she could be found guilty of professional misconduct and sexual assault. Have you asked your mate why she was so “desperate” for her obstetrician to examine “her nether regions”?

Currently, 83 per cent of O&G trainees are women. When you say, “I just wish there were more women entering the profession”, then doctors who are aware of the current statistics will be surprised by your ignorance of them.

RANZCOG members are currently discussing the virtues of gender targets and quotas for its Councils, Committees, and Board. Efforts to improve diversity in @RANZCOG’s leadership are not aided by a journalist asserting that men shouldn’t be obstetricians or that male obstetricians “hate women, and like to see them in pain”.

Gender shouldn’t be a barrier to a career or medical specialty. Assertions that they should be are sexist. Assertions that male obstetricians “hate women, and like to see them in pain” are highly offensive. If you are seeking to understand, then start by asking, not by writing or offending. If you are seeking to create clickbait, expect to be ignored in the future.

Medicine is traditionally a hierarchical and patriarchal profession. Examples of Graeme Reeves and Emil Shawky Gayed, the gynaecological mesh scandal, the speculum's origin, the background to Henrietta Lacks’ cells, and many more examples do not reflect well on the medical profession, or its gender bias.

There is nothing in your article that assists in addressing this gender bias. Indeed, all you’ve done is harm. In medicine, we aim to first do no harm. We don't always succeed, but we try.

Perhaps in your future writing you could seek to avoid perpetuating sexism, spreading misinformation, creating fear, and offending healthcare professionals?

 

Dr Michael Gannon, Obstetrician & Gynaecologist, former Federal AMA President, former AMA WA President, via interview on SKY News

Yes, this idea full of homophobic slurs and other bits of nastiness posed the question: why would a man want to have an expertise in women's health?

I love my job. I feel I'm very fortunate to have it. I think of those colleagues that I work with, that have taught me, and our patients, most of us are blind to the gender of people providing the care.

To the fact that there are clear differences between men and women and how they perform, how they act, how they do the job - that diversity in the job is healthy. This idea that everyone who looks after women's health should be female is wrong. We should be aiming for diversity in all healthcare professions, in all parts of health care.

This was an ignorant article, which failed to acknowledge the outstanding services enjoyed by Australian women and girls, and what they've enjoyed over a long period of time.

The full transcript of this interview is at https://ama.com.au/media/dr-gannon-sky-news-male-obstetricians

 

Dr Louise Farrell MBBS FRANZCOG FRCOG, Director of Postgraduate Medical Education, Head of Colposcopy Services, King Edward Memorial Hospital, Chair RANZCOG WA Training Accreditation Committee, via letter

Dear Nikki,

I read your article with great disappointment. I have been a Consultant Obstetrician for more than 30 years, after spending the preceding 15 years going through medical school and completing my training in O&G. It is a difficult and arduous process. I think your article portrays a simplistic view of gender that is incredibly destructive to both men and women. Being a woman does not render you of uniform views and outlook, nor the reverse.

As part of O&G training, the focus is on safety for both mother and baby. As a mother myself, I know I would not have hesitated in cutting off my right arm to get a safe delivery of my two children. My whole focus for myself was the outcome, not the process. Does that make me less of a woman than those who want it to be all about their experience? If it does, then I have met many, many women as patients over the years who shared my views.

Despite having had a reasonably successful career - I was at varying points in my career  Vice President of RANZCOG, President of the Australian Colposcopy Society, Director of O&G in the largest private hospital in WA for 20 years and Chair of the WA Training & Accreditation Committee of RANZCOG - I still regard my greatest achievement in my life is my generation of two beautiful children and now four grandchildren.

I absolutely hate gender stereotypes. Some of the kindest and most caring doctors I have ever met have been male doctors.

O&G is a job for anyone who cares about excellence in women’s health and has the skills and knowledge to deliver this. O&G is not equivalent to midwifery. The focus is entirely different and the training vastly different and very considerably longer. You were lucky that your pregnancies were such that your care could be conducted almost exclusively by midwives.

However, there have been many patients over the years who have been extremely grateful that I had been trained to do an emergency Caesarean section safely and efficiently and save their baby's life. My gynaecological operating skills have also saved the lives of many women. I acquired these skills entirely from men bosses.

Throughout my career, I have been supported by men who enabled me to provide better care to women than I could have provided alone. In places where medical training such as I have received does not exist; women and babies die as a result of pregnancy. Perhaps you could look up maternal mortality rates around the world?

The majority of those entering the profession are now women, which is very different to when I was training. However, I strongly believe we need a mix of gender to ensure that women continue to receive the extraordinary care to women that the Australian healthcare system delivers.

I feel greatly upset and demeaned by your article.

Yours sincerely
Louise Farrell

  

Dr Omar Khorshid, Orthopaedic Surgeon, AMA WA President, via Twitter

When my wife chose her obstetrician, it was for HIS ethics, professionalism, and skill - in that order. Is it really a job for a man? Yes, but not just any man, and >80% trainees are female now. Too much opinion, not enough journalism @NickiGemmell @drmichaelgannon @amapresident

 

Dr Nikki Stamp, Heart & lung transplant surgeon, via Twitter

For everyone who has read the piece @NikkiGemmell wrote on male gynaecologists in @australian, here is why it should never have been published: #ILookLikeASurgeon

It implies that gender matters in the ability to do a particular job in medicine. It does not. I have to remind people of that every day.

It implies that a male healthcare worker who looks at a woman’s vagina must have something creepily wrong about him. He doesn’t, he’s a professional.

It undermines the trust many women have had in their male doctors because it plants the seed that they’re weird. They’re not.

It’s written from the point of view of someone who has failed to understand that RANZCOG leads us when it comes to gender equity and leave policy in training.

Basically, it’s ill informed & adds unreasonable doubt over the ability of someone to do their job in medicine, based solely on their gender. If you want to know about gender in medicine @NikkiGemmell DM me. Then maybe you can use your platform for good #ILookLikeASurgeon

 

Dr Judith Gardiner, RANZCOG Committee Chair, via Twitter

As chair of the RANZCOG Committee that represents GP Obstetricians, I find this article highly offensive. It denies the amazing work my male colleagues do to provide safe maternity care to women in rural and remote communities. Shame on you, Nikki.

 

Prof Caroline Homer, Director of the Centre for Midwifery, Child, and Family Health in the Faculty of Health at UTS, Registered Midwife, via Twitter

I know many excellent and caring male obstetricians and equally many wonderful male midwives. Let us all be focused on providing quality care that is respectful and based on best evidence and keeps women at the centre, rather than slamming professional genders and choices.

 

Dr Hilary Joyce, Obstetrician & Gynaecologist, Fertility Specialist, Past President NASOG and RANZCOG, AMA Councillor, via Twitter

An ObGyn, woman, patient with complicated pregnancy and gynaecological surgery history, mother, mentee, colleague, medical politician, past president @NASOG and 1/2 of husband and wife specialty partnership, yesterday’s representation of our profession is unfathomable @ranzcog @ama_media

 

Dr Steve Robson, Obstetrician, Gynaecologist, Past President AMA ACT, AMA Federal Councillor, via Twitter

Um, @NikkiGemmell ... As @ranzcog President last year, when I organised the National Women's Health Summit, I said "Women are central to the health of the nation. I'm a bloke, yes, but I really, really care...

 

Virginia Trioli, journalist and presenter, ABS News Breakfast, via Twitter

In a weekend of utterly bizarre @australian articles, this takes us right over the top.

 

At the end of her article, Ms Gemmell concluded by saying, “…well, I write to understand, to get us to think. So please enlighten me”.

If anybody wishes to enlighten Ms Gemmell on this issue, she can be contacted at nikki.theaustralian@gmail.com, or you could comment on the busy blog on The Australian’s website.


Published: 17 Jun 2019