Gender justice requires gender amnesty

Andrew Papanikitas is deputy editor of the BJGP, and a GP in Oxford. He is on Twitter: @gentlemedic

I find myself embarrassed this issue to be an ostensibly British-born, White, public school-educated, straight cis-male. In a sense, that declaration of interest has to proceed a Life & Times introduction in a themed issue on gender.

When reading the spread of articles in this issue it struck me that we need diversity to be better clinicians, colleagues, and citizens. This insight is in part is inspired by Wahlert and Fiester’s description of ‘queer bioethics,’ which requires us to take a two-fold approach: (1) We must pay greater attention to the topics, identities, and issues that are blatantly queer, for the service of queer persons; and, (2) We must examine the most pedestrian, and the most germane of universal health issues (those we wouldn’t even instinctively think of as ‘queer’), and imagine how they might be complicated or rendered troubling by the injection of queer personhood.¹

A GENDERED PROFESSION AND ITS GENDERED PUBLIC

The diversity (including gender) very literally embodied by the primary care workforce in the UK is undoubtedly a strength. We can share each other’s gaze and expand each other’s horizons. In this issue Laura Douglas teaches us through her own experience of Asherman’s Syndrome, an overlooked condition characterised by uterine adhesions and infertility.²

This gender-balance no doubt has contributed to an enlightened variety of work patterns — the number of GPs is clearly greater than the number of full-time equivalent places at work. Charlie Massey, Chief Executive of the GMC, recently announced ‘There is no ready-made batch of GPs waiting to be plucked off the shelf to ease the pressures on the workforce,’³ but Nada Khan begs to differ, illustrating a variety of shelves.⁴ It would be a colossally sexist and untrue assumption that these shelves primarily make medical work more palatable for women, but full-time general practice is certainly not the family-friendly profession it once was, for any of us. The gender-balance also entails weaknesses. Adnan Saad reflects that it is gender rather than female-ness that may be at issue, ‘Practice[s] may need to appreciate that by trying to protect one group of staff, they may be exposing another group to vulnerabilities.’⁵  Saul Miller explores gendered aspects of GP training in terms of exposure to clinical cases, patient preference reflected in doctor avoidance, and expanding understanding around the health aspects of sexuality and gender.⁶

Ahmed Rashid’s Yonder selection includes research from the US that found that Black women in a study had the highest death rate from breast cancer and were less likely to have breast cancer screenings. The authors highlight that Black women often already face additional health and life disparity and may view such disparities as part of their daily lives.⁷

GENDER JUSTICE

If a theme links our book reviews this month, it is gender and justice. Margaret McCartney reviews a detailed and harrowing account of what happened at The Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDS); Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children. She reflects on the risk that healthcare organisations run when worries from staff translate into organisational defensiveness.⁸ Hannah Milton reviews Womb: The Inside Story of Where We All Began, an ‘unashamedly feminist’ book exploring anatomy, science and history related to the female genital tract.⁹ Kath Checkland reviews Hags: The Demonisation of Middle-Aged Women. The central thesis of the book is that a persistently sexist and misogynistic culture values women according to the extent that they are perceived to be youthful and attractive.¹⁰

All the books speak to an ongoing injustice, whether in the fair allocation of time and resources or in the perceived worth of individuals and their testimony.

EMPATHY THROUGH CREATIVE WRITING

Shamil Haroon gives us a prescient fly-on-the-wall view of AI-led general practice in the near-future.¹¹ Camille Gajria reflects on a sobering encounter with a patient while walking home from work,¹² and Rebecca Quinn challenges us to see beyond bland policy in a poem about assisting patients with housing letters.¹³ Creative writing (both the writing and the reading) asks us to inhabit other people, times and places, to see what they see and feel what they feel.

GENDER AMNESTY

While ‘queer bioethics’ is a good tool for thinking about all protected characteristics relating to gender, it also strikes me that this is not enough. We should be able to find ways of seeing the ‘queer’ stories, and ‘queer’ the stories we don’t identify as queer. However, we should recognise that we could all be the marginalised person, not to diminish the struggles of others but to value them as though they are our own.  We should also be able to ‘de-queer’ stories about unacceptable things happening to marginalised people, not to take away their unique personhood, but to recognise that none of us should have to accept such treatment.

 

The print version of this article can be found here: https://doi.org/10.3399/bjgp23X733305

REFERENCES

1. Wahlert L, Fiester A. Queer bioethics: why its time has come. Bioethics 2012; 6(1): ii-iv. DOI: https://doi.org/10.1111/j.1467-8519.2011.01957.x
2. Douglas L. Experiencing Asherman’s Syndrome. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733365.
3. In full: Charlie Massey’s speech on SAS doctors. Pulse 2023; 22 Mar: https://www.pulsetoday.co.uk/special/workforce/in-full-charlie-masseys-speech-on-sas-doctors/(accessed 14 Jun 2023).
4. Khan N. Is there a shelf with spare GPs coming to the rescue? Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733329
5. Saad A. Subconscious gender discrimination in primary care. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733317.
6. Miller S. Generating gender generalists. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733437
7. Rashid A. Pre-operative anxiety, breast cancer screening, patient decision aids, and medicinal cannabis. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733353.
8. McCartney M. Book review.Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733401.
9. Milton H. Book review. Womb: The Inside Story of Where We All Began. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733413
10. Checkland K. Book review. Hags: The Demonisation of Middle-Aged Women. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733425
11. Haroon S. Not obsolete, yet. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733341
12. Gajria C. Flash fiction: Sunset. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733377.
13. Quinn R. Housing letter. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X733389.

Featured photo: Rainbow postbox cosy in Oxford Covered Market, taken by Andrew Papanikitas, 2023