Subconscious gender discrimination in primary care

Adnan Saad is a GP Principal at Sheepcot Medical Centre, Watford; Associate Professor at St. George’s University, Grenada; and Clinical Tutor at Imperial College School of Medicine, London.

Gender discrimination and the rights of an individual to freely express their personal sexuality and gender preferences has received a lot of global attention.1 This has understandably been reflected in changes within employment and medical workplace infrastructure as awareness continues to grow.2

Modules such as equality and diversity training have become a mandatory part of one’s professional development, with the emphasis on trying to create a friendlier, more inclusive workplace by recognising and trying to eliminate biases and ill-feelings that may potentially result in an unhappy workforce and work environment. Hence by taking such steps, staff are less at risk of disengaging, having time off work, mental health issues, or even feeling marginalised.3

There has naturally been an active move to address disproportionate gender-related gaps such as pay, flexibility, sickness, compassionate/unplanned leave, contracts, the roles clinicians undertake, as well as career development and job promotion opportunities.4 These reforms have been further accelerated by the feminist and LGBT movements.5,6

“… despite best efforts, ‘subtle discrimination’ may still unconsciously exist … “

Thankfully many of these differences continue to be addressed in primary care either in anti-discrimination policies, a change of people’s thinking, or within staff contracts. However, despite best efforts, ‘subtle discrimination’ may still unconsciously exist affecting the way we may perceive our own work colleagues.

Men suffering chronic pain maybe viewed as brave (with an anticipation that they should carry on regardless of pain due to society’s stoic expectation of men); whereas women maybe seen as emotional or having problems in coping, and so may not be taken seriously as it may be felt illness here is being exaggerated.7

Furthermore, women returning from their contractually agreed maternity leave may experience more adversity from colleagues that could lead to feelings of guilt and inadequacy, the pressure of having to work harder to prove their worth, and worsening exhaustion.8

A further very interesting bias comes from where patients may seek out a female doctor, expecting more sensitive and empathetic support and care. This may naturally result in a higher number of complex consultations requiring consultations to be longer and clinics over-running,9 in turn leading to stress and exhaustion. The answer here may be to put blocks in the clinic and allocate double appointments for such cases.

“… practice[s] may need to appreciate that by trying to protect one group of staff, they may be exposing another group to vulnerabilities.”

Male patients that come across as demanding and/or verbally/physically aggressive are more likely to be allocated a male clinician to protect female clinicians from a potentially threatening situation. In many instances this may be done following contact with an (often female) receptionist, or because an alert had been put in the patient records ‘To see a male doctor only’.

The assumption behind this would be that men are physically stronger and so are less likely to feel threatened by such a patient, and that the patient is more likely to behave and stay calmer in front of a seemingly stoic male clinician who would carry a physical presence. However, the practice may need to appreciate that by trying to protect one group of staff, they may be exposing another group to vulnerabilities.

Male clinicians may feel obliged to uphold the protector role that is expected of them. It is well established that men are less likely to share their feelings and less likely to ask for help,10 making them more vulnerable to danger and difficulty. It is important for practices to recognise this issue and possibly offer a chaperone in vulnerable circumstances.

Workplace policies should ensure that a transgender individual can work comfortably without being treated differently; however, subtle discrimination may occur without openly surfacing. Raised eyebrows, judgemental glances, and defensive body language from staff or patients may be very hurtful to someone just trying to do their job and fit in to the workplace. Management strongly advocating support for them would be essential in helping the staff member feel less stressed and marginalised.

Whereas most primary care institutions have strong policies in place to protect the vulnerable from open conscious discrimination, we need to be more mindful of the subtle situations that may result in a staff member feeling vulnerable. If left undeterred this may lead to depression, marginalisation, poor productivity, time off of work, a feeling of being ignored, or the staff member leaving.

1. Brown CS, Stone EA. Gender stereotypes and discrimination: how sexism impacts development. Adv Child Dev Behav 2016; 50: 105-133.
2. Bates C, Gordon L, Travis E, et al. Striving for gender equity in academic medicine careers: a call to action. Acad Med 2016; 91(8): 1050-1052.
3. Maese E, Lloyd C. Understanding the effects of discrimination in the workplace. 2021. (accessed 8 Mar 2023).
4. Hay K, McDougal L, Percival V, et al. Disrupting gender norms in health systems: making the case for change. Lancet 2019; 393(10190): 2535–2549.
5. McCave EL, Aptaker D, Hartmann KD, Zucconi R. Promoting affirmative transgender health care practice within hospitals: an IPE standardized patient simulation for graduate health care learners. MedEdPORTAL 2019; 15: 10861.
6. McGinley AC, Porter NB. Feminist judgements: rewritten employment discrimination options. Cambridge: Cambridge University Press, 2020.
7. Wesolowicz DM, Clark JF, Boissoneault J, Robinson ME. The roles of gender and profession on gender role expectations of pain in health care professionals. J Pain Res 2018; 11: 1121–1128.
8. Juengst SB, Royston A, Huang I, Wright B. Family leave and return-to-work experiences of physician mothers. JAMA Netw Open 2019; 2(10): e1913054.
9. Schmittdiel J, Grumbach K, Selby JV, Queensberry CP, Jr. Effect of physician and patient gender concordance on patient satisfaction and preventive care practices. J Gen Intern Med 2000; 15(11): 761–769.
10. Fisher K, Seidler ZE, King K, et al. Men’s anxiety: a systematic review. J Affect Disord 2021; 295: 688–702.

Featured photo by Jr Korpa on Unsplash.

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