The American writer Joan Didion once said that she wrote to better understand what she was thinking. When Dr Gabriel Scally said “misogyny” at the launch of his report into CervicalCheck, the word rapidly moved to the centre of the crisis. It hit the headlines. It touched a raw nerve.
Soon afterwards, I opened a Word document on my PC and saved it as “misogyny”. I am a male obstetrician and gynaecologist. I have been a consultant for more than 20 years in the Coombe hospital.
Used by Dr Scally to describe comments made by a male doctor, the impact of the word was barely diluted by the qualifier “verging on”. Instead, it was accompanied, in many subsequent commentaries, by words such as “paternalistic” and “patriarchal”. The accusations were amplified beyond the confines of colposcopy clinics, to characterise a pervasive culture in women’s healthcare services.
At a recent national multidisciplinary women’s healthcare conference, a male consultant appealed to the audience to support male colleagues. The conference had nothing to do with cervical screening.
Over lunch at the conference, the word “misogyny” peppered the conversation. A female colleague described the current atmosphere as “toxic”. Male colleagues agreed – with even greater despondency. I was relieved she hadn’t said “toxic masculinity”; both words are seldom seen apart these days.
Matters came to a head when an enthusiastic male medical student dismissed my encouragement to consider a career in obstetrics and gynaecology. He said he was the wrong gender. To make matters worse, I didn’t try to dissuade him.
I felt guilty afterwards. I recalled the generations of male obstetricians and gynaecologists who had worked at the coalface in clinics, labour wards and theatres. Together with female colleagues and midwives, they achieved excellent clinical results – often in deplorable conditions and with dangerously low staffing levels. I also thought of those who had worn paths over and back to Hawkins House and Dr Steevens’ Hospital and become politically active in support of women. I had let them down by my silence.
Ever since I came across her poems as a student in the mid-1970s, I have greatly admired the work of Sylvia Plath. There is no woman I know who has written more truthfully, brilliantly and tragically about her life. I remember being profoundly moved by the many poems she wrote about pregnancy and childbirth.
In 1982 I was a UCD medical student in the National Maternity Hospital. Kieran O’Driscoll was our professor. Although his special interest was childbirth, he spoke very little about medical technicalities. Instead he focused on the emotional impact of labour.
He described the joy experienced by women having a baby. He said there was no equivalent in medicine. When it came to complications, he put isolation, vulnerability and fear at the top of the list – not slow progress and foetal distress. No one had ever spoken to us like this before. He reminded me of Plath.
After a week in the labour ward, I wanted to be an obstetrician and gynaecologist. A generation of medical students – female and male – were inspired by similar experiences to follow suit.
Sir Alec Guinness
In 1989, while attending a European gynaecology cancer conference outside Milan, I had the privilege of spending time in the company of Sir Alec Guinness – who was staying in the same hotel.
Over dinner one evening, after explaining my job as a junior doctor in the Rotunda Hospital, the veteran Oscar laureate surprised me with his insight. “Doctors need to be like actors. They need to see the world through the eyes of their patients – like actors see the world through the eyes of their characters. They also need to say their lines with great sincerity.” He hesitated. “In your case, your patients are all women. Think about that.”
When filling out the end-of-conference evaluation questionnaire, I indicated that next time around they should invite Sir Alec to give the keynote address on caring for women with cancer. They never did. I, however, never forgot what he said.
Words can be destructive. We have seen in the Scally report the great harm they caused to women. Misogyny is a highly serious accusation. The word comes from the Greek for “hatred” and “woman”. Invariably, it is used to describe the behaviour of men. I was shocked to see it in the headlines recently. Wrongly applied to an individual or a group of individuals, it denigrates and demoralises.
“Maternalistic” and “matriarchal” are generally seen as positive qualities – unlike their masculine equivalents.
Broad brush strokes
In a service increasingly provided and led by women, words such as “paternalistic” and “patriarchal” can no longer be used as broad brush strokes to characterise a culture among consultant obstetricians and gynaecologists.
Language has a text and a subtext. Sexism can exist in both. Either way, it has no place in the consultation room. Nor has it a place in reports, the media or public discourse.
I have been greatly inspired by the many highly dedicated women and men I have worked with over the years. I have also learned a lot about compassion, honesty and the importance of using the right words from a poet, a professor and an actor – one woman and two men. The next time the subject of career comes up with a medical student, this is what I am going to tell her or him.
Prof Chris Fitzpatrick is a consultant obstetrician and gynaecologist in the Coombe Women and Infants University Hospital and clinical professor in the UCD school of medicine