It is said that historically women have had a raw deal in Western systems of medicine. Women’s bodies have been routinely sexualized or their characteristics ignored or shamed. In a recent book1 a leading cancer doctor in the US, Dr Elizabeth Comen, has attributed it to centuries of being put down by the medical establishment and this has resulted in women being more likely to be misdiagnosed when suffering from common disorders such as cancer and heart disease. Their symptoms have been more likely to be written off as anxiety, and women sometimes react by apologising when they are speaking to their doctors.She argues that there is still misogyny in modern western health systems. And it is also more deeply felt by women lower down in the pecking order – such as being poor, of colour, of a different nationality, elderly, or having had lots of medical problems in the past. Examples she gives are doctors diagnosing women who were short of breath and complaining of palpitations, with “pseudo-angina”- a collection of neurosis-induced symptoms masquerading as genuine disease. It took a long time before it was realized there is no such thing as “pseudo angina” and that women were in fact being routinely under-diagnosed.
You might think that this is likely to be the case where the doctors in question were older and male, and that as more female doctors have come into the system this becomes less of a problem, and I am sure that this is correct to some extent. But female doctors are by no means immune from the temptation to treat women patients differently to men. As I am now retired from medical practice, and indubitably old, I get this treatment too. I have a longstanding, troublesome but non serious eyelid problem, and I have learnt that it is necessary to apologise in advance every time I see a doctor, and also sometimes an optometrist as well! Of course, I don’t know whether an elderly man would get the same brush-off, or whether they would learn to apologise. My memory of being a GP was that very few men would ever apologise to me for just presenting their symptoms, which they had every right to do. Perhaps I ought to do a survey!
In the same vein, women historically had a hard time in entering the closed world of medicine. Young women faced many barriers which had to be demolished. Historically in the UK, Medicine was a bastion of male influence, and this has changed only in my lifetime. When I applied for medical school in 1962, I found that some medical schools had a quota for girls. For the prestigious London medical schools, this wasn’t a quota to be reached but a ceiling – no more than 10% girls, regardless of quality of the applicant. For Oxford and Cambridge, there were a limited number of colleges for females (all colleges were for either males or females) so at Cambridge there were 9 boys for every girl starting their undergraduate courses. This certainly made it great for girls’ social lives!
I remember when I timidly spoke in a University medical debate, I put forward the fairly revolutionary idea that medicine needed female doctors, and so the profession should start to make it easier for girls to be doctors. Sadly, my suggestion was received in silence and the meeting swiftly moved on. Afterwards an elderly (perhaps he was about 50) gentleman took me aside and explained that women would not make good doctors and the profession should remain mostly male!
However I thoroughly enjoyed the training and took to being a junior doctor with alacrity. As one of the 10% I found getting house jobs easy, but as I looked around all I could see were men in senior positions in all branches of medicine, and women were in jobs like family planning, part time general practice and palliative care. I certainly felt that hospital medicine would be very difficult, and opted for general practice as an area where one could tread one’s own path. Later as a principal in general practice things became easier, though in meetings it was difficult to make oneself heard without provoking people (which I did, a lot).
However in 1975 the first UK sex discrimination act was passed, which outlawed discriminationand on the grounds of sex or marital status. It covered employment, training, education, harassment, the provision of goods and services, and the disposal of premises. It took time for this to be accepted in medicine, and I again was not popular when I took up the cause of female doctors being sidelined, and especially not when I pointed out that junior doctors with personal objections to abortion were attempting to prevent abortions happening. Abortion had been legal since 1967, and I well remember the situation at medical school where girls were being referred to consultants who had to try to find a legal loophole to allow a termination when they were good medical grounds why the abortion should go ahead. It was heartbreaking at times.
But slowly more and more women began to prioritise their careers while still having children, and even in my cohort there was one (but only one) who became not only a consultant in a prestigious speciality but also a professor. She had great determination and drive and was incredibly successful, but also empathetic and approachable. She is also tall, good-looking, with impeccable schooling and poise.
Female doctors have made great strides, and several recent studies have found that when medical patients (of both sexes) in hospital are cared for by female physicians, they may have less chance of dying (i.e., decreased mortality rates) compared with patients of male physicians. 2 Also female patients have a greater benefit from being treated by females. When doctors get complaints against them or are accused of poor conduct, it was found that significantly more male doctors were referred for investigation than female ones. This sex difference in who gets referred for disciplinary action is similar throughout the world. For instance, after controlling for all demographic factors, male doctors in the United States were three times more likely than women to have claims for malpractice made against them. In England only six of the 49 career doctors with problems reported by Donaldson were women.

Investigators thought that the factors driving the differences, such as male doctors underestimating the severity of their female patients’ illness, could be due to female doctors being better at communicating with their female patients, and female patients being more comfortable with receiving sensitive examinations and having detailed conversations with female physicians.
So not to put too fine a point on it, it seems to be clear that female doctors are now well established in medical teams in most countries of the world, except where barriers are put up against them for cultural or religious reasons.
But gender bias is still alive and well in the workplace, though not as prevalent as racial bias. which is sadly widesprad in the NHS. Some specialities are much favoured by women. For instance Obstetrics and Gynaecology, and Public Health had the highest proportion of female applicants (72.4% and 67.2% respectively) and surgical specialities and radiology had the lowest (34.7% and 35.7% respectively). Nowadays women have made successful careers in medical politics as well as in mainstream medicine, and though it takes exceptional social skills as well as ability, women have revolutionised medicine.
As a footnote, I was saddened to hear recently that there are professions where women have not yet achieved success. A young friend of mine has recently become a pilot, where the current percentage of female pilots is about 7%, and I see her facing the same difficulties that I experienced all these years ago. She has been accused of behaviour problems (such as swearing – think of male pilots being criticised for that!), and safety issues when the problem lay with a senior pilot, not her. She was sanctioned and is finding it difficult to get back her confidence. Misogyny is rife in that profession. The world still has a long way to go in getting equality of the sexes.

“All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today.” Dr. Elizabeth Comen, a breast cancer specialist at Memorial Sloan Kettering Hospital in Manhattan,

JAMA Health Forum. 2021 Jul; 2(7): e211615.
Published online 2021 Jul 16. doi: 10.1001/jamahealthforum.2021.1615