I had not in been in Vienna very long and I needed to see a gynaecologist, because I thought I was pregnant. I went to a gynaecologist’s office in the district where I was living. He was a really nice doctor and the office was also alright but I never went there again.
After arriving at the doctor’s office, the female assistant working there told me that I would see the doctor shortly. She instructed me to undress down to my underpants and take a seat in one of the rooms. This room was kind of like a second waiting room. So I undressed and took a seat wearing only my underpants and I sat there and sat there. I began to feel increasingly uncomfortable. Then another naked woman, wearing only her underpants, entered the room and sat down behind me. I sat there naked for over 30 minutes. I was so uncomfortable and I also felt so sorry for the other patient. Finally, I could see the doctor. During the examination I thought: “Oh no, when I leave his office, I will have to look at naked women waiting.” I knew I would never go to that doctor again. Afterwards I told my husband that I would try to find a Muslim gynaecologist because he would be more careful in dealing with naked women.
1. Identities of the actors in the situation
The narrator is a Mexican born woman with very high academic training (PhD, worked in research projects), who has been living and working in Mexico, Egypt, France and Lebanon before coming to Austria. Aside from working as scientist, she also has a diplomatic background.
At the time of the incident the woman had just moved to Austria to live in the same place as her husband, since they were planning on starting a family and having children. She chose to move to Austria and not follow her diplomatic career, because she had seen many long-distance-relationships crumble and wanted to have children only when living in the same place as her partner. At the time of the incident she was thought to be pregnant with her first child. She was in her early 30s.
The narrator explained that she considers herself a migrant (self-image). This perception was confirmed by having been confronted with stereotypical representations of Latin-American women while living in Austria and having been given this label (external labelling). While having a very positive view on migration and multilingualism herself (she speaks seven languages), she addresses how she has been devalued as a “Latin-American woman” and “migrant” in Austria.
She identifies herself as a practicing Catholic, having been raised as Catholic in Mexico.
Gynaecologist and assistant
A male gynaecologist, around 55 years old and a female assistant in her 20s were working in the gynaecologist’s office in an inner-city district of Vienna. Both were German-speaking. The narrator assumes the doctor to be Catholic. The doctor, by way of structuring the treatment of patients, seems to adhere to a Western view on medicine. Medically relevant conditions are diagnosed by a trained expert (himself) through established protocol with the patients having no active role to play in the process. Engagement with the patients’ bodies as indicators of their conditions takes priority in diagnosis.
There were other female patients present in the gynaecologist’s office. Their presence, waiting dressed down to their underpants in one of the office’s waiting rooms, was particularly relevant to the critical incident. One female patient entered the waiting room where the narrator was sitting and sat down behind her. Her presence was felt by the narrator and contributed to the shock element. Moreover, the narrator imagined other naked female patients entering the waiting room, while she was in the examination room. She thought about having to pass by them on her way out.
Both the doctor and the narrator are highly educated. Aside from this most of the elements of their social identities drive them apart. The doctor is male, Austrian and in the role of an expert, while the narrator is female, a Mexican national who recently migrated to Austria and is the patient. Moreover, the situation is routine for the doctor, while the narrator is in an alert state, since she thinks she might be pregnant for the first time.
The assistant is not as highly educated as the narrator but she represents a member of the medical establishment and the situation is routine to her. Furthermore, she has a close connection to the doctor as he is her boss.
The narrator and the other patients are all women waiting to see a doctor. Since their social identities are not easily known or play no role in the encounter, they seem to be in the same situation.
2. Context of the situation
Physical: The incident happened in a gynaecologist’s office that was made up of an entrance area, multiple waiting rooms and the room where patients met the doctor. Within the practice no specific spatial arrangements were put in place for undressing and making the naked body available for examination.
Social: The narrator was taken through the office with its different rooms by the doctor’s assistant, then placed in one room to wait for the physician. She had never been to this doctor before, and was unsure of the specific proceedings onsite. At the same time, visiting a doctor’s office is commonly characterised by a separation of expert versus lay person, who usually turns to the expert in a state of need. As a consequence the encounter is marked by a difference in knowledge and status between the expert and the lay person. The assistant represents an in-between-position, since she is hierarchically positioned beneath the doctor (in terms of professional status and expertise deemed relevant for treating patients). On the other hand, she is familiar with the proceedings onsite and belongs to the medical system, thereby being able to instruct patients.
The hierarchical dimension is further enhanced by the fact that the narrator was not a regular at this doctor’s practice. She was a migrant experiencing the Austrian medical system for the first time. While there was no problem with insurance, the narrator reports a sense of insecurity in dealing with Austrian institutions that she attributes to being labelled as “migrant” or “woman from Latin America”.
Among medical specialties gynaecology is commonly thought to be a very sensitive one. Visiting a gynaecologist is associated with anxiety by many women and feeling exposed and uncomfortable in the examination situation. On the other hand, gynaecology deals with women giving birth and is thereby associated with new life. The specialty also points to gender as a relevant dimension of social life. Gynaecology was incorporated into medicine considerably late in its development as a professional field. Before gynaecologist practices were overtaken by a predominantly male medical profession, they were primarily performed by female midwives. Especially within feminist discourse there is a critical position on male gynaecologists serving as experts on the functioning of female bodies.
Psychological: From the perspective of the narrator two factors contributed greatly to the psychological state she found herself in. One was the status of being a recent migrant to Austria, unfamiliar with its medical practices and other ways of life and not feeling completely well-versed in German. Secondly, the narrator was thought to be pregnant, which put her in a state of insecurity, anticipation and excitement.
3. Emotional reaction
The narrator felt uncomfortable in the situation and grew ever more so the longer it lasted. She felt uneasy and wished the situation to be over soon. She grew ashamed at the thought of having to pass by naked female patients on her way out, because this had to be unpleasant for them as well.
4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock
Being naked is not a state in which the narrator feels comfortable. Rather specific contextual elements need to be given for her to feel safe when being naked. Otherwise she feels exposed, pointing to a view of the naked body as something private that needs protection.
- Nakedness should happen at one’s own choice – the same applies for seeing other people naked – and be fitted into a specific context. While undressing for an examination by a doctor seems warranted, sitting naked while waiting for this examination and being confronted with other naked patients crosses a line. Thus, the adequacy of being naked and one’s corresponding feeling are highly context-dependent.
- To the narrator being dressed down to her underpants is equivalent to being naked, pointing to partial nakedness being perceived as nudity. This might reflect in the context of a semi-public place, where wearing only underpants is already unusual. It might also be testimony to the narrator’s approach equating underpants with being naked.
- Viewing naked bodies in inadequate contexts is connected to shame.
- Her approach to nakedness is tied to religious orientation: The narrator seems to consider a doctor’s (person’s) religion as a relevant factor regarding their ability to treat naked female patients with care. She implies a difference in how nakedness is viewed between her Catholic upbringing in Latin America and Austrian Catholicism. Her own values of care and protection are more likely to be shared by a doctor of Islamic religion (inter-religious similarities).
- Gender differences do appear to play a role; the narrator emphasises the fact that she had to pass by naked women. Yet in a medical setting, undressing before a male does not seem to constitute a problem, pointing to professional identity superseding gender identity.
A medical procedure is subject to specific rules and inherent power hierarchies:
- Even though being naked seems to be a sensitive topic for the narrator, she does not question having to undress or feels the need complain to either the gynaecologist or his assistant about waiting naked. She seems to accept the power hierarchies that are inscribed in this incident between her as patient and medical authorities.
- The doctor symbolises a specific function for the narrator – to examine her medically due to the suspicion of being pregnant. In this function the doctor’s gender seems irrelevant when following medical procedure.
- The narrator’s acceptance of the power hierarchy is voided only by the presence of other patients when the situation is transformed and the hierarchical difference becomes questionable.
- The power hierarchy between doctor as an expert with specific knowledge and social status and lay person is enhanced by the fact that one personis naked while the other is clothed looking at the naked person. While the doctor carries all the insignia of his profession and can show facets of his individuality via his clothing, the interior of his office etc., the naked narrator enters the interaction without the usual signs of social status and individuality.
Individualism might be another value that was threatened in this incident. The fact that the doctor showed no interest in the narrator as a person before subjecting her to the standardised measure of undressing could have been contributing to threatening the narrator’s individualist orientation.
Adaption to specific local rules of conduct / insecure status as migrant:
- The narrator labels herself as a migrant unfamiliar with specific codes of conduct in the Austrian health care system and the specific doctor’s office at hand. Her preference seems to be to view the members of the gynaecology practice as authorities and to follow their instructions, even when she feels uncomfortable along the way.
- This preference might be fuelled by her feeling insecure when coming in contact with Austrian institutions (such as elements of the medical systems) and not knowing informal rules and having experienced forms of discrimination before.
Compliant communication style:
- She exhibits a preference for avoiding or removing herself from an unpleasant situation instead of choosing confrontation.
- While this preference may be attributed to the power difference between the narrator and the representatives of the medical system, it may also rest on the fact the complaining would allow them an insight into her emotional state.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?
Slightly negative: The gynaecologist is depicted as inconsiderate and oblivious of patients’ needs, yet he is not demonised. He is not described as a horrible person or bad doctor, just someone inconveniencing the narrator, causing her never to seek his services again.
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator
The gynaecologist adheres to a Western medical style and this style covers all elements of his practice i.e. spatial arrangements, communication with patients and diagnostics.
- The medical practice is marked by clear power hierarchies between the doctor, the doctor’s assistant and the patients. Medicine in envisioned as a top-down-process that is passed down from a knowledgeable, well-trained physician to patients.
- Patients are thought to be passive in the process of diagnosing and treating physical conditions. Their participation in these processes is neither wanted nor facilitated.
- Bodies are being separated from the persons inhabiting them; the focus of medical attention is placed on the body.
- The patient’s individual perspective is deemed irrelevant during diagnosis and treatment; their condition is indicated by their bodies and matched with standards of procedure. Individual elements such as the gender of the patients to be treated and the gender of the gynaecologist are deemed irrelevant during the professional encounter. Therefore a clinical understanding of the medical profession is exhibited with little or no regard for emotions attached to one’s own naked body being looked at by strangers or cultural images of female nudity.
- Interaction with patients aims at detecting the physical condition and styles of communicating with patients are not at centre of the doctor’s considerations.
- This lack of communication transcends into the type of interaction between the assistant and the patients. The patients are not informed on how long they will have to wait without being dressed or how they will move around in the different rooms of the office etc.
The practice is oriented toward efficiency:
- In order to make efficient use of time and space, patients are not treated in an individualised way, but according to a standardised means of approaching patients. Patients are already undressed when they come to see the doctor so he does not need to wait for them to get ready.
- Patients are moved spatially through the practice. The ones arriving are gathered at the entrance and the ones waiting for treatment placed in a different room, ready to enter the doctor’s office.
By this handling of patients the practice documents a valorisation of functionalism: patients are not people but conditions to be treated. The doctor follows a problem solving approach in his way of work. He focuses on the task at hand and is less involved with the social and interactive elements accompanying the treating of patients.
- The way problems are solved follows a hierarchical mode.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
- Approach to naked patients / unprotected bodies within medical treatment
- Exposing one’s body is a sensitive activity for many people. Yet it is commonly required within medical treatment. As a consequence specific preconditions should be put in place when examining naked patients.
- The spatial arrangements should accommodate the sensitive nature of exposing one’s body: i.e. rooms that can be closed with no other patients present and dim lighting that lessens the feeling of being exposed.
- While the incident revolved around undressing down to one’s underpants, it is instructive for handling exposed body parts as well. It points to the necessity of carefully instructing patients on what will happen and guiding them through the process to avoid making them feel uncomfortable. Acknowledging the sensitive nature of undressing and thereby expressing care might be one element of alleviating feelings of insecurity.
- Communication in doctor – patient interactions:
- Within a Western style of medicine expertise of a patient’s condition rests with the medical expert. The patient is diagnosed through an established medical procedure; His or her role in diagnosis and treatment is deemed marginal. Due to these facts, little emphasis is placed on communicating with patients. Lack of or inadequate communication with the patients can contribute to them feeling ill-treated, not accepting the proposed course of treatment or refraining from seeking treatment again.
- If treatment is structured according to this hierarchical model, it should be questioned whether patients are even afforded the ability to complain, pointing to a culture of communication between doctor / medical authorities and patients.
- Contrary to a concept of medicine as a top-down-process, medical treatment can also be imagined as a participating process, in which patients and their individual backgrounds and emotions play a vital part for diagnosis and treatment. Engaging patients in this process, members of the medical profession need to emphasise the development of communication skills.
- Streamlining of medical practice vs. quality of care
- An orientation towards considerations of efficiency might be a reasonable and sometimes necessary measure for medical professionals considering the high workload and economy of medical treatment. Yet these concerns can adversely affect patients’ experience and impact on the course of treatment in a negative way. Thus, efficiency needs to be synchronised with standards of quality care.
- Culturally variant codes of conduct contribute to insecurity on how to behave in medical settings, what to expect and how to express discomfort:
- These codes can be attributed both to the status of being a migrant living in a new country and unaware of the medical system’s conventions,
Also to the experience of being a lay-person in an expert environment.