Madam Doctor

The incident

“During my time as a medical student, I worked for a while as an intern at a large and busy hospital in Palermo. During an internship program at the urology ward of the hospital I was assisting a doctor in the urological and oncological clinic.

When it was my turn to assist the doctor during a medical examination of an elderly male patient, the patient all of a sudden refused to be examined in my presence. The patient asked the doctor to have all female staff to leave the room.

The situation made me very nervous and resentful – especially because this was not about me being an intern, but merely about me being a woman.  However, the doctor was very firm on his decision to carry out the medical examination in my presence. The doctor made it clear to the patient that his conditions would not be accepted, and it was not an option to have female staff and professionals to leave the room.

Reluctantly, the patient accepted the doctor´s decision, and I was also allowed to examine the patient.”

1. Identities of the actors in the situation

The narrator is an Italian woman. At the time of the incident, she is 24 years old, highly educated and from a middle-high social background. Her religious-cultural background is Catholic. She is a student of medicine.

The person, who caused the shock, is an elderly Italian male patient. The patient has a low level of education.

A male Italian doctor working in the urological ward was also present alongside two female interns.

2. Context of the situation

The incident takes place in the physical context of a urological and oncological ward of a very busy hospital in Palermo, Italy.

The hospital is generally characterised by great bustle and a stressful working environment for the doctors and all medical staff. Despite these conditions, the staff take the time to meet patients’ needs and overlook their intolerant behaviour and lack of sensitivity to the staff’s stressful work situation.

3. Emotional reaction

The narrator felt belittled, angry and disappointed because of the lack of respect shown to her and the other lady doctors in the room. This event shed light on the sense of shame and reservation of the patient and on what was perceived as a sexist conception of the medical profession, where the “doctor” is the man, and the woman is not on the same level. This was also confirmed by the fact that, even though she was dressed just like the doctor (white coat and scrubs), the patient, who did not know anyone in the clinic“greeted us by saying “Good morning doctor, good morning ladies”.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

1) Gender Equality

In this case, the male patient did not directly offend the narrator and the other female doctors and staff members. However, by his behaviour, he indirectly created a tension and showed poor sensitivity in defining women’s professional roles within the hospital. The narrator believes in equality between women and men. She despises stereotypes where women are perceived as less skilled than men, and where women are considered inferior to men and only undertaking jobs of less responsibility than those undertaken by men.

Thus, the narrator realised in the situation that sometimes it is still a disadvantage to be a woman in certain professional areas. This was almost confirmed symbolically as the male patient would only perceive the male doctor as the only doctor in the room and the only person who could possibly be a representative of the medical profession. Even though the narrator and all other female professionals in the room were all dressed like the male doctor (white coat and scrubs), the patient, who did not know anyone in the clinic, still greeted all professionals by saying “Good morning doctor, good morning ladies”.

2) Helpfulness/Professionalism:

The student (narrator), after this shock, realised that there are cultural limitations that may prevent the normal development of the medical profession. She presents herself as a professional when she is working, and expects respect of the profession from the patients. She believes in her “call” to help others and wants to be respected for this and her professional attitude.

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?

From the analysis a negative image emerges, because the narrator is disappointed by the reality, in her medical profession, with stereotypes related to female doctors and also by the lack of sensibility and education of patients.

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.

1) Autonomy threat

The patient might have felt the need to preserve his intimacy as it could be too much exposure for him to undress in front of 4 doctors. Not only facing nudity but also the lack of control while he will be examined.

2) Intimacy and gender roles

The male patient wants to preserve his right to intimacy. We do not know much about the motive of the consultation but we have some clues by the urological and ward where it took place so the fact that the patient is a man and the 3 interns are women, has more importance. We usually feel more comfortable undressing infront of someone or our own gender. The patient is not able to split the fact that the women are doctors too; he cannot see them as professionals but only as people from the opposite gender.

3) Medical profession and gender roles

We can also make the hypothesis that the patient has an understanding of the specific field of medicine (urology) to be a profession for men only. Thus, he may be convinced that only men can understand intimate male parts, and women should not be in the profession because no matter how much they study they will never be able to understand.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

The described situation represents a critical incident, because the narrator has experienced a strong feeling of dismay, surprise and disappointment, when she witnesses how male doctors are preferred to female doctors and medical staff in certain hospital practices strictly related with the intimate parts of the male patient. At the same time, this is not true for female patients’ intimate parts, as the medical practice of gynaecology sees a large number of male practitioners.

The incident highlights another specific issue. Trust in the doctor-patient relationship is very important, and the trust of the patient in the doctor was broken by the presence of the lady doctors in the examination room. The way the male patient acted exposed his lack of respect for the lady doctors and for the profession, as he was not able to look beyond the gender of the lady doctors.