gms | German Medical Science

12th Graz Conference – Quality of Teaching

18.09. - 20.09.2008 in Graz, Österreich

Why does Gender have a role in Medicine?

Lecture/Vortrag

Search Medline for

  • corresponding author Carin Muhr - Uppsala University, Department of Neuroscience, Neurology, Uppsala, Schweden

12. Grazer Konferenz - Qualität der Lehre: Skills and Attitudes. Graz, Österreich, 18.-20.09.2008. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc08grako10

DOI: 10.3205/08grako10, URN: urn:nbn:de:0183-08grako109

Received: January 15, 2009
Revised: February 5, 2009
Accepted: February 18, 2009
Published: April 6, 2009

© 2009 Muhr.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Lecture/Vortrag

If we ask the questions: Why should we be concerned about Gender? Is it unscientific to be gender blind? these questions will start a reflection that enables identification of how aware the organisation is. Gender awareness can, from an organisational context, be graded in four stages:

  • Stage 1 Denial;
  • Stage 2 The Problem is percieved to be Women;
  • Stage 3 Incremental Adjustment; and
  • Stage 4 Commitment to a New Culture.

Introducing and applying a Gender perspective in medical education can be seen as Transformative Learning which Mezirow describes as "becoming critically aware of one's own tacit assumptions and expectations and those of others and assessing their relevance for making an interpretation".

Gender competency is one of many that are needed to provide optimal care for a patient. Furthermore, gender perspective is one of many perspectives like health, cultural, ethnic, social, economical and political to analyse the conceptual reality.

Gender within the medical profession includes biological, psychological as well as social aspects. Biological, psychological and social factors interact and make up a unit which is impossible to separate into isolated parts and are all essential to take into account as they define the life situation of the patient.

Within the medical profession subjects like gender, communication, care and psychosocial aspects are considered ”soft” areas. Gender medicine contains both biological and psycho-social aspects, thus ”soft” and ”hard” core areas.

Within the last decade a gender perspective in medical research has provided an increasing amount of data demonstrating gender differences. Gender differences have been identified concerning signs and symptoms of diseases like cardiac disorders, mental depression, eating disorders, osteoporosis, rheumatological diseases, headache, suceptibility to environmental factors, infections, efficacy and side effects of medication and other treatment modalities.

A body of knowledge exists to base the fact that gender perspective is needed to provide optimal care. We also know that cultural norms will define what is regarded as appropriate in each gender and have a significant impact on health issues meaning that gender perspective is needed.

Today all new pharmaceutical products will be registered only after being tested in both women and men. Still, however, much of the research is not undertaken with a gender specific perspective and much of the ”knowledge” we apply is not researched in a gender specific way. Thus when the results from the study DIGIT [1] was reevaluated by different researchers, analysing women and men separately a completely new picture emerged. In the whole material, women and men initially evaluated together, showed benefits concerning time spent in hospital for the treatment group. However, women, when analysed as a separate group, now were revealed to have a higher mortality in the treated group compared to the placebo group [2].

Domestic violence is a major medical concern and common in all societies and within all social groups affecting both women and children. For example, domestic violence is more frequent than diabetes during pregnancy in Sweden. These women who are victims of domestic violence will need and rely on the skills of the medical profession for care.

In the medical education therefore we should ask why and how gender is applicable in any given health situation in order to allow us to better understand and care for our patients.


References

1.
The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336(8):525-533. Zugänglich unter: http://content.nejm.org/cgi/reprint/336/8/525.pdf. External link
2.
Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med. 2002;347(18):1403-1411. DOI: 10.1056/NEJMoa021266. External link