Athena's journey: medicine and the feminine

This thesis is a study of the relationship between medical culture and women doctors. It seeks to answer the question ‘What do women do with their feminine when they become doctors’. The question is important to women doctors, to patients, to workforce planners and to all those who intersect with or are involved in the medical profession. Over the past 30-40 years women have joined the profession in increasing numbers in Australia and other countries with similar cultures such as Canada, the UK and the USA, and now comprise approximately half the medical school cohort and nearly a third of the medical workforce. Introducing women into the previously masculine culture of medicine has a substantial impact on the women, and also on medicine. The research detailed in this thesis identifies some of that impact in ways that will be useful to both women doctors and medical students, and to workforce planners. The study is also an exploration of research methods that are effective in uncovering the comparatively silenced voice of women in medicine. It identifies what can be found by applying the lens of feminist epistemology to medical culture. It explores the knowledges brought forth by three approaches to research, each building on the other, each valid in its own right, and each assisting in identifying what is missing from the other approaches. It uses both quantitative and qualitative method to study the research question. Working with a post-modern feminist epistemology I use triangulation to refine the essence of the findings. The three methods comprise 1) qualitative data from interviews with nine female doctors that focused on their lived relationship between their female selves and their profession, and qualitative data from a national survey of rural doctors focussing on how women express their femaleness in their professional practice; 2) quantitative data from the national survey of rural doctors; and 3) a study of mythology of the feminine and its relation to the history of the construction of medical knowledge in the European tradition on which Australian medical culture draws. In the data chapters findings are analysed wherever possible using all three knowledge sources. Thus the methodology used for this study is actually methodologies. I have used my skills as an historian to locate the story of women in medicine, quantitative survey research to transform anecdote to data, and qualitative interview research as an heuristic device to discover what is really going on, what is possible, and to provide the thematic framework for the data analysis. The unifying theme behind this multi-disciplinary approach is feminist theorising about women, the feminine, power, medicine, authority and knowledge within occidental culture. The theoretical challenge is to bring these disparate ways of creating knowledges to a coherent and defensible conclusion. That is a challenge appropriate for this study, for I am concentrating on uncovering how medical knowledge is created, in whose image is it created, and identifying the consequences of excluding women as co-creators of this knowledge, as experienced by women doctors. The broader question, of the impact of the exclusion of women from the creation of medical knowledge on that knowledge itself, and consequently on patient care, is part of work I do as an academic in the Faculty of Medicine, Nursing and Health Sciences at Monash University. This study then, is researching an important question. The thesis has four Sections, each of which comprises between two to three chapters. Section One has three chapters. Chapter One introduces the study, describes the research approach and contains some information about me, the researcher, that provides context for the research approach taken. Chapter Two considers current feminist challenges to the construction of scientific knowledge and a description of the epistemology, methodology and method used in gathering and interpreting the data for the research. Chapter Three explores myths and archetypes about the feminine, considers what these tell us about the process of wresting the keys of the kingdom from women, discusses the witch-burnings and their impact on women and medical knowledge, and ends with a brief history of women in medicine. Each Section is introduced with a Chapeau that reflects on the data to be considered. Section Two comprises two chapters that describe the impact of the culture of medicine on women doctors, using data from the myths, the interviews, and the national survey. Section Three comprises three chapters that consider the impact women are having on medicine, including the strategies women use to resist some of the adverse effects of medical culture on their female selves, and identifying what women are doing to change that culture. Section Four examines the relationship between women doctors and healing, and the thesis concludes with a consideration of the impact of women on medical culture and practice.

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