• The Editor

How Do You Make Change When Male-Centric Medicine Endangers Women’s Health?

Interview By Sofia Sacerdote

Dr. Alyson J. McGregor’s book Sex Matters: How Male-Centric Medicine Endgangers Women’s Health and What We Can Do About It came out at the beginning of the summer. I got the chance to chat with her over Zoom one recent afternoon. Dr. McGregor, an emergency medicine physician who has devoted her career to bringing issues of women’s health to a national stage, is the Director for the Division of Sex and Gender in Emergency Medicine at Brown’s Alpert Medical School, as well as the co-founder of the Sex and Gender Women’s Health Collaborative. As we (virtually) talked, she sat outside on her porch with her two dogs, Feta and Basil. We discussed her book, related her work to the national surge of racial justice work this summer, and exchanged book recommendations. Below are highlights from our conversation.

Sofia: You write that in picking up Sex Matters, your readers become “standard bearers.” You empower your readers to become advocates for our own health by giving us the knowledge and the tools to do so. I know that you hold several different roles in advocating for structural changes in medicine; how do you strike a balance between empowering individuals to advocate for their own health while also calling for change in the system so that it doesn't have to be on women to do that?

Dr. McGregor: That’s a loaded question and it cuts to the challenge of making systemic change in something as big as medicine and health because there are so many facets to it. Throughout the past decade of wanting to make change for women’s health, I first started to do research and add to the literature. Then I tried to advocate for research to include women and not only to include women, but to then analyze the study based on sex. But while working with journals and editors, I realized we can't wait for all the research to come in—there's a lot of evidence that we could start teaching right now in the health education curriculum in order to bring that to clinical practice. And then later I realized we can't wait for that either: there are women I see in the emergency department who are suffering from this ingrained bias everyday. And so I thought, while I'm still doing this advocacy and education within the medical world, let me try to educate especially women—but really everybody—to learn how to advocate for themselves. I'm hoping that it has a domino effect, so that when women advocating for themselves have a conversation with their doctor, they push their doctor to become more aware of all this through that one encounter. I'm looking for change to happen more quickly than it normally does.

Sofia: You wrote a chapter of your book about the intersection of racial health disparities and sex-based health disparities, and I was wondering if you have new thoughts given how this summer’s focus on the Movement for Black Lives has catalyzed many conversations about racial bias in the medicine.

Dr. McGregor: I don't consider myself an expert in race, but when I look at the differences between health outcomes based on biological sex between men and women, it's impossible not to see the impact of compounding biases: if you look at men and women and you look at the outcomes of a heart attack or stroke, women do worse than men. Then when you look within the women, you’ll find that women of color do worse than white women, making it clear that additional biases are compounded when our entire basis of our medical knowledge is based on white, healthy men. It's a compounding bias risk especially for women of color. I think the COVID pandemic in tandem with the Movement for Black Lives is bringing unconscious bias to the forefront, and I think it's a good time to shine a light on it.

Sofia: Yes, I think it's all too easy in conversations about sex and medicine to leave out Black women. And I think in conversations about racial disparities in medicine, it's again, easy to leave out Black women. In addition to the advice you give to the readers in your book, do you have specific or additional advice you give to Black women?

Dr. McGregor: I advise all women to ask their doctors whether they are comfortable understanding the differences between biological sex and if you should have different medications or different testing. And when I talk about race, I also advise people of color to ask their doctors how diverse is the hospital where they work? What we’ve seen in the literature is that women think of women. And so when you have women in a mixed physician group, not only do the women patients receive better care from the women physicians, they receive better care from the male physicians—the rising tide lifts all boats. And the same thing holds true for other areas of diversity; there are some studies that show that when Black men had a Black male physician, they were more likely to be sent for preventative care. I think our ability to identify ourselves in a patient just underscores the importance of diversity when looking for your healthcare system.

Sofia: Yeah, and that's a great argument for why we need to support more women and people of color in coming into medicine.

Dr. McGregor: Exactly. When I first started this work, many of my colleagues were advocating for women physicians equal pay, equal opportunity. And I thought what's missing is the women as patients: how the medical system looks at their healthcare. But as I grew and learned, I realized that these issues need to be raised together because the more women we have as researchers, as journal editors, as curriculum leaders and deans, and the more diverse and the more thought is going to be poured into making sure that women as patients get the same level of care as men. 

Sofia: Absolutely. I really love your holistic way of looking at it and seeing it all as interconnected. In her new memoir Untamed, Glennon Doyle writes about the issues women face more broadly in society, many of which apply to health care and connect to your book. Doyle writes that her “job is to listen deeply to women.” That seems like a big part of your job as well. How is listening to patients who are women different from listening to men?

Dr. McGregor: I just added Untamed in my Amazon cart! Communication styles have been shown to be different between men and women. For instance, if we just look at the context of pain: if a woman comes in and has a painful condition, say the same condition as a man who’s in the room next door, she’s likely going to communicate her pain differently to their provider. Those differences include cultural norms, like it's okay for women to cry or to get anxious or to scream while it's not always considered okay for men. Now let's look at the gender or the sex of the physician, which means now we’re talking about two people who are negotiating how much pain this patient has. In some of the pain literature we find that when a woman says that she has lots of pain, a male provider thinks “well, they're always a little bit hysterical. She’s probably exaggerating a little bit, so let me just kind of turn the volume down.” And for a woman with a male physician, she might think “he's not gonna listen to me, so let me turn the volume up.” And so there's this negotiation that happens when it's a discordant gender, whereas women providers don't necessarily turn down the volume when they see women patients. So I think that looking at that one example, we can see how people may showcase their discomfort based on their gender, their culture as well as implicit biases on both sides of the doctor-patient relationship.

Sofia: Triage is a health humanities blog, and for me, lots of what we do is about giving a voice to physicians as writers and as readers and as people who appreciate the arts and the humanities. Along those lines, I’m wondering if there’s a book you’ve read recently that you want to talk about as well as how it's influenced the way that you're practicing medicine.

Dr. McGregor: There's two books I’ve really loved this year. The first is called Vagina, a Re-Education by Lynn Enrigh. What I love about this book is that it’s a reeducation—what Enrigh has done is say “yes, even with reproductive organs, we need a reeducation.” It's beautifully written through Enrigh’s own storylines. 

And then the other one is called Invisible Women by Caroline Criado-Perez. She does what I do, but at the scale of the entire society. She looks at how our entire society was built by men, with men's occupations and physical wellbeing in mind. It just blows my mind to see into all these other areas of our world that I don't study that have a similar male-centric viewpoint.

Sofia: What gives you hope for the future of women's health?

Dr. McGregor: I am seeing things like this one particular resident who is reading the book and told me about a moment she had while seeing this woman with a chronic pain condition. She said she had this guttural instinct that was just like an eye roll. And then she stopped and said, “wait a minute, what would Alyson do here? What is the book trying to teach me in order to remove that stigma?” I wanted to clap for her because I had that same stigma—I had the same eye roll. We were taught to emulate our advisors and our teachers and our seniors, and so a lot of that stigma gets passed on. And so the question is: how do we break that cycle? I’m hoping my book has some power to it.

In addition to that, I'm seeing things like our medical education summits which are now including dentistry and nursing and allied health and pharmacy. And I am so hopeful for the youth because I feel as though your generation already knows this is important. 

We wrapped up the conversation, chatting more about the details of our favorite books and exchanging words of gratitude. And Dr. McGregor is the first to humbly affirm that her field—the work of providing women better care and including women in every level of medical research—is “wide open.” She encourages students like me to “get in, pick a niche,” and build careers around it. I know that in addition to the ripple effect Dr. McGregor hopes Sex Matters will create among patients’ and physicians’ awareness of sex and gender, the book empowers students like me to think critically about sex and gender throughout our entire medical education.

Order Sex Matters online. Gift it to your loved ones, your friends, and even—as Dr. McGregor says many of her readers have done—to your physician!

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