SairaS

The recent BBC dramatisation of Adams Kay’s memoir of his time as an obstetrician and gynaecologist, 'This Is Going to Hurt', has hit a nerve with many. For some it’s a thought-provoking work of brilliance – that highlights the real-world fragility of the NHS and its workers. For others, the deep vein of misogyny that runs through it is unacceptable, and the dehumanised portrayal of childbirth triggering for many. Whilst the BBC series is semi-fictional, the objections are part of a trend of women speaking up about being mistreated/disbelieved by medical professionals, resulting in delays in diagnosis and serious harm (in addition to the psychological burden of being gaslit). It’s not surprising that many of these stories are gynaecological. The uterus may no longer be seen as the source of hysteria, but it has now been replaced by the female mind (or the unpredictable female hormones, which are felt to ultimately control their minds). We view female pain differently to male pain. Female pain is normalised, as women’s natural physiological processes are presumed to be inherently painful. This myth seems widespread among obstetricians and gynaecologists; for example, frequently using the yardstick of ‘period cramps’ when describing female pain. This comparison manages to both ignore the fact many women do not find menstruation painful, and simultaneously belittle those who do have pathologically painful periods. It’s easy to forget that for most of western history, women’s reproductive health was not even considered worthy enough to be in the domain of the medical profession (that role being filled by midwives or lay women). Last year, I spoke at the Royal College of Obstetricians & Gynaecologists (only founded in the 20th century) about the origins and development of our speciality; and how that history still impacts our views, particularly on female pain and decision making. The response was predictably mixed, but there was a degree of defensiveness I had not anticipated. Perhaps because we see ourselves as the good guys; trying our best to care for women in a broken, understaffed system. It’s that broken system that’s the setting for ‘This is Going to Hurt’. While the book was nearly universally praised when it was released in 2017, I had found it almost unbearable to read at the time. The sexism, overconfidence, bullying and ‘rag-week’ humour were too painfully familiar to me, as a junior in the speciality; and the praise heaped on the book amplified that feeling. I am also not alone in doubting if the punitive treatment of the (largely white) women in the book would still have been seen as funny if the protagonist was a Muslim man? Would the sarcastic quips be as witty if the arrogance was from a black woman? There was more nuance in the TV series; with the recognition that (the more fictionalised) anti-hero’s attitude to women was not acceptable – but it was still glamourised. The arrogant, complex, maverick battling inhuman fatigue (while still maintaining excellent hair, and no professional boundaries) is a TV doctor trope. It’s a shorthand for clinical brilliance that sadly persists in the real world. It’s that lack of humility that is particularly dangerous in our speciality and puts women at risk. Because our patients are female, it is also particularly easy to fall back on the cultural misogyny we have inherited, and blame women themselves when we can’t explain symptoms. But my experience is that these attitudes are waning, and the obstetric culture of the mid-2000s depicted by Kay increasingly dated. Junior doctors would find his description of ‘Brats and Twats’ bewilderingly alien. But the real change is being forced by women themselves. The public is increasingly questioning and insisting on improvement; and we are rightly having to listen. Further reading Medicines, research and female hormones: a dangerous knowledge gap Dangerous exclusions: The risk to patient safety of sex and gender bias My endometriosis hell and why chronic pain patients need an end to 'medical gaslighting' Regulatory flaws: Women were catastrophically failed in the mesh, Primodos and Sodium Valproate tragedies The normalisation of women’s pain ‘Women are being dismissed, disbelieved and shut out’ Gender bias: A threat to women’s health