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Institutional sexism

Coalface tales

James Booth

Thursday, 11 April 2019

AdobeStock_123919361-sexism.jpgI had something pointed out to me at work a couple of months ago by the newest member of the team. I was out of the surgery for my admin day, and she observed that the entire surgery workforce, from reception to GPs, would be made up of women. She’d never had this experience in the NHS before, and it occurred to me that, as far as I knew, it was a first for us. A slightly surprising first, given that women have made up a majority of GPs in the UK since 2014 and that proportion continues to rise. Interestingly, the only remark about this by a patient has been from a member of the PPG, who expressed that he now found it hard to get an appointment with a male doctor. This is a reversal of a perennial grumble we have had in years past. He did ask why the last three new doctors we had taken on had been women; they were simply the best people who applied in each case. I had always – and somewhat naively, I think – thought that primary care was perhaps the area in medicine least likely to be dogged by chauvinism and misogyny. 

Women in general practice have been in the news this past week. Anyone taking more than a passing glance at the medical press will have seen the articles in GPonline this week in which two colleagues have, with great courage, spoken out about their experiences with sexism in the BMA. It has been heartening that this has garnered national media interest, with supportive pieces running across the spectrum of our newspapers and television news coverage, which I think is a testament to the honesty and clarity of that initial article. It is shaming for our profession that such attitudes still exist, and have cost us dearly in terms of new leaders. I’m lucky enough to count the authors of the original article as friends; they are entirely the sort of doctor all of us would want both as our own GP and leading us nationally. It is dismaying that they have needed to take these steps, and their bravery in doing so deserves all of our respect. I also think it bears noting that nothing in what they say has been personalised; this is a problem at an institutional level and sadly for all of us, that’s the institution that represents us all.

Some of the stories emerging this week have been horrible; describing behaviours and conduct that has never been acceptable, least of all now in 2019. I dare say that to many, they have been met with some surprise; after all, as my patient noted, aren’t women making up the majority of GPs these days? Well, if you have a look down the list of current GPC members it becomes apparent that this grassroots reality isn’t reflected in our national representation – 8 out of 9 policy leads, for example, are men. I fear that because we see women visibly in roles across the NHS, we have become complacent about the prevalence of sexism. I know I have been; assuming that a problem has gone away because I see little of it in my own little corner of the primary care world. And yet, it has been there: in the disparaging of women’s voices on social media, in the phrase “the girls in the office,” in throwaway comments about there being “a lot of women” on a committee.

As I’ve reflected further this week, I have actually been taken aback by how many similar incidents I have myself witnessed in my past time in the NHS. I can remember a senior consultant making a highly personal and sexualised comment to a fellow junior doctor, a teaching session in which a trainee was visibly harassed by a senior colleague, a tutorial at medical school in which the career aspiration of every young woman present was met with “that is/isn’t a good job for a mother.” To my shame, what I can’t recall is speaking up when I heard these. No-one else did, either. 

So, what can we all do about this? I’ve already written to my GPC representative expressing my concern and asking that any enquiry has the confidence of the complainants – we should all do the same, in my opinion. We should look at our workplaces and ask if we do enough to make them free of these kinds of institutional attitudes; we should no longer assume that medicine has moved on from this antediluvian chauvinism and misogyny. We need to challenge patients when they express these attitudes. As men, we need to empathise more with the world in which half or more of our colleagues work; and we need to do this by listening. We can start by hearing, very clearly, what has been said by courageous colleagues recently. Most importantly, though: we need to believe those who tell us of their experiences, and we need to commit to not walking by when we see unacceptable attitudes. As has been said, “The standard you walk past is the standard you accept.”

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the named GP for Safeguarding Children locally. All views expressed are his own.
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