Sexism in medicine? It’s not ‘All in her head’

By Danielle Friedman

NEW YORK: Six years ago, Dr. Elizabeth Comen, a breast cancer specialist at Memorial Sloan Kettering Hospital in Manhattan, held the hand of a patient who was hours from death. As Dr. Comen leaned in for a final goodbye, she pressed her cheek to her patient’s damp face. “Then she said it,” Dr. Comen recalled. “‘I’m so sorry for sweating on you.’”

In her two decades as a physician, Dr. Comen has found that women are constantly apologising to her: for sweating, for asking follow-up questions, for failing to detect their own cancers sooner. “Women apologise for being sick or seeking care or advocating for themselves,” she said during an interview in her office: “‘I’m so sorry, but I’m in pain. I’m so sorry, this looks disgusting.’”

These experiences in the exam room are part of what drove Dr. Comen to write “All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today.” In it, she traces the roots of women’s tendency to apologise for their ailing or unruly bodies to centuries of diminishment by the medical establishment. It’s a legacy that continues to shape the lives of women patients, she argues.

Today, women are more likely to be misdiagnosed than men are and take longer to be diagnosed with heart disease and some cancers; they may be less likely to be offered pain medication; their symptoms are more likely to be written off as anxiety — or, as the book title suggests, as being all in their head. “The anxious female, the hysterical female, has been a ghost looming and woven through all of medical history,” Dr. Comen said. “It’s a default diagnosis.”Collectively, she argues in the book, these injustices help to explain why many women report feeling invisible, frustrated or ashamed in doctors’ offices. Shame may be the symptom, but Dr. Comen believes that a deeply misogynistic medical system is the disease.

A mother of three in her mid-40s, Dr. Comen is quick with a camera-ready smile, which has helped to make her a regular in media coverage of breast cancer. She occasionally tears up when discussing her patients. She once wept on the job in medical school, and a male resident responded by telling her to “pull herself together.”

“I felt like I had to excuse my response,” she said, sitting behind her desk. “And now I cry with patients all the time.” Her approach has been shaped by decades of experience, as well as by what she learned about the female body’s place in medicine while majoring in the history of science as an undergraduate at Harvard. The sense that women’s bodies were not just different but broken is obvious not just in the way doctors spoke of the female anatomy but in the medical vocabulary itself: the female external genitalia was termed ‘pudenda,’ a Latin word that means ‘things to be ashamed of,’” she writes.

In “All in Her Head,” Dr. Comen offers a sweeping look at the ways in which she says modern medicine has disregarded women. For centuries, she writes, early medical authorities believed that women were merely “small men” — though lacking external genitals and comparable mental capacity, ruled by noxious humours and hormones. For too long, doctors dismissed “what could be legitimate physiological problems as irrelevant, as hormonal, and therefore not important,” said Wendy Kline, a professor of the history of medicine at Purdue University.