Copyright Sociological Research Online, 1998

Sex and Medicine: Gender, Power and Authority in the Medical Profession

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In 1849 Elizabeth Blackwell became the first woman to be placed on the British medical register. By the 1990s women had come to account for over half of all medical graduates and the proportion looks set to increase. In her new book Rosemary Pringle considers the implications of this transformation for the practice of medicine and, in turn, for conventional assumptions about gender, power, inequality, and patriarchy. If, after a century of marginalisation and downright hostility women are now having a major impact on medicine, Pringle suggests, we can no longer conceptualise medicine as the lynchpin of patriarchy or indeed assume that western cultures are patriarchal systems.

In exploring this premise, Pringle brings a skillful blend of historical analysis and interview material divided into chapters which focus on the sub-disciplines of surgery, gynaecology, the physician specialities, anaesthesia, psychiatry and general practice. In each case, Pringle asks how far have women become integrated into the field, at what levels, facing what difficulties and - critically - what impact are they having on practice in their field? In addition, Pringle offers chapters on relations between doctors and nurses and women doctors¹ involvement in the feminist health movement. The interviews span an impressive range of women (150) and men (30) aged from 24 to 92, working across the medical hierarchies in their chosen specialisms. The interviews were carried out in both Britain and Australia, and Pringle takes care to contextualise the specifics of each case, although in fact she finds striking similarities between the two countries. (Nonetheless, whether this is constitutive of a global medical culture, as she suggest, seems debatable).

Throughout the book, Pringle takes great care to avoid easy ascription of male dominance or female powerlessness and this adds up to a forceful and convincing gendered analysis which need take no recourse to reification or fixity. In this, Pringle achieves a fine example of how the often rather abstract theoretical developments within gender theory over the past decade can be integrated into new empirical research. In particular, her research illustrates the fragmentary experience of gender (with particular reference to the impact of class) and the dynamic nature of gendered social relations. Drawing from Foucault¹s work on power allows Pringle the scope to focus on agency, context and change, whilst use of Bourdieu¹s concept of Œhabitus¹ allows rich description of priviledged medical identities, and analysis of the position of different women and men in relation to these, without a hint of essentialism. Thus, Foucault and Bourdieu effectively provide broad Œframeworks¹ for the book, as Pringle identifies in Chapter One. Disappointingly however, the remainder of the book does little to extend the use of these concepts, raising them only sporadically where illustrative points are made about individual specialisms. In this sense, the distinctive contribution which Bourdieu¹s work, in particular, might make to our understanding of sex, gender and medicine seems to slip away leaving us with what we know already: that cultural norms and expectations in medicine tend to fit more closely with constructions of masculinity than those of femininity.

This said, Pringle has uncovered extensive evidence to show beyond doubt that women entering the medical field are re-shaping those cultural norms and expectations (or Œthe contours of the field and the habitus it calls forth¹ (p.127)). The overwhelming achievement of Pringle¹s book is the subtlety of her analysis and the complex picture which she offers of the ways in which sex, gender, sexuality and class are intertwined across a constantly shifting medical field. This indeed renders untenable any simple analysis claiming that medicine equals patriarchy whilst maintaining the centrality of gender to any understanding of medical discourse and practice.

Susan Halford
University of Southampton

Copyright Sociological Research Online, 1998