Introduction

On 7 November 1869, thirty-nine medical students from the Women’s Medical College of Pennsylvania attended a medical lecture at Pennsylvania Hospital. The teaching session had been negotiated some months in advance and was intended to expand their clinical exposure. Instead, the visit was hijacked by a heckling mob of over 200 male medical students from two local medical schools. Over the course of an hour, the students harangued the ‘she-doctors’, spat tobacco juice on them, and after the lecture followed them and harassed them on the street. (Reference Tierney1)

The men behind the ‘jeering episode’ were roundly criticised in the press for their ungentlemanly behaviour. (Reference Blackguardism2) In a published letter, a male medical student responded that it was men who had been affronted by ‘this shameless herd of sexless beings who dishonor[ed] the garb of ladies’. The women students had forfeited the right to gentlemanly treatment by being ‘beardless neuters’, afflicted with the kind of ugliness ‘only seen in hell’. (3) Not being ladies, they were appropriate targets for the sexualised attention shown by the medical students. They were both sexless, and ripe for sexual humiliation.

There are no published accounts by the women who were targeted in the jeering episode. However, the first generation of women medical students adhered to a strict code of female demureness. As the men spat and cat-called, the women remained seated without flinching. They may have reflected on the flimsy protection provided by a ladylike demeanour.

The jeering episode is more than a moment in the history of pioneering women doctors. It laid bare the institutional fissures about sex and gender that have persisted in medicine to the present day. In varied ways, women doctors over generations have noted or contested the attention paid to their bodies, and performed a certain type of doctorly womanhood in order to minimise sexual risk and gender-based marginalisation in the profession.

Why should it matter now? In most countries, women entered the modern medical profession over a century ago. Women have moved into every medical subprofession. There would be few medical schools where medical students are not instructed by female professors and female clinicians. Yet women doctors remain anomalies in the global health workforce. In nearly two-thirds of the countries which report their health workforce statistics to the World Health Organization, more than half of all doctors are men. (4) In the hierarchies of medical subprofessions, medical research and medical academia, women continue to be clustered in more junior positions. Women in the profession continue to occupy a position of difference, defined by and in relation to male doctors.

The medical profession has been persistently troubled by the meanings and actions attributed to gender. For the male students and their professors behind the jeering episode, gender was dichotomous. There were men, and there were not-men: a category which included women and the beardless neuters who had no business trying to be doctors. Beneath their invective there seethed an unsettling concern that these new women doctors represented a challenge to the existing gender order. In this chapter we set out the case that women in medicine continue to negotiate their way through a profession that reflects and enforces masculine power. Although this chapter focuses on women, the same processes are in play against people subordinated by hegemonic masculinity – people with diverse sexualities or gender identities – and the disadvantage is further intensified for those who also hold minority ethnic or religious identities.

Hegemonic Medical Masculinity

To state the obvious: the medical profession remains a place dominated by men. Both medical education and hospitals – the pre-eminent medical workplace – are structured around what the gender theorist Raewyn Connell calls hegemonic masculinity. (Reference Connell5) Connell argued that masculinity is not a fixed attribute of any individual, nor is masculinity necessarily confined to men. (Reference Connell and Messerschmidt6) Rather, masculinities are patterns of practice through which individuals engage with the position of men in society. Individuals (men, and to a lesser extent women) move through and produce masculinity by engaging in masculine practices, working in groups or societies or institutions. These practices structure the distribution of resources and of power in the form of authority, and the production of meaning and values. (Reference Schippers7) Masculinity therefore is fundamentally relational; masculinity exists in relation to femininity.

Hegemonic masculinities may not be the most common form of masculinity practised by individuals, but they tend to be the most admired in a society, and often represent an idealised state for men. Hegemonic masculinities legitimate and perpetuate the gendered order of a society. They are supported by masculinities which interact with one another in complex ways. Complicit masculinities are those practices and systems which enable individuals to benefit from men’s social dominance while not directly themselves oppressing women. (Reference Connell5) Individuals who embody subordinate masculinities represent a subversive contrast to hegemonic masculinity – typical examples include sexual diversity in heteronormative cultures – which may nevertheless still consent to the dominance of hegemonic masculinity. (Reference Hennen8) Individuals who embody marginalised masculinities include those who belong to non-dominant racial or class groups. They too may support hegemonic masculinity through being suborned through exemplary examples (e.g. exceptional performance by a black athlete) or through controlling metaphors connecting blackness and criminality. (Reference Yang9)

The practices of hegemonic masculinity – being action-oriented, authoritative, ‘rational’ and independent of thought – were salient in the evolving profession of medicine in Europe through the eighteenth and nineteenth centuries. It took a well-funded philanthropic foundation to cement them into medical education internationally. In 1910, Abraham Flexner produced his enormously influential report on North American medical education. To correct what he saw as the inconsistent, under-regulated, unscientific training of doctors, he proposed a science-based, rational, university-led education, based on the German model of education. (Reference Flexner10–Reference Bailey11) He saw no reason for proprietary medical schools for women, and considered most of the medical schools for black students to be inadequate and unnecessary. The American Medical Association was highly supportive of his efforts to professionalise medical education by increasing barriers to entry. (Reference Bailey11) Compliance requirements resulted in the closure of all women’s medical schools, and two of the nine medical schools for black medical students. As a result, medical graduates in the USA became more homogenised and the profession of medicine was increasingly white, male and upper class. (Reference Wooster12) The actual number of graduates fell, and the proportion of women graduates in US medical schools did not rise above 6% until the 1960s. (Reference Barkin, Fuentes-Afflick, Brosco and Tuchman13)

Flexner’s rational, science-based curriculum has become the global standard. (Reference Bleakley, Brice and Bligh14) Most medical readers of this book will be familiar with the model through their own training. (Reference Weisz and Nannestad15) Even advocates of different models of education, such as the Cuban and Brazilian place-based, community-oriented medical programmes, continue to cite their respect for the Flexnerian approach. (Reference Antunes Dos Santos and MDPT16–Reference Vela-Valdés, Salas-Perea, Quintana-Galende, Pujals-Victoria, González Pérez and Díaz Hernández17) Flexner – like many of the Progressives who supported medical education reform in North America – held a strong view that society would work best if controlled by a benevolent elite. (Reference Wooster12) That benevolent elite was in his time almost entirely comprised of men in positions of power and influence. Hegemonic medical masculinity reflects both the influence of Flexnerian education and the organisational hierarchy of hospitals, both of which in turn reflect the prevailing gender order.

The markers of masculine medical hegemony can be difficult to discern. Many men and women will argue that there is no specific male privilege in medicine, that any woman with sufficient dedication can forge their own path within the profession. To illustrate oppression, Marilyn Frye (Reference Frye18) used the metaphor of the birdcage. A bird, Frye says, may not recognise the bars of the cage as interlocking mechanisms constraining their freedom; instead it sees the bars as just part of their known world. Our notion of the ideal professional doctor can function as a birdcage. We may not be able to recognise hegemonic masculinity, but still it is there. In her analysis of changing concepts of ‘the good doctor’, Whitehead (Reference Whitehead19) charts a discursive shift from character to competencies. This has had the effect of obscuring the gendering of the ideal doctor. The Flexnerian scientist-physician was a person of character – intellectual, incisive, authoritative, reasoned, upright – which matched the male ideal of the time. In the 1970s, the new discourse on competencies emerged, focused on role performance. The good doctor could be produced through a pre-determined set of values, attitudes and behaviours. Framing professionalism around competencies or entrustable professional activities encourages doctors to view the professional ideal as independent of gender.

Hegemonic medical masculinity can be seen in entry systems to medicine which privilege men. Between 1979 and 2002, the National University of Singapore capped women’s enrolment to one-third of the cohort, on the grounds that female doctors had a higher rate of attrition through their career. (Reference Tambyah20) The nine Japanese universities found in 2018 to be rigging the entrance exams in favour of male applicants advanced the same excuse: ageing woman doctors would leave to care for their husband, children or elders. (Reference Schieder21) In both these cases, attrition of women professionals was normalised as a response to their role as birthers and carers, and less capable male students were advanced at their expense. For the profession, losing capable women, skewing the profession to men, was not seen to represent a substantive problem. Structurally, men benefitted from the patriarchal dividend. (Reference Connell22)

Hegemonic medical masculinity is a global phenomenon. Even in countries where women comprise most of the medical workforce, the most prestigious positions in academia and medical organisations are held by men. In Latin America, the higher echelons of medical leadership where decisions are made about health care systems, medical education and health policy, are largely male. (Reference Knaul, Arreola-Ornelas, Essue, Nargund, Garcia and Acevedo Goméz23) Although women comprise more than 70% of the medical workforce in Russia, they are clustered in the least prestigious professions, those which bear a metaphoric relationship to mothering, such as primary care or paediatrics. (Reference Harden24) In Estonia, during the Soviet occupation, women doctors received lower salaries and received comparatively little benefit from the informal or black market economy for medical services. (Reference Barr and Boyle25)

People who embody what Connell termed complicit masculinity have key roles in supporting an institution’s masculine hegemony. Complicity requires that a group agrees to the procedures through which domination and subordination occurs. It is a ‘cautious conspiracy’ that sanctions the processes and planning that enable hegemony to occur (Reference Gómez26, p. 118).

A senior male specialist tells a homophobic joke at the expense of another male doctor, in front of two of his peers. One of them laughs at the joke and the one who doesn’t later counsels the targeted doctor not to take the joke personally. Each doctor witness in this case demonstrates complicit masculinity. The witnessing doctors have directly allied themself with power, and by joining in or discounting the meaning of the joke, reinforce the fragile status of the subordinate. In this story the complicit doctor witnesses could be either male or female. The fact that women can and do become engaged in complicit masculinity indicates the fallacy of thinking that representation of women in the career structures of medicine is sufficient of itself to overturn hegemonic masculinity.

The increase in women in medicine has given rise to a particular anxiety of masculine hegemony: that women may reduce the status of the profession. (Reference Biringer and Carroll27) In 2004, Carol Black, the president of the Royal College of Physicians in the UK, asserted in a newspaper interview that medicine, a profession which had been ‘dominated by white males’ risked losing its influence as it became dominated by women. (Reference Laurance28) In her view, women were unable to take up leadership positions because of their responsibilities to family. Black advocated gender parity in medical school entry through strategies to increase male entry. As only the second female president of the College of Physicians in its history, Black said she was able to talk about this sensitive issue ‘because no man can bring it to the fore’. As a woman in authority in a system of masculine hegemony, Black here gives a textbook example of masculine complicity, as performed by a woman.

Is there such a thing as hegemonic femininity in medicine? If hegemonic medical masculinity in practice is recognised through assertiveness, authority, and rationality, hegemonic medical femininity, as the other in this idealised relation, is recognised through submission, self-effacement and intuition. In medicine, hegemonic femininity characterised in this way is typically attributed to the nursing profession. (Reference Davies29) This is not to say that individual nurses are submissive, or that submission is a professional characteristic of nursing. Rather, the institution of medicine – particularly in hospitals – is enacted through regimes of submission manifested in the organisational practices of nurses in relation to doctors. In hospitals the most experienced nurse often needs to submit to the authority of the most inexperienced of doctors to obtain medications for patients, advocate a procedure or advance a diagnosis.

A woman doctor has little use for hegemonic medical femininity. Their challenge is to negotiate hegemonic masculinity without being harmed by it. They might do this through adopting a range of masculinities, or they might adopt what Schippers (Reference Schippers7) calls alternative masculinities and femininities. Alternative masculinities and femininities may embrace traits and practices that do not privilege a hegemonic relationship between men and women. In medicine, such a project might be demonstrated outside of the large institution or in particular medical disciplines that are emerging, or do not have an established career structure. Doctors and nurses working in the early days of the HIV epidemic recount actively seeking to develop new masculinities and femininities in medicine, often through actively countering masculine hegemony. (Reference Bayer and Oppenheimer30)

Hegemonic medical masculinity finds itself under the spotlight at present. The disclosure of sexual harassment and gender discrimination in the medical workplace has thrown light upon its troubled gender relations. In response, those in authority and those enacting complicit masculinity have sought to shore up masculine hegemony. One strategy is to exceptionalise people’s experiences of harassment. Many inquiries into sexual harassment in medicine have advanced the ‘bad egg’ argument, that the perpetrator of harassment is an outlier, rather than a predictable outcome of a system of masculine domination. Another strategy is to trivialise harassment practices. After attending a course designed to counter sexual harassment in medicine, a male anaesthetist said, ‘What’s wrong with telling a woman she looks nice in her dress?’ He had distilled the message of the course to this: he should exercise caution against women’s unaccountable sensitivities to compliments.

Performing Gender as a Woman Doctor

The Professor was respected for his dedication to teaching of students. He did not discriminate between them, and was punctilious in ensuring equality of opportunity for male and female doctors and students. No doubt the female student had expected a recommendation about textbooks to read, videos to watch. Instead, he casually recommended a beauty regime.

While Connell’s theory of hegemonic masculinities offers a productive way to understand the workings of the medical system, it skirts around gender and the daily negotiation of difference. Judith Butler (Reference Butler31; Reference Butler32) proposes that a key feature of the hierarchical relation between men and women is a naturalised gender dialectic, in which heterosexual desire assumed to be grounded in biology, is the ontological basis of gender difference. Masculinity and femininity are the product of this fundamental relation; heterosexual regard for the female is masculine and the object of masculine regard is feminine. The Professor in our example is not sexualising the student with intent. Rather he is operating within a system of relations, signs and practices in which a woman is reconstructed through heterosexual regard as the one who is seen, rather than the one who sees.

Women doctors may also embody pariah femininities. Pariah femininities are defined by Schippers as ‘the quality content of hegemonic masculinity enacted by women’, and which are apprehended not as feminine but as not-masculine (Reference Schippers7, p. 95). Pariah femininities are typically enforced in relation to masculinity, and are noted by both men and women. Epithets indicating pariah femininities in medicine may include being a demanding bitch (taking the masculine quality of authority), being uncollegiate and disrespectful (being independent), or being a cock-teaser (exhibiting sexual authority).

The ‘beardless neuters’ who were the victims of the jeering episode – and many of the pioneering women doctors – embodied a pariah femininity, defined as not-masculine but not feminine. This was even more so when they explicitly wore men’s clothes or behaved in masculine ways. The first Chinese-American woman doctor, Margaret Chung, called herself Mike at medical school and wore a man’s suit and tie. (Reference Wu33) Gertrude Stein appalled her peers at Johns Hopkins Medical School by smoking cigars, challenging professors and taking boxing classes. (Reference Bliss34) Mary Edwards Walker, a decorated military surgeon and advocate of dress reform, seems to have posed a lifelong challenge to traditional binary categories of gender. Early in her professional life she wore the dress reformer’s garb of bloomers and simple skirt. Later in life she wore men’s clothes, claiming to do so for the freedom they offered. ‘I don’t wear men’s clothes, I wear my own clothes’, she magisterially explained to the police arresting her on the made-up charge of illegal cross-dressing. (Reference Fischer35)

These women were explicitly engaged in performance. All people perform gender. Butler points out that gender is materialised through regulatory conventions and norms, which are ‘forcibly reiterated’ though our institutions (Reference Butler32, p. 2), and realised through performance. A doctor performs their gender (usually one of a binary) in relation to normative obligations and expectations within systems and relations of power. (Reference Butler36) A doctor’s gender is imputed to them through their performance of it.

Medicine is a highly performative discipline, and doctors are conscious actors. They are taught to take a consultation in a structured fashion, using a patterned flow of conversation gambits to elicit the information they need to diagnose and treat. They learn how to approach a person, and how to initiate the intrusion of an examination of another person’s body. They learn communication strategies which help them to ingratiate, to placate, to demonstrate empathy, and to engage in difficult discussions. Patients often distinguish a good doctor from a bad doctor on the basis of this performance. (Reference Grundnig, Steiner-Hofbauer, Katz and Holzinger37)

The Professor’s advice to the medical student to wear lipstick is really advice about how to perform her gender in an acceptable manner. The student may be concerned that she is being asked to perform femininity in a way that inevitably positions her as subordinate to masculinity. She may consider if refusal to wear lipstick may be regarded as an act of pariah femininity. She may toss up attempting to engage in hegemonic masculinity. In all of these she will be negotiating her embodiment in the act of performance.

The Body of a Woman Doctor

How does a woman doctor negotiate her own embodiment? In her famous conjecture, Simone de Beauvoir proposed that one is not born, but becomes a woman. (Reference De Beauvoir38) Taking this insight further, Monique Wittig (Reference Wittig39) argued that a person’s sexual characteristics also inform a presumed social destiny. For Wittig, gender is a category made malleable by the biological category of sex, reflected in cultural ideals of the ‘inner essence’ of woman. Rather than becoming a woman, a woman is obliged to perfect their womanhood according to social apprehensions of what sex entails.

In medicine, the clinical eye often constructs the female body as vulnerable, obscure and governable in ways that men’s bodies are not. (Reference Schildrick40) De Beauvoir observes that as a girl matures she faces an increasingly hostile and threatening society; her maturing body becomes a source of shame or the subject of threats from others. (Reference De Beauvoir38) Like any woman, the female medical student is aware of her self as seen by others. In becoming a woman doctor the female medical student learns to distance herself from her embodiment. All doctors do this to some degree. We can trace some of this broadly back to the socialisation of doctors. The student schools themself to develop a ‘clinical eye’ through the study of the scientific elements of the body – disintegrated, depersonalised, and subject to their gaze. If we participate in the fiction that we have no body, the physical intimacies of medicine – touching the bodies of others, viewing and learning about the body in group settings with other adults – become abstracted and less overwhelming.

Adopting the clinical gaze may be experienced as a relief by young women. Nawal El Sadaawi entered medical school in Egypt at the behest of her parents in the 1950s. In Memoirs of a Woman Doctor, the fictionalised account of her medical training at Cairo University (Reference El Sadaawi and Cobham41), she writes of stepping outside of her gender as she enters medical school:

For Nawal El Sadaawi, this is a moment of liberation. She provides a compelling account in The Hidden Face of Eve (Reference El Sadaawi42) of the fraught journey of young Egyptian women to womanhood in a culture where girl’s bodies are a source of shame and a site of assault. Carrying out a death sentence on her body was both a professional act but also a source of relief.

For many women doctors, their own disembodiment is the essence of professionalism: the ideal state of becoming Dr No-Body. At the same time, a woman cannot really eschew her physicality: she is always to others a person in a woman’s body. Women’s bodies are constantly presented as a problem in a way that men’s bodies are not. The dress code for women medical students entering the University of Queensland/Oschner Louisiana medical programme is ‘a professional proper fitting blouse with slacks or skirt (avoid excessively low-cut necklines or revealing clothing)’. Male students are advised to wear ‘a proper fitting dress shirt and tie with appropriate trousers (no jeans or shorts)’. Women’s bodies need to be desexualised to be professional. Men just have to cover their knees.

To illustrate the impossibility of the ideal of Dr No-Body, consider the case of pregnancy. The physical fact of pregnancy is an assertion of the body. The pregnant body becomes large, unwieldy. The person’s centre of balance changes. They may no longer be able to walk or stand as easily. Nevertheless, most pregnant doctors and medical students strive to function as if they were not pregnant. They do not seek special consideration – nor is it likely to be granted. University policies around pregnancy frequent state no specific leeway is to be provided to the student, unless they have medical complications, such as hyperemesis. The woman is obliged to struggle against the fact of her pregnant body to continue functioning as a professional, and be perceived as such.

Sexualised discomforting of women in medicine has been described since women walked into the medical classroom. Sophia Jex-Blake, one of the first women to receive a medical education in Great Britain, described male students from the University of Edinburgh shouting anatomical epithets at her in the street. (Reference Knox43) She understood their meaning, even if the police did not. In the USA, Emily Barringer, the first woman doctor to hold a hospital surgical training appointment, was the subject of sustained harassment by her fellow residents. Over the dinner table they discussed rape cases in gynaecological detail, pointedly enjoying her discomfort. (Reference Barringer44)

Flexner viewed the co-educational Johns Hopkins Medical School, opened in 1893, as the ideal for his new model of medical training. (Reference Flexner10) Women students commended the respectful demeanour of their fellow male students. (45) That respect didn’t continue into the men’s private conversations. The female cohort of one year were referred to as Battle Ax, Buffalo Bill, Strawberry Blonde and Karyokinesis. (Reference Bliss34) All of these can be read as sexualised epithets: two highlight the women’s perceived lack of sexual attractiveness, and two involve sexualised appreciation. A celebrated textbook on the relatively new concept of karyokinesis had just been produced by two Johns Hopkins graduates, using – for the first time – photographs of the fertilised ovum. (Reference Maienschein46) The Johns Hopkins students who gave their colleague a name associated with sexual fertilisation were employing the same tactic of demeaning a woman in coded scientific language as the Edinburgh students who shouted rima pudenda at Sophia Jex-Blake.

Although the proportion of women in medical schools has increased, students and young doctors continue to report the practice of clinicians engaging in generalised sexualised banter. This is often accepted by young female doctors as just part of the general ambience. Their role is to not pay attention, to let it fall off their backs. In a study of sexual harassment in five US medical schools, Wear, Aultman and Borges (Reference Wear, Aultman and Borges47) report one student commenting on a degrading comment made by male doctors in an obstetrics and gynaecology term. They had expressed collective shock that a patient they thought was too fat and unattractive to be sexually active was pregnant. As it was ‘not in reference to me’ the student was unbothered by the comment. In becoming a woman doctor, the young woman learns to step outside her body while at the same time recognising that within the profession her body is considered degradable and shameful.

The situation is even more challenging for those existing in a matrix of oppression, as explored by Patricia Hill Collins in her treatment of intersectionality. (Reference Collins48) Virginia Alexander, a black medical student in the 1920s, repeatedly complained of a professor who pointedly told ‘every discreditable, dirty and insulting story he could think of’ about black people in classes attended by black women students. When the women complained to the Dean, they were advised to rise above their race (Reference Du Bois49, p. 33) – in fact, this was an injunction to set aside their race and their gender. In the USA, reports of widespread harassment in medicine directed towards women of colour, compared to men, women, and men of colour, were extensively documented in the National Academies of Science Education and Medicine consensus study. (50) The same intersectional disadvantage is also reported by queer women. In a large survey of US surgical residents, LGBTQI+ women were found to have higher rates of sexual harassment than non-LGBTI+ men and women, and LGBTI+ men. (Reference Heiderscheit, Schlick, Ellis, Cheung, Irizarry, Amortegui, Eng, Sosa, Hoyt, Buyske, Nasca, Bilimoria and Hu51)

In highly patriarchal cultures, becoming a woman doctor involves navigating public spaces where sexual harassment is normalised – as in the case of ‘eve teasing’ in South Asia. In order to practise, women doctors in Pakistan need to find ways to commute safely from home to work sites independently. Failure to find ways to navigate the sexualised public space can result in women giving up their careers. In these circumstances, learning to drive offers a way to create a safe space around their bodies in the public space between home and work. (Reference Masood52) The risk of harassment does not stop at the door of the hospital, however. In an article on everyday harassment of female workers within Pakistan’s hospitals, a doctor in her early thirties described how she had lost her perspective on it as abnormal:

The doctors recount running a gauntlet of staff casually leering as they walk in the open spaces between wards in hospitals, targets of sexualised innuendo while trying to keep themselves aloof through the portrayal of a professional stoic demeanour: a contemporary echo of the thirty-nine women in the jeering episode of 1869.

Conclusions: Gender and Sexual Risk

Masculine and medical hegemonies arise from two systems of structuring of power relations which mutually reinforce one another. The problem for women doctors under masculine medical hegemony is the one-two punch of being obliged to be complicit within the hegemony, while remaining vulnerable to personal sexualisation within it. As a result, women doctors face a heightened risk of sexual harassment and abuse in the workplace.

Masculine medical hegemony is unavoidably sexually inflected. If stepping outside their bodies is a marker of the woman doctor’s professional self, they may become inured to language and practices which in another workplace might be recognised as subtle grooming, as in the following example of a senior surgeon in a US hospital who habitually made explicit sexual remarks to medical students:

The senior doctor in question was later formally accused of sexual harassment. Behind every doctor who engages in public sexual discomfiture and private sexual harassment are a lot of people who have been complicit in supporting masculine hegemony – from the people who repeatedly employ him as a lecturer knowing his language, to the other staff who make light of his behaviour, to the people who advise female students not to be alone with him.

When a doctor is harassed or assaulted by a fellow doctor, she may be taken by surprise. No matter how much she has blown off a comment, she finds that she is in fact reducible to a sexual object by one or many doctors. Some may freeze in the moment of assault, particularly if it occurs in the presence of patients. Some may not have discerned grooming behaviours, especially if they are couched around acts of professional benevolence, such as offering extra training or special opportunities. Most will experience a fundamental loss of faith in the professional contract they believed they held with their peers. Many may lose confidence in their performance of gender. ‘What message was I sending?’ a woman doctor asks, a question which individuates hegemony and locates the blame in the wrong place.

Medical hegemony and masculine hegemony are not inevitable. The realisation and countering of masculine hegemony requires conscious focus and awareness of its existence and the ways in which it is propagated (Reference Connell54). To use Frye’s metaphor, the bird should study its cage. It is possible that the realisation that sexual risk is endemic in its profession may be a realigning moment for masculine hegemony in medicine. It is possible that alternative masculinities and femininities may emerge in medicine and be imbricated through its authority structures. What would a medicine that is not structured around masculine hegemony look like? We might imagine that it would have a more flexible, more open approach to career development, and that women and men would be equally represented across subdisciplines and in positions of authority. We could imagine that this would mean more openness to people who faced intersecting marginalised positions, including people from minority ethnic positions and people who did not come from backgrounds of wealth and privilege.

At the same time, medical hegemony may be facing its own reckoning, with the devolution of medical knowledge and technological capability to patients afforded by technology. If a person can manage their own medical needs with little medical oversight, then there may be a decreasing role for the professional hegemony. We might imagine a less hegemonic medicine would be evidenced in a more patient-led medical practice, sharing more of its practices with other disciplines. But we should be wary. The profession is likely to resist any moves that may be interpreted as counterhegemonic. Medicine is a global project, and masculine medical hegemonies are emerging in many post-colonial contexts. Somewhere, everywhere, a doctor is learning to perform their gender. Somewhere, everywhere, a person is becoming a woman doctor. They have just begun the project of negotiating medical masculinities.