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What Twitter Gynaec doesn’t understand

Medical textbooks, classrooms, unofficial convention—in India, it’s all set up for women to suffer, says this writer

Research indicates that doctors underestimate the pain of women patients.
Research indicates that doctors underestimate the pain of women patients. (iStockphoto)

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This week a gynaecologist took to Twitter to announce her annoyance with patients complaining about being asked whether they are married. She wrote, “All these lovely ‘woke’ women tweeting about being offended by the question, ‘are you married’, asked by their ObGyn, let me tell you something as a doctor. Martial (sic) status is imperative in the diagnosis and treatment of a patient, especially in OBG.” Then in a thread short on illumination and long on smugness, she proceeded to not explain why it was “imperative” to address the imaginary patients as “darling” and accused them of “rebelling to look cool”.

Several doctors and other gleeful participants in the Twitter thread were fixated on the idea that “woke women were offended” by the question of whether they were married or not. Now you might wonder if there has been an avalanche of Indian women complaining about their gynaecologists asking whether they are married.

In 2013, a young writer, Zenisha Gonsalves, reported a story for The Ladies Finger, the website I co-founded. A particular angle in it—unmarried women complaining that doctors’ shorthand, asking whether you are married, doesn’t get them accurate medical treatment. For instance, a vaginal cyst may go undetected because the doctor doesn’t recommend a trans-vaginal ultrasound because the patient is unmarried. Because preserving her un-trespassed vagina is more important than checking if she has a potentially dangerous growth. Gonsalves’ story resonated so much that within days a small group of young people had seeded a marvellous crowd-sourced list of “non-judgemental gynaecologists” across dozens of Indian cities and towns.

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Because it was not about one question. It was about how gynaecologists compromise our health and medical treatment in favour of making sure our bodies remain in service of society. What if you are queer, what if you have no intentions of ever having children, what if you are a single mother, the possibilities are endless. It was a story that every single woman I have ever met would have wanted written.

In reporting both on gynaecologists in an everyday context and what medical students are taught about examining victims of sexual violence, we found out that the process is stacked against women. Anyone invested in the social dimensions of medical research and practice knows it is highly gendered. Medical research is only just beginning to acknowledge that women have different symptoms for the same illnesses (even heart attacks). Men and women need different dosages for the same medicines. We now have research indicating that the pain of women patients is underestimated by doctors and nurses around the world. (Pro tip. If you are a woman, it is good practice—unless you know your doctor well—to overstate your pain to be taken seriously.)

The bloodlust on that Twitter thread was indicative of how quickly “keeping it real” goes to “let’s give these women a good slap or two”. A good slap or two is the national solution for any woman doing more than breathing quietly. Back in the early 2000s, I knew how to say, “Crying now? I bet you didn’t cry like this when you were spreading your legs,” in four languages, having heard reports of maternity ward violence at every “water-cooler” conversation among women activists. Sohini Chattopadhyay’s reportage on this labour room violence (a quote from her 2015 Scroll story: “The young doctor doesn’t remember the first time he slapped someone in the labour room. Everyone slaps patients, all his MBBS classmates did and the postgraduate students do, too. It is almost a rite of passage.”) The short version of her 2018 story about organ donation in The Hindu: In India, women are organ donors, men are organ recipients. Both stories tell you the same thing: Women’s bodies and their pain do not count.

Medical textbooks, classrooms, unofficial convention—in India, it’s all set up for women to suffer. It is not accidental. It is assumed that for a woman to not suffer pain is a luxury she should never long for. And never more than when your reproductive/sexual organs are a factor. A psychiatrist friend in Bengaluru once told me more than one of his gynaecologist peers had confided that they tried not to be gentle just in case the patient enjoyed being touched. You know, if the speculum or the gloved fingers of a strange man or woman turned you into the moaning, eyes-closed girl in the condom ad.

The Twitter gynaecologist’s thread had its supporters—mostly male doctors and men. Unsurprising, because she was mocking relatively privileged women. Calling her imaginary interlocutor “darling”, like a 1980s villain, was a dead giveaway. One of the oldest tricks to keep women’s demands suppressed is to frame it as the demand of an elite darling. Twitter Gynaec and other such people like to signal: I am not serving you, fancy person, because I am serving the poor and deserving. Real women are focused on real things. Real women are strong. They have babies in the field and then go back to work and are not oversensitive to the questions of busy doctors. You know that this is a con: If anyone cared about real women, India would not have such a shocking maternal mortality ratio (103 per 100,000 per live births, in 2017-19).

If Twitter Gynaec had explored the actual difficulties of taking medical histories when patients come with a range of inhibitions, conventions, anxieties, a range of histories, that would have been an important conversation. But it would have been a matter of interest only for doctors who do take the trouble of taking medical histories.

Here are two highlights from Jishnu Das and Jeff Hammer’s study on doctor-patient interactions in India, a study quoted extensively in Abhijit Banerjee and Esther Duflo’s Poor Economics. The median interaction between patient and doctor lasts three minutes in the private sector and two in the public sector. The number of questions a doctor asks a patient? Three. Of course, when “have a baby and this problem will be sorted” or “stop eating ‘non-veg’ and you won’t have these issues” continue to be deemed expert recommendations, there is no need for medical histories.

The one time I nodded in agreement during that long and theatrical thread was when Twitter Gynaec said, “And for those of you who think we are judgemental… well, with 100s of patients lined up outside the OPD, we are barely aware of our own sex lives, forget yours!” Even a broken clock is right twice a day.

Nisha Susan is the editor of the webzine The Ladies Finger and author of The Women Who Forgot To Invent Facebook And Other Stories.

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