Women in general practice: muted groups in medicine

A WHILE ago, the Royal Australian College of General Practitioners’ (RACGP) Archives Committee was alerted to the fact that not enough College history had been collected regarding the history of the women of general practice and history as told by women GPs.

In 2017, for the first time, more women than men were working within general practice. There were 973 more women than men registered as GPs in March 2017, according to Medical Board figures. This is not reflected in the gendered histories of the archives of the RACGP.

Professor Chris Hogan, Professor Max Kamien and Dr Gillian Riley, along with the women on the RACGP Archives Committee, have set out to address this.

First, some background from the anthropologists. As an awareness-raising exercise on inequality, anthropologists developed the “muted groups” theory. It wasn’t originally applied to only women, as it represents the many different ways that humans can mute the voices of others:

“Muted group theory includes the question whether everyone in society has participated equally in the generation of ideas and their encoding into discourse. Have groups developed separate realities or systems of values that do not get adequate recognition in the dominant representation of our society?”

Part of the reflexive analysis of themes within interviews is to understand not only what is being said but also listening carefully, paradoxically, to what is not being said. Who remained quiet? Which questions or topics or voices were muted and why? How much of the understanding is generated by the researcher’s own filter and is there anything else being said that has not been adequately heard by the interviewer? It’s a soul-searching and complex issue well described in qualitative research, and within quantitative research, it is categorised more neatly as bias. Notably, there is no research without bias, try as we might to be rational. Rationality being a value of medicine, it is hard to reflect that we might fail within our own medical culture.

Carol Gilligan, a Harvard sociologist, suggested a few decades ago that there are different languages and priorities in ethics and the moral universe that are gendered. This led to her observations about the prioritisation of relationship over legalistic interpretations of the world for females, compared with the relative prioritisation of legalistic imperatives over relationship for males. Both rules and relationships are of course important to every gender, but it was an interesting sociological observation that gender could affect the way people interpreted the world and priorities, even down to language and values used.

Why that difference was expressed thus and its effects upon the world are interesting to ponder. Does it still exist?

Given the recent Medicare furore over coclaiming GP item numbers for mental health care – and from anecdotal evidence we see on the GPDU forum, the predominance of female GPs involved – it would seem the ethics of care is still not well prioritised in policy regarding medicine.

We could extrapolate to see that there are a myriad number of ways to experience the same thing depending on who you are and where you sit.

The trap for us all is to think that our experience of a profession or specialty is the same for each of us and that we might understand the “other” simply because we did the same thing. Undoubtedly, this applies to racial differences, sexual orientation, religious minorities and all the ways we differentiate normality even down to illness, which has been well described as yet another form of othering.

On the GPs Down Under Facebook forum we have noticed that we have a higher percentage of women within our group in membership numbers and yet our top ten contributors do not reflect this percentage. I often wonder why. We moderate the site with our gender-balanced administration team and there are professional standards set for the level and tone of conversation. There are barriers identified for women speaking up, and perhaps even the free and protected time to participate is different depending on the gender.

To that end, the Archives Committee of the RACGP and the Women in General Practice Committee are inviting women to contribute their personal narratives of practising as a GP in Australia – the challenging, the difficult, the light and breezy, as well as the dark sides if they wish. The details of data storage will be available from the Archives Committee.

It was only a few decades ago that we were called the novel “lady doctor”, and I can remember the comments through medical school of a medical education being wasted on women. The structures and practices of that time kept voices muted at risk of violating the predominant culture. This was articulated by research performed by sociologist Dr Joanne Wainer in 2005. This research, through the voices of women in medicine, illustrated the myriad hurdles that women medical practitioners faced just to express their authentic selves. When we see how the issues of mental health and longitudinal relationships are valued, even within the Medicare Benefits Schedule relative to procedural practices in medicine, it is hard to see if there has yet been progress.

Dr Gillian Riley, one of the RACGP archivists, has provided a vignette of a woman in medicine from 1908. It is time to tell her humble story. The town where she served still honours her achievements of care today.

Dr Ettie Lyons graduated with a Bachelor of Medicine from the University of Sydney in 1908. From 1910 to 1917, she served low income people of inner Sydney as Superintendent of the Sydney Medical Mission. In 1917, she moved to Taralga with her partner and nurse Rebe Wright and set up a practice there, becoming the first female doctor on the Southern Tablelands. In the annals of history, Dr Lyons was not stellar – she ran a normal general practice. She served her community for 30 years. She used her position to promote other women in practice – nearly always employing female locums, for example – and is still remembered by locals today. She was a pioneer and is worthy of recognition.

Dr Ettie Lyons espoused the high ideals we all swore at interview and fellowship oaths with which we would serve our communities. It is indeed the voice of female GPs, and we invite you as women readers to submit your story in your own words. I wish we could have heard Dr Lyons’ own words on the nature of her practice.

As the myriad of successful conversations on GPDU can demonstrate, to have a conversation with all groups exploring the different realms of experience is a wondrous thing. I also invite all women on GPDU and beyond to speak up. Medicine needs to unmute the voices of difference.

For a copy of the guide to record your GP history please contact history@racgp.org.au

Dr Karen Price is a GP in clinical practice and doing a part time PhD at Monash University. Her research is investigating the role of peer connection in Australian General Practice. She is the codeveloper and facilitator of GPs Down Under, a 6500+ member community of Australian and New Zealand GPs. She has helped develop mentor programs for both the AMA and the RACGP. Karen has presented nationally and internationally; plenary lectures; workshops on women’s medical leadership; social media; resilience, and informal learning.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.