What’s it about Ayushmann Khurana-starrer Dr G that’s deeply disturbing? First it makes gynaecology look like a discipline that’s a disposable choice for the brilliant, a necessity for poor scorers. Second, it classifies male gynaecologists as would-be sexual predators, with a senior asking the protagonist to lose the “male touch.” A doctor is a healer with a human touch and never has this been called into question.
I myself came into this world courtesy a male gynaecologist, that too in a complicated scenario where my mother had developed typhoid. All the women in my maternal line, be it grandmothers or aunts, have always had male gynaecologists, trusting them with their lives and more. That too at a time when gender sensitivities were not exactly top draw. In fact, such was the loyalty that often two generations would end up consulting the same gynaecologist. Yet it is true that male gynaecologists today are few and far between, particularly in the heartland, a societal mindset disqualifying their talent and looking at them through the lens of gender and cultural bias. In Delhi, none of the bigger private hospital chains prefers a male gynaecologist either. Some of the ones that do have no more than one in their staff. Dr Puneet Bedi at Indraprastha Apollo Hospitals, New Delhi, is one such consultant gynaecologist, self-admittedly surviving because of his specialised talent that has ensured a committed patient base over the years, and one that has kept expanding.
Science has no place for stereotypes
“A Bollywood movie reinforces every silly prejudice in the book about gender, medical practice and the doctor-patient relationship. Actually, if you really want to know what I have been doing as a gynaecologist, I promise you the story is very boring. What I have done and continue to do is about sleepless nights, working without food and water, long hours and about buying lifelong stress at work. It is about constantly living in fear of making a little mistake, or even an oversight of not detecting in time a possible indiscretion of nature which may compromise two people’s lives. It is not about the doctor’s gender for heaven’s sake,” says he, anguish evident in his voice.
Says Dr Rahul Manchanda, Senior Consultant and Head, Gynae Endoscopy Division, PSRI Hospital, “I think the bias comes from the way we look at women’s health as just a motherhood issue and complications associated with it. In fact, gynaecology is one of the most complete disciplines of medicine which requires multi-faceted expertise. It involves surgery, obstetrics, foetal medicine, preventive healthcare, screening and every organ that’s impacted by female hormones. Once the patient comes and has confidence in you, there is no going back. That’s another people-friendly skill, to calm down patient fears.” He also doesn’t understand the hypocrisy of approach. “You trust a male surgeon for a gallbladder, liver, kidney, heart or a cancer surgery but you wouldn’t go to a male gynaecologist for a check-up and assessment. Goes to show how much we care about preventing serious diseases among women,” Dr Manchanda says.
Dr Bedi agrees that women’s health is not considered serious enough and is relegated to being incidental to our larger health issues. “Gynaecology is hardly treated as a speciality. In fact, it is consigned to the attic of medical sciences. Even a routine surgery may have a Rs 5 lakh insurance cover but for childbirth, the insurance will be as low as Rs 50,000, barely enough to cover routine hospital expenses. Besides, a gynaecologist shares the responsibility of ensuring a healthy generation for the future. Low birth-weight babies may develop complex health conditions in later life and our job is to ensure that the baby is born resilient,” says he.
Evolution of gynaecologists in India
In fact, Dr Bedi has been studying the evolution of gynaecologists in India and has rationalised the bias that has crept in, particularly in northern parts of the country. “The colonialists set up a Western medical system. In fact, the British set up medical facilities for mostly military rather than civil purposes in the three port cities of Calcutta, Bombay and Madras as these were known then. Gynaecology was a neglected discipline in the larger scheme of things. Also, the interiors of the country, and even Delhi, were deprived of the advanced medical facilities of the port cities. So the exposure to cosmopolitanism and modern sciences was confined to these cities. That’s why you would find many gynaecologists thriving in these centres even now compared to the north. Besides, English being a major language barrier, many British doctors needed an Indian intermediary to understand their patients’ condition. And when it came to women’s health, they did rely on midwives as the go-between,” he says.
Dr Bedi also reasons how qualified women medical practitioners in Europe, unable to find positions in hospitals there, were shipped off to the colonies to serve in hospitals here. And once here, they created what they were denied, medical schools for women and hospitals peopled by them. For example, CMC Vellore was founded by Dr Ida Scudder in 1900, daughter of US medical missionaries who started training women compounders and nurses. “There was CMC Ludhiana and Lady Hardinge in Delhi. The second was founded in 1914 as the lack of a separate medical college for women made it almost impossible for Indian women to study medicine. These offered Licentiate in Medicine and Surgery (LMS) degrees, designed by the University of Glasgow for colonies. The MBBS degree came in 1946 and till the 1950s, there was no modern obstetrics in India. Consequently, gynaecology was just reduced to a primary concern of birthing babies and sending them off with the mother, a halfway house between modern medicine and traditional healing. All of this led to the currency of gynaecology as the preserve of women,” says Dr Bedi. “In fact, for a long time men continued to be trusted for caesarean section surgeries over women. So, while surgery was good enough for men, they weren’t subsequently considered worthy of routine maternal health,” he adds. Concurs Dr Manchanda, “Historically, general surgeons were male, so reverse psychology worked and gynaecology was seen as a sphere for women.”
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Dr Bedi even maps the cultural bias regarding male gynaecologists as being confined to Delhi, Uttar Pradesh, Rajasthan and Madhya Pradesh. “Even Punjab, Kashmir and Jharkhand have a fair number of male gynaecologists,” says he.
Listen without prejudice
Dr Bedi took up gynaecology not because he was just “mesmerised by the process of childbirth” but because he lost a lot of women members in his family during childbirth. “My grandfather would say that to save a woman’s life was saving a family. That’s the value we should attach to maternal care. It is a societal responsibility,” he says.
He didn’t come across any discrimination during training, which contrary to popular cinema, is a rigorous process. “It was the recruitment that mattered. For example, the number of male gynaecologists being hired in Government hospitals has been going down. Even private hospitals keep the few that exist based on their unique core competence.”
Bedi also highlights how male gynaecologists are always trained to be extra cautious and respectful so that they can get their patients’ trust. “In fact, I have seen many of my women colleagues trivialise their patient complaints or get judgmental about them, arguing they are also women and have gone through similar problems. It is a question of winning trust, not pushing the patient away,” he says.
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Dr Manchanda, whose mother has been a renowned gynaecologist herself, feels that the numbers of male gynaecologists are dwindling simply because “there aren’t many to be hired” in the first place. “Students are not signing up because of a lack of opportunities, not because they don’t want to. When we assign gender to the gynaecologist or bring in cultural and inherited biases, then understand that we are sacrificing women’s health,” he says.
