A Few Big Picture Examples in Medicine and at Home

The patriarchy is a hierarchical social system in which the two main groupings of power, sexual and financial, are passed down through the male sex and through which the female sex is excluded. 

At home this takes the form within differing family expectations of sons and daughters. Sons can go out on their own independently, daughters need to go with friends. Mom will clean up after sons, daughters have to clean their own rooms. Daughters are taught to put others’ needs and opinions before their own, sons are taught to believe in themselves. Sons are meant to do well in math and science, daughters in language and reading. Sons taught to be assertive, daughters taught to manage people with grace.  Sons are taught to invest in their economic agency (focusing on school, getting a job), daughters are taught to invest in their sexual agency (focusing on their relationships and appearance).

The media does not pressure boys to fit a model physique to the extent girls are expected to fit a model physique. In general as boys grow into men, they overestimate their attractiveness as their appearance does not hold as much value as financial security. This is largely due to the lower economic agency of women enforced by these social gender roles which influences women to select men in long term relationships for financial security over sexual appeal and sexual intelligence. 

The discrepancy of sexual and financial power between the male and female sex within heterosexual marriage manifests as wives having to give sex to their husbands even when they are not in the mood as he has not invested himself in a way to make her in the mood. In order to maintain her financial security and prevent her husband from having an affair, the wife will forsake her own sexual and emotional needs to secure the needs of his ego. Wives take on the majority of domestic labor once they have children which also negatively affects their sex drives and time for entertainment. In contrast husbands are not raised in society or by their families to be emotionally self aware of how their actions would affect their wives emotionally and sexually . Men’s sexual pleasure comes at the cost of women’s sexual pain or lack of pleasure due to lack of male sexual performance accountability in society. The fragility of the male ego is given priority over female sexual and emotional health and pleasure. The strength of the male ego is not tested and thus through the patriarchal structure made even more fragile. Marital rape was not even officially recognized as a human rights violation until 1993.

These more intimate sexual and financial power dynamics between men and women at the individual level influence the broader group dynamics within the hierarchical workplace of medicine. This is most prevalent in departments and institutions which are male dominated and where women have internalized the patriarchal culture of dominating and controlling others or use sexual currency for protection at work.

The patriarchy ignites upward in academic medicine through the significant social deference given to men in these positions of power. In the patriarchy, to be male is to have power and one of the perks of expressing such power is behaving with sexual impunity along with earning a lot of money. Sexual harassment is one such symptom but also bullying less powerful men in the patriarchy is part of this social power system.

The maintenance of gender roles keeps women excluded from power in that if they want their jobs protected then they need to use sexual currency or else show that they are far better performers than the men to avoid scrutiny. Many junior female residents date more senior male residents and faculty or are married to them. A father, brother or more senior male friend who is a resident are more valued political influences.

Other examples include it being OK for male doctors to leave early to play golf but it would be noted if female doctors did the same unless they went above and beyond in performance. Male doctors are seen as good dads if they have to prioritize family over work in their schedule, female doctors are seen as bad doctors if they have to prioritize family over work. Patients themselves will choose female doctors over male doctors because they believe that female doctors would have had higher expectations placed upon them in their training.

These are just a few examples, women physicians have several more.

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