Skip to main content
Log in

The (Gendered) Construction of Diagnosis Interpretation of Medical Signs in Women Patients

  • Published:
Theoretical Medicine and Bioethics Aims and scope Submit manuscript

Abstract

Medicine maintains a distinction between the medical symptom -- the patient's“subjective” experience and expression, and the privileged medical sign -- the “objective” findings observable by the doctor. Although the distinction is not consistently applied, it becomes clearly visible in the “undefined,” medically unexplained disorders of women patients. Potential impacts of genderized interaction on the interpretation of medical signs are addressed by re-reading the diagnostic process as a matter of social construction, where diagnosis results from human interpretation within a sociopolitical context. The discussion is illustrated by a case story and empirical evidence of the gendering in the doctor-patient relationship. The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault'sideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven. Further deconstruction of the chain of signs from a feminist perspective, assigning validity to the voice of the woman patient, might broaden the understanding of women'shealth, illness and disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  1. Foucault M. The Birth of the Clinic. An Archaeology of Medical Perception. New York: Vintage Books, 1994/73.

    Google Scholar 

  2. King LS. Medical Thinking. A Historical Preface. Princeton, New Jersey: Princeton University Press, 1982: 73–89.

    Google Scholar 

  3. Armstrong D. The patient's view. Soc Sci Med 1984; 18: 737–744.

    Google Scholar 

  4. Honkasalo, ML. Medical symptoms: A challenge for semiotic research. Semiotica 1991; 87: 251–268.

    Google Scholar 

  5. Chinen AB. Modes of understanding and mindfulness in clinical medicine. Theoretical Medicine 1988; 9: 45–71.

    Google Scholar 

  6. Albert DA, Munson R, Resnik MD. Reasoning in Medicine. An Introduction to Clinical Inference. Baltimore: The Johns Hopkins University Press, 1980.

    Google Scholar 

  7. Malterud K. Women's undefined disorders – A challenge for clinical communication. Family Practice 1994; 9: 299–303.

    Google Scholar 

  8. Code L. What Can She Know? Feminist Theory and the Construction of Knowledge. Ithaca & London: Cornell University Press, 1991.

    Google Scholar 

  9. Hoopes J, ed. Peirce on Signs. Writings on Semiotic by Charles Sanders Peirce. Chapel Hill/London: The University of North Carolina Press, 1991.

    Google Scholar 

  10. Graffy J. Patient choice in a practice with men and women general practitioners. British Journal of General Practice 1990; 40: 13–15.

    Google Scholar 

  11. Philliber SG, Jones J. Staffing a contraceptive service for adolescents: the importance of sex, race and age. Public Health Report 1992; 97: 165–169.

    Google Scholar 

  12. Brink Muinen A van der, Bakker DH de, Bensing JM. Consultations for women's health problems: factors influencing women's choice of sex of the general practitioner. British Journal of General Practice 1994; 44: 205–210.

    Google Scholar 

  13. Orzano AJ, Cody RP. Gender concordance between family practice residents and diagnoses in an ambulatory setting. Family Medicine 1995; 27: 440–443.

    Google Scholar 

  14. Pendleton D. Doctor – patient communication – a review. In: Pendleton D, Hasler J, eds. Doctor – Patient Communication. London: Academic Press Inc, 1983: 5–53.

    Google Scholar 

  15. Colameco S, Becker LA, Simpson M. Sex bias in the assessment of patient complaints. Journal of Family Practice 1983; 16: 1117–1121.

    Google Scholar 

  16. Armitage KJ, Schneiderman LJ, Bass RA. Response of physicians to medical complaints in men and women. JAMA 1979; 241: 2186–2187.

    Google Scholar 

  17. Peterson MC, Holbrook JH, von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnosis. West J Med 1992; 156: 163–165.

    Google Scholar 

  18. Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med 1991; 325: 221–225.

    Google Scholar 

  19. Kjellstrand CM. Age, sex, and race inequality in renal transplantation. Arch Intern Med 1988; 148: 1305–1309.

    Google Scholar 

  20. Safran DG, Rogers WH, Tarlov AR, McHorney CA, Ware JE JR. Gender differences in medical treatment: The case of physician-prescribed activity restrictions. Soc Sci Med 1997; 45: 711–722.

    Google Scholar 

  21. Lurie N, Slater J, McGovern P, Ekstrum J, Quam L, Margolis K. Preventive care for women. Does the sex of the physician matter? N Engl J Med 1993; 329: 478–482.

    Google Scholar 

  22. Bensing JM, van den Brink Muinen A, deBakker DH. Gender differences in practice style: a Dutch study of general practitioners. Med Care 1993; 31: 219–229.

    Google Scholar 

  23. Bouchard L, Renaud M. Female and male physicians' attitudes toward prenatal diagnosis: a Pan-Canadian survey. Soc Sci Med 1997; 44: 381–392.

    Google Scholar 

  24. Seto TB, Taira DA, Davis RB, Safran C, Phillips RS. Effect of physician gender on the prescription of estrogen replacement therapy. J Gen Intern Med 1996; 11: 197–203.

    Google Scholar 

  25. Banazak DA. Late-life depression in primary care. How well are we doing? J Gen Intern Med 1996; 11: 163–167.

    Google Scholar 

  26. Wallen J, Waitzkin H, Stoeckle JD. Physician stereotypes about female health and illness: A study of patients sex and the informative process during medical interviews. Women & Health 1979; 4: 135–146.

    Google Scholar 

  27. Hall JA, Irish JT, Roter DL, Ehrlich CM, Miller LH. Gender in medical encounters: an analysis of physician and patient communication in a primary care setting. Health Psychol 1994; 13: 384–392.

    Google Scholar 

  28. Lilleaas UB. Når forskjellen blir synlig – kvinner med kroniske muskelsmerter i et kjønnsrolleperspektiv. [Making the difference visible – women with chronic muscular pain in a gender role perspective] Arbeidsnotat 8/95 – Senter for kvinneforskning. Oslo: Universitetet i Oslo, 1995 (in Norwegian).

    Google Scholar 

  29. Johansson EE, Hamberg K, Lindgren G, Westman G. “I've been crying my way” – qualitative analysis of allmenn group of female patients' consultation experiences. Family Practice 1996; 13: 498–503.

    Google Scholar 

  30. Lupton D. Medicine as Culture. Illness, Disease and the Body in Western Societies. London/Thousand Oaks/New Dehli: Sage Publications, 1994: 131–160.

    Google Scholar 

  31. Eccleston C, deWilliams C, Rogers WS. Patients' and professionals' understandings of the causes of chronic pain: Blame, responsitility and identity protection. Soc Sci Med 1997; 45: 699–709.

    Google Scholar 

  32. Sherwin S. No Longer Patient. Feminist Ethics and Health Care. Philadelphia: Temple University Press, 1992: 145–153.

    Google Scholar 

  33. Koran LM. The reliability of clinical methods, data and judgments. N Engl J Med 1975; 293: 642–701.

    Google Scholar 

  34. Elmore JG, Wells CK, Lee CH, Howard DH, Feinstein AF. Variability in radiologists' interpretation of mammograms. N Engl J Med 1994; 331: 1493–1499.

    Google Scholar 

  35. Latour B, Woolgar S. Laboratory Life. The Construction of Scientific Facts. Princeton/ New Jersey: Princeton University Press, 1986.

    Google Scholar 

  36. Hampton JR, Harrison MJG, Mitchell JRA, Prichard JS, Seymour C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. British Medical Journal 1975; 2: 486–489.

    Google Scholar 

  37. Melbye H. Diagnosis of pneumonia in adults in general practice. Scandinavian Journal of Primary Health Care 1992; 10: 226–233.

    Google Scholar 

  38. Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG. Prevalences of endoscopic and histological findings in subjects with and without dyspepsia. British Medical Journal 1991; 302: 749–752.

    Google Scholar 

  39. Daniel, SL. The patient as text: A model of clinical hermeneutics. Theoretical Medicine 1986; 7: 195–210.

    Google Scholar 

  40. Fehr D. Kropp og symptom i en tegnteoretisk kontekst. [Body and symptom in a semiotic theoretical context]. Sosiologi i dag 1996; (4): 65–77 (in Norwegian).

    Google Scholar 

  41. Rudebeck CE. General practice and the dialogue of clinical practice. On symptoms, symptom presentations and bodily empathy. Scandinavian Journal of Primary Health Care 1991; Suppl 1: 72–81.

    Google Scholar 

  42. Scott JW. “Experience”. In: Butler J, Scott JW, eds. Feminists Theorize the Political. New York/London: Routledge, 1992: 22–40.

    Google Scholar 

  43. Hunter KM. Doctors' Stories. The Narrative Structure of Medical Knowledge. Princeton/New Jersey: Princeton University Press, 1991: 3–26.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Malterud, K. The (Gendered) Construction of Diagnosis Interpretation of Medical Signs in Women Patients. Theor Med Bioeth 20, 275–286 (1999). https://doi.org/10.1023/A:1009905523228

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1009905523228

Navigation