David Sundwall Comments

I was a resident in Harvard’s Family Medicine Residency Program from 1969 through 1973. Yes, this prestigious medical school had such a program then, part of the “movement” to be more responsive to social concerns in medicine. It was established shortly after the discipline of family medicine became a new medical specialty in 1968, concurrent with the American Academy of General Practice becoming the American Academy of Family Practice. This was a relatively short-lived training program, however, and after six years or so Harvard disbanded it, choosing to focus their postgraduate training in primary care by offering residency programs in Primary Care Internal Medicine and Pediatric. Nonetheless, it was an exciting time, with a band of earnest faculty and residents committed to providing our patients with comprehensive, compassionate, coordinated care across the spectra of illness and age, focusing on preventive services.

My chief resident, Bruce Ditzien, was a good example of a young doctor committed to addressing health equity, and as I recall he was exceptionally well trained in the science of medicine as well. He was a great role model for us residents, and during a conversation I also learned that his wife was part of the nonprofit Boston Women’s Health Book Collective, a group of feminists who together created the book Our Bodies, Ourselves, first published in 1970. This was a landmark book, which the New York Times described as “America’s best-selling book on all aspects of women’s health.”

In an editorial in this issue of AJPH, Norsigian (p. 844) states that Helen Rodriguez-Trias, MD, a past president of the American Public Health Association, acknowledged the feminist perspective that women brought to women’s health issues because women considered power relations. I learned firsthand the impact of these efforts when I was in the process of providing a woman’s health exam in our Family Medicine Health Center on a young feminist college student.

As I recall, we were alone together in the exam room (it is hard to imagine we did not then customarily have chaperones when conducting pelvic exams), and when I proceeded to drape the lower half of her body with a sheet, she grabbed it away from me and shouted, “Don’t hide from me—I want to see everything you are doing. And I want to see my cervix, so get a mirror so I can.” I was stunned—embarrassed and humiliated. I thought I was being respectful of her, covering her naked body as I performed the pelvic exam, as I had been taught. But she did not see it that way, apparently feeling that my being behind the sheet prevented her being a participant in the exam. Of course I complied with her request and did the routine pelvic exam, with her full participation, and we subsequently discussed contraception options.

As awkward as this event was for me, I can honestly say it changed the way I provide care for female patients. This experience made me painfully aware of how “power relationships” between them and their providers (both male and female, I imagine) can be perceived by women as inappropriate and incorrect. I have since insisted on having a woman with me in the exam room for any examination of a woman’s genitals and offered the patient the option of being draped or not. I am confident it has improved my care for women and hopefully improved their understanding of their bodies and their own responsibilities in participating in decisions related to their health.