Gender disparities in medicine: How popular literature mirrors society [PODCAST]

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“Coffee in hand, I decided to try and collect my thoughts. I realized that a large portion of the literature we grew up reading has in many ways tried to implant this subconscious bias that contributes to gender disparities and these ideas about women that have continued to ruminate throughout parts of society to this day. Literature in and of itself is a reflection of the times in which it is and was written. Sadly, examples of stark contrasts in comportment, demeanor, and overall health and well-being amongst men and women are nowadays ever-present and are all around us.

It is of paramount importance that we as physicians now take a step back and analyze how subconscious bias affects us in all aspects of medicine.”

Theodore Klug is a clinical research fellow.

He shares his story and discusses the KevinMD article, “Gender disparities in medicine: How popular literature mirrors 2020 society.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Here on the show we have Teddy Klug. He is a clinical research fellow, and you co-wrote the KevinMD article “Gender disparities in medicine: How popular literature mirrors 2020 society.” Teddy, welcome to the show.

Theodore Klug: Hi, thank you for having me.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Theodore Klug: My background is in English, specifically comparative literature and poetry, but I graduated from med school this past May from the University of Arkansas. With those seemingly very different components to my education, I tried to find a way to combine my English background with my interest in science. So in college, I started taking a deeper look into medicine within Charles Dickens novels, and I found that, interestingly enough, illness was more often than not associated with female, and disease was associated with male. At the time, that was not really the focus of what my thesis was, but I always kept that in the back of my mind.

After graduating from medical school and doing research this year, and with all that’s been going on in the political culture, and then currently in the news, and just with the pandemic, it came back to me that that’s something important moving forward to look at. So I dove headfirst into that topic again and really have been looking back at literature as a whole and the theme of illness and disease applying to different genders. It’s prevalent not just throughout Charles Dickens novels but throughout all of literature, and in my mind, literature a lot of times mirrors what’s happening in current-day society, and so it seems that those same themes are continuing today.

Kevin Pho: Excellent. So let’s dive into that article that you co-wrote. It’s titled “Gender disparities in medicine: How popular literature mirrors 2020 society.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you and your co-authors decided to write it?

Theodore Klug: Yes. So I co-wrote this article with Sarah Yeakel and Dr. Joshua Wiedermann from the Mayo Clinic, and unfortunately, they couldn’t be here today. But we specifically are working with a group out of Harvard called the Global Otolaryngology-Head and Neck Surgery Initiative, where we’re looking at disparities in health care across the globe, and our subgroup is specifically looking at gender disparities. So this became a time where I thought that maybe this kind of niche area could come into play, where we looked at popular American literature and how it tends to portray gender disparities in health care. We’ve also found that that tends to occur across the globe as well; it’s not just an issue within the United States.

But in the article, I just kind of dive into how, over the past year during this pandemic, I’ve really gotten back into reading. It’s something I’ve kind of gotten away from in school, but specifically, within Bleak House (that was the novel that jumped out to me the most in Charles Dickens), Esther Summerson, the female protagonist, embodies this notion of illness being more female versus disease being more male. She’s stricken with what is described as a smallpox-like illness and becomes temporarily blind, but then it comes back. With illness, I tend to think of that as more of a subjective issue, where there’s maybe something going on, but it’s not treatable; it’s transient. Versus disease, where it seems permanent, tangible; you can see it. And that oftentimes is more associated with males.

So I’ve been reading quite a bit over the pandemic, and I just started picking different books off the shelf, and it seems to be just prevalent throughout all of literature. One of the examples that I tend to look towards the most in popular literature is Harry Potter. Harry has the scar across his forehead. We can all see it, we all have read about it, it’s famous, and it’s always there. So for me, that’s disease; we see it. Versus someone like Hermione Granger or Doris Umbridge: They are both very particular. Hermione is very particular with her time, Doris Umbridge with all her various knickknacks in her office and her particulars with how students act. So a lot of times, people tend to look at those two as maybe having obsessive-compulsive disorder. It’s an issue, an illness, in a way that we know exists, but it’s kind of difficult to see, especially with how mental health care is nowadays. We’re more aware of the intricacies of it and that it is a legitimate medical issue, but in the past, maybe that was one of those things where it was like, “I don’t really know how we can treat this.”

So just from an everyday perspective, Harry Potter in many ways mirrors these same issues, and examples tend to abound. The article really is just looking into what we can do to address these gender disparities based off of what we’re seeing in literature. The issue of subconscious bias comes up as well: how we all need to realize and take a step back, that we all come in with our own biases, whether they’re conscious or not, and they affect the way that we give our advice and participate in the health care system.

Kevin Pho: Now, is there anything that we could learn specifically from classic works of literature in terms of recognizing gender disparities? I guess, in other words, are there any lessons from literature that we can use going forward?

Theodore Klug: Sure. So there have been a few authors that have addressed gender disparities in a more unique way, where they’re not only attributing illness to the female characters, but it’s to the male characters as well. So moving forward, just looking, when you’re reading, at how disease or illness is described by authors and which characters it’s attributed to, you can see whether or not those same disparities are showing up within literature.

I recently got back into The Great Gatsby, and I also hadn’t read Harper Lee’s Go Set a Watchman. In The Great Gatsby, we see Daisy described as someone that might have histrionic personality disorder, versus Tom Buchanan, who has a permanent limp from the war. So in my mind, I’m thinking, “OK, this is the same kind of gender disparity issue we’re seeing, where it’s a mental health issue attributed to a female and then more of a disease, a permanent entity, attributed to a male.”

And then in Go Set a Watchman, Jem, Scout’s brother, has passed away, and so, permanent disease. But Scout in many ways kind of defies this notion of female illness. She also is struck with a number of diseases, and moving forward, in many ways, takes the role of the primary person within Harper Lee’s novel, speaking on behalf of her father. So with the transformation from To Kill a Mockingbird to Go Set a Watchman, even though they were written out of order, it’s almost like Harper Lee decided, “OK, I’m going to kind of show that Jem is unique from Scout, and Scout is unique from Jem, but they both encompass these different realms of illness versus disease within society.”

Kevin Pho: We’re talking to Teddy Klug. He’s a clinical research fellow, and he co-wrote the KevinMD article “Gender disparities in medicine: How popular literature mirrors 2020 society.” Teddy, as an English major, that gives you a little bit of a unique background going into medical school. So now that you’ve finished, how has your English background individualized your medical education in contrast to your peers?

Theodore Klug: I’d always loved reading and writing growing up, but I was also interested in science, and those seemed to be two totally different realms, two different areas of academics. But after finishing medical school, I really felt that having an English background allowed me to connect with patients in a unique way, to put myself into their shoes and just take what I’ve read in the past and attribute it to what I’m seeing before my very eyes. It’s not the traditional route to major in English, then go to medical school, but I would recommend it to anyone. It’s really neat how, when you read a novel, it might seem far, long ago, and in the past, but then some of the same ideas and notions, like we’re discussing today, are in front of us every day we step outside our door. So it just always was a part of my medical education, taking what I’ve learned through my English degree moving forward, how to best treat and care for patients.

Kevin Pho: As a physician, I think one of the most powerful traits that they need to have is, of course, communication. Not only do they need to communicate in front of patients, but they need to be great writers as well, to share their ideas, especially on my site, if they need to. If they want to change minds, they could write editorials and op-eds in a newspaper, and unfortunately, a lot of physicians aren’t the best writers. So I guess, from your English background, what are some easy tips that you can share with my clinician audience on how they can improve not only their communication skills but their writing as well?

Theodore Klug: Definitely. So this year, with research at Thomas Jefferson, I’ve admittedly had difficulty writing scientific articles because they’re very cut-and-dry. There’s no flourishing language or flowy, whimsical tones; it’s very cut-and-dry, to the point. But I think when you decide to go forward and write more of an everyday literature article, you need to put your own personality, if possible, into the piece. It’s not just scientific journalism where you’re stating the facts. It’s OK to be your own unique person when you’re writing and to get your ideas and your personality across within the writing.

I think just moving forward, or I at least need to realize, that there are different ways of writing and getting a point across. I’ve definitely boned up on my scientific writing this year; I’ve gotten away from the flourishing language, but it’s always fun to go back and forth and to just show that we all are multifaceted, and we can all have something to contribute, both in the scientific realm and then in the more personalized English literature realm.

Kevin Pho: Are there any other lessons from works of English literature that we physicians today can learn from?

Theodore Klug: Yeah, I think, just, it’s a very prevalent issue nowadays, the idea of subconscious bias. When you pick up a novel or a poem and you read it, just take a step back and just look: What were your first impressions after reading that? Why do you think that was the case? What do you think in your upbringing, your background, caused you to think that? And then just think about it relative to how others perceive it. It’s also unique to you to go out and read the critics’ comments on a novel or a poem and just see what they’re thinking about it; then you can also take into account what their subconscious biases may be. So it’s no fault of our own. We all have subconscious biases, but I think it’s important to also reflect on why we have those and what they are, and then specifically apply that to the health care realm, treating patients moving forward.

Kevin Pho: My final question: What’s your take-home message that you want to leave with the KevinMD audience?

Theodore Klug: If you can, just pick up a book, take the time to read it, and then see how it might affect you as a clinician moving forward, if there’s anything you can glean from the author that might help you in your clinical practice, and also just reflect on the subconscious biases moving forward.

Kevin Pho: Teddy, thank you so much for sharing your time and insight, and thanks again for being on the show.

Theodore Klug: Thank you so much for having me.

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