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Im delighted to. So before we get into your book, i actually wanted to talk to you a little bit about your jouey physician. So you received your m. D. From harvard medical school. You then completed a in internal medicine at mount sinai, and youre now a medical oncologist at memorial sloan. But you received your b. A. In l history and specifically the history of science. And so i was wondering if you could talk a little about your academic interest in history sort of has shaped your medical career. Right. Well, i was really fortunate as an undergraduate, harvard, they offe this incredible concentration on this major that allowed us not to have to choose between science and humanitie an interest in medicine. But really the ability to combine the reality that we know, which is that science and medicine do not exist in a vacuum and that its inextricably linked to culture, politics, religion. And for me, i loved history. D o. I loved the context of who and why we are, the way that we are in science and biology, grounds and understanding and gives us the langua bodies work. But ive always been fascinated by understanding the lens with which weried me through this day, that learning really helped me understand the narrative aspect of medicine. And as an oncologist, so much of what i do is, yes, about the biology and the science that mutations, but perhaps even more so, the stories that patients tell me about themselves, about what makes them want to live, what helps them thrive, and how i can best help them in that journey. Yeah, its clear to me that your history, education and y medical career profoundly shaped this book that you wrote. And because its really an interwoven tapestry of meditations on how the past informs the present. And even in your introduction, if i can quote from it, you write quote, the past is a presence in every Doctors Office and every Research Institution in medical exam rooms and artemis cadaver labs, hospital hallways and operating rooms. It haunts our footsteps as we navigate the medical maze of Womens Health that was built by n whose ideas about women, while sometimes wellintentioned, were limited at best and paranoid, misogynist and abusive at worst. So can you talk a little bit more about this historic presence in medicine and how it and maybe how it motivated you toabsolutely. So in my own career, ive taken care of thousands and thousands of wame a mother myself and as a daughter, caring for women in my family, listening to the stories of women and experiencing them myself, i became these narratives of women feeling dismissed, invalidated for their pain, shamed, blamed, and also underbroad or how muche landscape of Womens Health really is. And what i understood it to be, even from my own medical training and for me trying to pack that legacy that infects us when we show up at the Doctors Office today, whether as a doctor or a patient meant for my training, really going n time to better understand how was this system built the way that it is. I know professional. You have an interest in history as well that is your career and and in my world i really think about everybody, every body that we are in and show up inas onlys to collectively understand how we can make our future better is to really understand the history of what we come from. And for me, that meant head to toe, looking at all the ways that i do think that women have been dismissed. And yes, i write about thewere. And the aim of the book is not to say, oh, there were these horrible men and all they did was terrible things. And that no one had any good motivations. Ofourse, history and human nature is far more complex than that, really more to understand the context of which our system was built and how do we reframe that develop a new and better narrative moving forward . Yeah, and i think you do a wonderful job of■that will. Well, well get into those details in a moment, because youre right, it isnt just this sort of like, you know, simple narrative of, you know, bad men doing bad things, but that, you know, as you write about it, its its a very complicated story, but i think its actually a really wonderful transition to to get in to talk about, you know, some of the book. Your book is called all in appre title because it really does capture the essence of how male physicians in general have historically approached Womens Health ce and. And i was hoping you could talk a little bit more about this, especially the notion that Womens Health comaints have historically been dismissed as even mere as as fantasies or even mental illness. Absolutely. Solutely. Well, you know, it took a while to come up with the title of of the book. But once we did all in her head, it justbecause when i say the tf my book is on her head, almost every woman has a story to tell me. Oh, oh, my gosh. When i went to the doctor, i was told this or i was dismissed that it was this thread that kind of wove its tapestry into the cultural narrative that i explore, or in terms of better understanding the history and unpacking some of the stories. One of the things that was so how much of the historical focus on Womens Health care was that we were just vessels and hormonal vessels once we discovered those hormones, you go really back in time to the greeks. You know, were all hysterical from thisde untethered and and was the nature or the basis for all our medical ills. And once we knew throughout history, we were not subject to a wandering womb, it then became our ovaries. And then, you know, once we had the discovery of hormones that we were all bathing in this hat was making us formidable crazy at the lens with which our bodies were studied was really is this atypical improv, irrational version of the reference male. And that theme is carried through throughout medicine even insidiously toh yeah. And in the book you provide example after example of sort of complicating some of these, what we might call sort of heroes of medicine. And along the lines of, you know, this idea of of dismissin. And i was particularly as someone who teaches the history of medicine, i was particularly struck by your example of the renowned physician, William Osler, and his belief that heart and heart problems were not necessarily attributed to Heart Disease. Im wondering if you could share some of that story. Yes. So, i mean, throughout my medical training, including whe ied the history of medicine, william sir William Osler, was this godlike founding father of medicine in the United States. He was this canadian whmo ultime residency system at Johns Hopkins university. As we know it today. And really the father ofo, so much of the medicine that we practice today. And when i went back in time to really understand why is it if we think about the present Heart Disease is the number one killer of women in the United States . We also are taught in medical school in many instances, certainly during my training, that the way that a woman presents with Heart Disease or a heart attack is atypical relative to the man. Lets sit with that for a second. We are greater than 50 of the population is the number one killer of women in the United States. And somehow our symptoms are not average, are not typical. Thats simply ridiculous. And it and it really highlights this how important thethe wordso describe Womens Health disease become so important. And for me, it was necessary to go back inime to understand who laid the groundwork for this. Now, of course, sir William Osler did amazing. Absolutely incredible things for medicine and had so many discoveries. But when it came to Heart Disease and going back to his original treaties and textbooks about what he wrote about womens Heart Disease, its really shocking. Case aftas case, he describes mrs. B or mrs. C because they all just got an initial bill for them as having pseudo angina or evenefers to c. Basically, our chest pain is fake or our chest pain is hysterical. There in i just read it the other day. Theres even one line in the textbook where he says, these its the number one killer of women in the United States. Then when you look at how he describes the classic man who explains, oh, this is a man whos hard working. Hes white haired with his engines running and running and running. And then he collapses with this elhai0e on his chest. And that is the classic imagery of a man having a heart attack that you expect to see in an emergency room, because thats youre taught. You see it in movies and its part of the public lore. And then what happens is when women have heart symptoms, theyre not as aware of what they might be because weve not been by doctors in the hospital. Yeah. And he makes several appearances inour book, right. So its not just about sort of Heart Disease, but also even thinking about ibs. One of the ways that i did the research for this book was to simply say what are some of these female predominant nditday out from interviewing other experts in other fields, or even from my own patients . Irritable bowel syndrome, we know, is a more female predominant disorder, as are summer gas■troitinal disorders. And i went back in time to say, well, who were the first people that coined these terms or first discussed these medical conditions . And and then its like it was an it was an an act of show. Dont tell. I just needed toown words, what they said about women. So one of the first articles by William Osler and others was called mucusand it was about, again, symptoms of irritable bowel syndrome. And what was shocking to me is so much of the article was about the psychological condi od not y trying to understand the physical biology of it. And when i thought about my own training and what are some of bi■ inherited when i even spoke to a gynecologist the other day who said to me, you know, i was afraid for my doctor to put ibs in my chart in my knew that the moment that happened, i would be seen as a difficult patient. And going back in time to what William Osler and others said about these women who were diagnosed with irritable bowel syndrome, worse, theres this whole narrative about those patients are more difficult or challenging to te care of, and no one wants to arrive at the Doctors Office with a Scarlet Letter before they even had a chance to explain what their re. Thats what this is really about. This book is unpacking the idea that before even women get to the Doctors Office, they arrive with shame. They arrive apologizing, they they arrive blaming and that just simply has to stop because were not allowing women to truly acce better care. You know, i think one of the the really great things about your book is how you weave in these past and present narratives. And, you know what youre touching on right now about, you know, looking back in time to see where mees ideas come from. I think is is it a really important perspective . And im wondering how do you think thesethink are stuck in te past . How do they filter themselves into present medical education . I think they filter themselves in so many ways. What was really heartbreaking for me and eye opening for me is its one thing to go back in stories, say, oh my god, i cant believe they said that. Okay, were going to remove womens. Itre going to remove their ovaries and all women are crazy. I mean, thats easy to say. Oh, thats terror or thats bad. You know whats even worse in some ways, how■ subtle . A subtle look into today when i thought about and looked into how ofn do we ask women about sexual side effects from cancer related medications . In my field as an oncologist, youre two times ask men about sexual side effects than we are women. And i take care of women of all ages when i really thought about that, there were many ways that we have left women behind. We have assumed that there sexual life, that the way that they choose to find joy simplyt than men or dependent on a male narrative. And that and that insidious legacy is, again so heartbreaking when you realize, even for myself as a physician, that i have to drank the koolaid. There were many instances in my practice where i made assumptionabout me and i am glae this book for myself. Its the book that i wish i had any informed better doctor, all patients. Yeah, yeah. And im glad sexuality because really a significant theme in your book is how physicians, particularly malesicians in the past linked many aspects of Womens Health to sexuality. Whether that was concerns about excessive Sexual Activity or rt of medicalized womens sexual desires. And you give numerous examples of this in your book share somef those examples . And maybe think through why do you think there was such a fixation on womens sexuality among male physicians . Yes, you know, i wasnt expecting to find this the way that i did. I i was shocked in my research at every turn, what i whether i was trying to study the original diagnoses of scullys basis, whether thinking about asthma or whether i was looking into womens skeletons in general, or the way thate exercise. At every turn, i would find some founding father of medicine linking womens sexual desire, a fear of it, or as is booming. I dont even have thejust loomid to control it, understand it, or prescribe it at a mans whim. So for to how we coached women or told women as physicians that they could exercise. Bicycling is a fascinating, fascinating example. I was really interested in the idea that why is it that so much of the history of womens exercise is about either teaching them not to or that the goal is to be thin and small and not strong . Well, at the turn of the century, we know that bicycles were a huge pastime. They were also the symbol of the Suffragist Movement and gave Women Mobility from their home. While there was another problem with them, that in that mobility, in tha freedom, there were lots of doctors that came out in famous medical journals and in the lay press to say, bad news for you. If you exercise well, your face is going to be frozen in a grimace. Youre going to develop bulky muscles. To happen . Ow what el your sexual day is going to go into overdrive. You may even become a chronic masturbator and not even be able to and i mean, how do we go from exercise to sexual function . It is just mind boggling to me. The number of times that womens sexualitheir dire is brought up as either something to be feared or something to be prescribed for hysteria, but only but only with your husband and only when he desires it. So there is this constant thread that we know throughout history and culture and politics of the need to control women and the behavior. And that is woven throughout our medical system when it comes to womens sexuality and their desire and theira libido. Yeah, i think one of the favorite examples that you provide in the book is the bicycle example. Analysis that you give is that there is the bicycle in some ways seems like its a metaphor for the for india, for womens independence. Right. You have this lovely example of like, you know, a concern about women. You know, that maybe its okay if they ride bicycles, but just not too far. Right. We dont want them to go too far. And when i was reading it, i really readexample of mens fear independence. Through this, you know, examination of sexuality. And history to my students, especially when we talk about the fear of female masturbation, my students always find it. And, you know, there is an aspect of humor there. But i do think what youre saying is correct. And i try to emphasize the real implications for womens agency with these diagnosis. And and i know this is true for the past, but how do you think these ideas have entrenched themselves into the sort of medical practice today . First of all, im so thrilled that you teach this to your students. And clearly we are cut from the same cloth. And its incredible to know that there is education going on today for the future and the future even better. I think i see in my practice in particular, so i take care of a lot of young women who we may have to thrust into chemical menopauseore of their cancer being driven in by estrogen. And so there are women in their twenties who have to suppress function and give them further medications that downregulate the amount of estrogen that they produce. And this happens just immediately overnight. Theres no gradual progression into menopause or natural progression. This is from one day to the next. Their whole world changes. And throughout my career, up until very recently, the idea that their sexual function might be important to them is complete. Lee was completely oncologists routinely addressed by any means, Even Research to understand how we might be able to supplement from a sexual nction and from a physiologic function. Some of that aspirin to prove their sexual function was really something that was ignored. Only recently have we start to really think about for that population how it might be necessary and helpful. And then when we think about , with the discovery of hormones, youd think that there would have been more attention to actually how we might be able to women feel better. But the pendulum has swung in so many different directions. And now with a huge percentage of our population, menopause. So we its as if we forgot that older women might want to have sex as well. Its its really horrific. And are still playing catch up with this dramatically. Really good moment to move a conversation to talking about it. Point in your book that i think still resonates today, and this is this sort of historical tendency to pathologize womens bodies. And i think that this is actually really evident in your very nuanced examination of Plastic Surgery. And as you correctly note, you know, the field initially focused on rehabilitate injured soldiers and but throughout the 20th century and and into today, its involved its evolved into something very different. Can bit about that . Sure. So so much of my book is about how womens medical needs are dismissed. Plastic surgeries is almost the exact opposite. So as you stated, so much of the history of Plastic Surgery originated from battle wounds and were disfiguring soldiers. And so the rise of reconstructive surgeries, along with the ability to operate on people with anesthesia, really revolutionized the field of Plastic Surgery and it also became a field where doctors, male doctors, could pathologize the way women looked. Capitalize on this idea that a womans value is based on her physical appearance and her ability to get a and that was n the world. And so whether it was the breasts orf your face or whatever, you know, beauty value that could be placed on a woman, this became something that the field really capitalized on. And lets think about it today. Theres in many ways Plastic Surgery and dermatology are these incredible fields where we beautiful things for people. And i and i honor that there is value in many for many people and in vanity and empowering them in the way that they look standards very punishing and the fields and both those fields, whether its dermatology or Plastic Surgery, maybe capitalizing on this idea of of women being valued for their beauty and their beauty alone. And so i say to women, im all for about the history of these procedures. Think about what youre considering doing, thinking about who and why you are really doing it make an informed decision about how you want to feel your best self. Yeah, and i think, you know, when we were talking at the very beginning of our conversation mentioned sort of these complicated histories. This is one area that i think is is really beautifully done in your book. You know, because i was struck by your discussion in of sort of inventing disorders to, quote unquote, cure through Plastic Surgery. As you mentioned, macrame or small breasts and also the evolution of labial plastic procedures. And yet i also think that a really important part of your discussion is not only understanding the paternalism and misogyny and the history of plastics surgery, but also, you know, recognize the complicated mo■tivations behind a womans decision to get Plastic Surgery. And, you know, in in your book, you write,write that that complx interplay between beauty and health can make the difference between a patient who is living versus merely surviving. And and this this was a really beautiful passage. And, you know, as an oncologist, i love to hear you talk a little bit more about that. Yes, i think the easy thing would be to say, oh, all these beauty standards are just punishing and to kind of go through the different physicians that, as you said, pathologize parts of womens body that, okay, now were going to call small breasts, micro mass diet. And of course, the history of breast implants was not for Breast Cancer patients and mastectomy patients are really just this idea that we could give women bigger breasts and we could make this we could capitalize on the market value of that. Of course, the history is far, far more nuanced than that. And in my field, you know, ive spoken ages, but a huge part ofw anybody feels about themselves can be this is looking back in the mirror. And for breast■ cancer treatme, although its slightly changed in recent years, so much of that affected their sense of self, whether it was the type of surgers had, like mastectomies and history of some physicians just referring to breasts as useless appendages. Why should it matter for them anyway . We kept them hair, the loss of d and sense of self. And i think when you are really ta whole patient, how women look and feel in their bodies is critical to their sense of self. You may have one woman that might say, you know what, my breasts are not as important to me. I want whats called an esthetic flap closure, where you remove the breast and you and you to treat ck dont want any implant. And you have other women who say, this is so important to my sense of self. I need that. And i think there is his strictly been a dis■missal of wl as something that we shouldnt care about in the field of oncology. Because while ive saved your life and now of course, we know that you survive is not enough, we want to survive and we want to thrive. And as i said, for many women, thatns restoring their bodies. Spirit as whole of a self as they could possibly feel. I want to make one point about that. Hair is incredibly important to some women. Others it may not be. If you look at the history of a new treatment to preserve as best as possible hair during chemotherapy, something called a cold cap where you wear almost like a swimmers cap thats very cold on the scalp. That decreases the amount of hair follicle. Hat could go for and in some chemotherapy regimens can really preserve a lot of hair. For the most part. That has historically not been covered by ins. That is something that women have had to pay thousands of dollars out of pocket. Now, clearly, fory be more impom than some men imagine. If this was a male quality of life issue, i almost am certain that this would or covered insu. Something to think about. Wow. Yeah. And i think, you about what yout mentioned about not having, you know, maybe access to things like Insurance Coverage or, you know, having to pay out of pocket thousands of dollars really leads you to one of the next things that i wanted to tais sort of thinking about where at least throughout your book. And you also have a recurring theme of, you know, the marginalization or disregard of womens voices. You know, which frequently leads to instances of things like medical coercion or even medical violence. And this is obviously particularly true for women of color and throughout your book, you discuss this historical gender, race and class and health care and how its directly led to disparities in health care, particularly for black women. So can you talk a little bit about some of the stories that you include in your book and how it sort of affects women today . Absolutely. One of the tragically hard things to read about in all of ■ myesearch was just how much misogyny went and inhand with racism. For all that im talking about, besides me in medicine and that legacy that we inherit today, it is compounded astronomically for black women in the United States, for indigenous women, its its you that play out in so many different ways. In my specialty, for example, black women are 40 more likely to die from Breast Cancer than any other ethnic race. In large part, thats not a function of the type of disease that they get because of access to care. And you see that theme throughout our current periods in the Health Care System across the board, whether its someone like serena williamsismissed for her shortness of breath and actually having a pulmonary embolism, whether its the woman going for Pain Medicine because she has sickle cell anemia and is having an acute in crisis. I paint the idea that women were meant to suffer or end and suffer more is horrifically and tragically compounded for minority women in this country. And there are so many really tragic examples of that, whether it was Birth Control pills being fermented on in puerto rican women, whether it is dr. Marion operated on on slaves over and over and over again without anesthesia to try to perfect critical surgery is that we do today that maybe have saved lives but on the backs of on the horrifically sad tragic facts of black women is something that we have to understand and reconcile in the history of medicine. They minority women are so poorly cared for in this country . Across the board . Yeah. And can you say i want to say e other point. Oh, yes. Go ahead. I was going to say one other thing about that, which is that in order to truly care for society fairly and appropriately, we diversity in our medical workforce. Depending on which field you look at, it may only be as many as 3 or percent of black women in those fields. You need to encourage and fire and have opportunity is for young women at every stage of their career to enter medicine. Because i spoke about important of women being able to look at the also really important that when women go to the doctor that they can have an experience wi a phthey may have a background h them, they may have even Better Outcomes as of that. Now, that doesnt mean that we cant have differenta taking care of each other. Of course not. But it means that there needs to be a diversity in the workforce so that everyone has a seat at decisions. Making the right what do you think are the things that are standing in the way of that happening . Like, what do we need to do . What do fellow doctors need to g field . There are so many things that we do. For me, it really became understanding history. The history of where we come from and just how much bias we have all inhit as patients and as doctors. When we show up, the Doctors Office today. I think one of the things that was so important for my medica0g mentors along the way me to make sure that we encourage mentors at every level and that we encourage young girls to go into medicine. And it is an incredible field. Its incredible way to serve a community that has been bred of little profession, joy of mine all along the way. We make space for different voices, for different looks. Day. We were talking about how many of us as women have been scrutinized in person or simply the way that we look. Again, that is compounded for minority women. And this woman had dreads. Shes in her fifties now and said that she constantly had tod why she could still be professor virginal and look professional with dreadlocks. Thats ridiculo. Abby, your patients have dreadlocks. Whats the problem with your having them as well . And ive experienced this in a different level as a woman. But again, i think its compounded for minority and we need to have a diversity of spirit, of ethnicities, of races in our workforce. Yes. Yes. And, you know, i think one of the things that your book does very well is, you know, you you get to know who you are as a doctor, as you know, as a physician, as a woman, as a wife, as a mother. In your personal stories and your professional observations and with these historical analysis. And you sort of alluded to this one thing that i really appreciated about the book is in your conclusion, you sort of confront the challenge of critiquing the very medical system that youre a part of. Right. You you acknowledge that youve seen the lasting effect of historical biases in your own medical education and and and that youve inadvertently sort of perpetuated some of these things. And and i guess, given this backdrop, how do you recognize reconcile these challenges . And as a woman and a physician and maybe more importantly, how do navigate selfcare in a sustaining way that you can continue to provide the care that youmm do. Selfcare. Such an interesting term and in a trap in so many ways. I think we find many, many women ss and looking for ways to be heard and validated in their bodies, in their pain, in their health, thei joy. And i have been a part of that myself as well. Your question really gets to both many sides of it, both as a physician and having an authentic fair about how i choose to practice care for my patients. But another part of my conclusion was being a patient myself and for all the researc, for all of this work to try to empower women. When it came to being a patient myself, i apologize for being sick and minimize my pain. And i ended up in a really bad situation as of it far worse off than i ever needed. Overwhelming me to realize that with all of my research, with all of my resources, with all of my access prey to the same things imld trying to help women with. I dont have any perfect answers. I think we have an imperfect Health Care System. But i do think that we all need a champion with us that. Sometimes when were sick, when we are anxious, need somebody by our sides to join us at a doctorsment. Say, you know what . I know youre overwhelmed. Im going to be another set of eyes and ears for you. Im going to help advocate for you. Is that doctor patient doctors there with the best intentions, maybe compressed to an only 15 or 20 minute meeting with you, not because he or she wants to be, buur system of medicine is in many ways broken. And we have to figure out how to partner with an imperfect health care but i really urge readers to take a step back and realize, chances are, your doctor entered the field because they really, really care. Under these externl forces that get in the way of that beautiful, sacred and privileged doctor patient relationship. We can still access that. Youll get to the heart of the matter, particularly if youre in a trusting relationship with your doctor. Absolutely and you know, the care that you■n show for the patients that you profile in your book is, you know, its it and you can just sense it. And as youre reading it and i guess thats sort of the motivation behind, you know, my question. And because im this, how doesd how do other physicians and, you know, handle this, you know, handle all of this trauma that you encounter, you know, day after day and, you know, know, because im particularly a historian of women physicians. I talk to a lot of women physicians. And i know that theres a high and, you know, because have this weird construct of physicians requiring especially women, can they have it all . You know, they cannot. An so, you know, just thinking through how do we how do we create a moracprofession for wos who tend to, you know, have this expectation then of providing more sympathy right typically male physicians, but then how do you sort of survive it, if that makes sense . Not only does, i thank you so much for that question. And i dont know if you saw, but i just took a huge exhale, exhale when you asked it, because there is so much there and so much thatk, i am still trying to learn myself. But you get at something really, really important throughout history, women are seen as being better listeners and having more empathy. You look at outcomes for patients. Patients overall do better when they have a female physician and weand theres this other phenomenon, an across the board. When i interview physicians at every field, even trauma specialty, even consults inteca consults that women will give that mom consults, theyll have that little extra tender care that we do so well as women. One of my real goa o this book is not to say that women are better doctors or that by simply flooding the medical system with more women that will end up in a better place. Really, to say that we are honor that feminine spirit, both men and women can have. We will have better empc, in me. And for far too long its been this narrative that doctors primarily cure and nurses, primarily women care. Theres no reason why we cant have both, because that is what everybody really wants medicine. They want the medication. But they also want to be heard. They want to be validated. They want to be seen as a whole person. Theres no reason why2 . Women tt better than men, but yet when we are asked to, we spend more time with patients. We can therefore see less patients given amount of time. Less and in turn, if were promoted based on volume or protected time to go do research, we are less likely to be promoted. Theres study after study after study that shows this, and from a personal level of course, this has been a very, very hard went into oncology, not because im some compartmentalize detached person, but because i do care. Every story that aat tells, even if i try to test myself in some measure, lives in my own body. And ive had to really learn. And ill go along the way falling many, many, many times figure out how do i nurture my own spirit . How do we separate a little bit fromt dying mother . Could be me and try to show up for my own family when i go home or even show up for myself. I dont know the answers to , empathy, the more we honor nurturing and know that to fill that bucket, its time. Its time with patients. It also means that its time by yourself outside of work, the ability to find your own joy. One of the things i asked my patients that i joy . Well, if doctors are not able to have their own joy, if theyre not sleeping, if theyre not ngout, how can they honor that n their own . Patients need to create a medical system that allows doctors to rejuvenate themselves so that they can show up as better■w empathic and nurturing physicians themselves. Yeah i think thats really important. And wh youre saying about, you know, women physicians, naturally more you know, sympathetic than male physicians and all sort of thcultural sort of learning that that women have. It reminds me much of all of the early debates about women physicians in the field ever since know Elizabeth Blackwell got her you know first woman to get the medical degree in 1840s and and you know the very welln doctors by the historian Regina Sanchez called sympathy in science. Right. Andquestion of, you know, elizah blackwell argues that women need to be physicians because theyre inherently more sympathetic. D another physician, mary putnam jacoby, she she argues that we cant make these essentialist arguments about physicians. And and then throughout your book you you bring in examples of people like Horatio Storer and Edward H Clarke who are basically like women cant be doctors because theyre too fragile and and hright. And i think this is particularly interesting to talk about, given the fact that, you know, just in the past few years, women have outnumbered men in enrollments in medical schools and and yet these disparities still exist, as you sort of outlined. How do we move . I dont know if you have an answer to this, but how do we. Yeah, do we move forward . Well, i think ive heard too many times people say, well, were getting so much better because theres more medical students who are women and, more s are entering the field. Okay, thats a great start. But how of all of those women are being promoted . How many of those women who may choose fields that involve more content of care or spending time with patients . How many of those are being valued for the type of care that theyre providing . Y institutionalized medicine is about your ability to discover a gene and not really how you care for patients . I think thats a big problem in medicine, and i frontier is really how we honor patient care and how we lose that feminine spirit thats been sidelined so long in medicine and take that back into the system and thats not a numbers game thats in affable measure of quality. And we know we cant put a number on that. Theres no percentage that we can provide for that, right . Yeah. You know, i actually want to turn back to the book for a moment because one of the things that i wanted to make sure the past you was something that i personally as a historian havent really thought a lot about. But when i read it, i was like, yes. And that is your discussion about sort of these male physicians ideas about the womens bodies and how thats impacted woment out that its oy recently that research has started to seriously examine gender in sports injuries and at one example, and i was really interested in your discussion of concussions and how the science hasnt really turned their attention women athletes or even Domestic Violence survivors and yeah, so the whole idea of a female athlete is, you know, kind of scary, right . And it was not until title nine that women were really allowed to enter sports and partake i or to the same degree as men. And throughout history, recent history, the idea that certain sports injuries were going to be more predominant in women, the science and the field has yet to up with that. When i was 14, i tore my acl and my knee. Its a ligament to my knee, which we know now is an injury that can be up to nine times more frequent in women, in soccer players, basketball players, any sport where you plant and cut. When i first had that injury, my orthopedic surgeon, famous orthopedic, said to me, well, lets see how active over the years, well, that liment incredibly important for any stability in the knee. And were still trying to figure out how we operate more women to reduce these injuries. And there are so many different injuries that female athletes can have. And the ways that we need to encourage women, for example, to strength train at a land better, how to jump better that specific to their bodies is really an area of underresearched and under aone specific example of s also we think about concussions in football players. And i think its fantastic that we want to protect the brainof ootball players with new helmets and new protect of precautions. Thats essential. But one of the things in reading b was researching my book was learning how women may suffer more consequences long term consequences from concussions, from but also this epidemic in our country of concussions and Domestic Violence patients. I had no idea about this by taking care of thousands of women, but one in every four women in the United States is theof severe physical violence at the hands of an intimate partner. So you may have a Police Officer coming, you or a doctor talking to a patient who is there for some sort of injury. And they cant fully explain their story because theyve been hit in the head and someone may asmere drunk or high or not giving a full story. Many of these women have been repeatedly in the head and suffer thats simply an an i think an epidemic in this country and one which our medical system does not adequately address. When that woman enters the titches on her head, thats not the first time we should be caring about the violence shes endured. Me that theres also this sense of getting back to the osler and womensease. You know, men and boys so much in the culture are sort of taught to learn, to look for s of, you know, heart attacks or or concussions if theyre in sports. Theres protocols. Everyones looking out for that. But it occurs to me, you know, from Heart Disease to, you know, concussions. Oftentimes, women themselves and therefore dont think about looking for these signs. Yeah, well, i think theres a long history going all the way back to even original sin. We are taught to endure, we are taught to suffer and in that we are also taught to care e ourse. And we see that in female physicians going the extra mile and feeling to be the most empathetic version of themselves and t ■wtake ce of themselves is their own mammogram. We see that in the mom suffering with incredible discomfort during just assume that the heavy bleeding is normal because all the women have had that in her family. We see the woman maybe suffering from alzheimers. Men. But who is caring for the elderly . Women in our when theyve often cared for the rest of society theres so much more that we better in that narrative, not just about looking for signs and that men have been taught more about whatbodies, but also thaty normally izing women suffering. We cant be normal. Their endurance, we cant be normalizing their ability to be a mom, to work as a doctor and also suffer. Thats just simply unacceptable. And so many levels of medical care we see that happed. Im again right. Well, who do you think is the audience for your book . Who who do you wanto reading this book . And and what do you hope they get out of it . Well, of course, i hope women of all ages read this i also hope that men read this book. I know that, you know, its being on the cover. But you can read it, too. We dont have to have that bias that this is oy for women or so. I hope that medical students, doctors read it. But what i read is we really hope is that for the woman that has wanto drive more in her bod afraid to ask her doctor just one question. Think a little■8 bit more abinhs with in her own body. And after reading these stories of other women going all the way back in time, all the way into the present, is there a difference story . Tell yourself about your body. That story. Be a little bit more empowered. Would you feel a little bit more empowered . And an illness but that for the time that we do have, we all can thrive and live our best lives right . Yeah, i agree. And i also think that for that woman that you mentioned that you hope reads this book,nice jg physicians. Right. Sort of recognizing that you, too, you know, are struggling with■b of the things that other women struggle with. And doubts, insecurities and all right. Se i got all of them packed into my history. Im working through the same things and i am right along with my patients doing the best that i absolutely. I actually also want to ask you and this might be sort of an odd question, but, youbook and yourn see the wide influence that his story ends have have on your on on your book and your work. ■yyou know, you cite historians such as Judith Levitt and deidre cooper, susan reverby, who who weom historians that have inspired your work and besides the ones that you mentioned in your book and and what books do you think other physicians or what of his story . And should other physicians be reading . I have two names for you. And i hope theyre listening. Mr. Kelly and mr. Dudley. Mr. Kelly was my Elementary School history teacher, and for my first essay exam in history on egypt. I was so nervous and he said, just tell me everything you can. And i just never stopped writing. And i never stopped reading until he took it away from me. And mr. Dudley, mhistory teachee high, hes were the most formative teachers in my life who gave me a love of learning a lo awareness that history is not just something of the past, but entirely informs and enlightened after i then in college of course, had amazing history of science professors and teachers and classmates who shared in that love with me. And yes, this book h over 800 citations. I relished in the ability to go back in time to work with different history , s undergraduates who are equally enthusiastic about this work. But when i really think about who inspired me the most, it was my childhood history gratitude r them. Starting. Starting you early on. That love for for history. Yes. So i think, you know what youre saying to me and just sort of getting back to the sort of love of history. You know, i just wanted to also add thyoim a historian and also advise and students who are premed, i think a lot of premed students think that they have to major in in a stem and, you know, in a stci, your example of majoring in history is really an example of how thats you know not necessarily the case and sometimes how history can you know better inform you as a as a physician. And im wondering if you have any thoughts on that. Absolutely. I think the humanities are a beautiful way to access what it actually your doctor and your premed will get in that organic chemistry by the way, i hardly ever use that. Maybe a little bit for fun. Youll get in the organic istry or get in all your prerequisites, but what it really means, take care of another. Not about that chemistry, not about the biology, but its about the natural tive of medicine, about the stories we tell ourselves about who we are. Its about the perience cared fr many, many people over the course of my lifetime and experienced illness myself, that the biology, thethat you could f on them. Ill take choice question or exam is lives differently in two different people the e experieny differently ending on where a person comes from, where they come from, has everything toom o with their past. In the present, not really comes from history. It comes from art that comes from all the humanities, poetry. So i thinkone premed students. Yes, do their prerequisites, but also engage in the bigger orld is when you really think about what medicine is. Its about how we all want to live better, how we want to suffer less. And that includes how we find joy, how much of how we find ho. Yeah, well said, i guess, you know, i want to know whats next for you. Eanother book . As i was reading through your book, i was thinking, you can write a whole other book about the history of like masculs heh care. Book two, maybe, oh, i love that. Well, you asked me about burnout in medicine. And one of the things that reinvigorated my love of caring for patients was the chance to breathe and think about our Health Care System and to write this book, it such a passion and joy and love of mine to be able to write this book. I be honored to write another book. Of course i have many ideas. I would involved in teaching medical students and the future and helping to shape the future of those interested in medicine. So hopefully ty ive been inspd and to really realize how sacred and privileged it is to take care of the next humanat we could do better and this book allowed me to access that passion again. And i would love to be able to write another book. Write another book, but but rest and not burn out in the meantime, i lets hope. Lets hope. Well, doctor cohen, it was such a pleasure to talk to you about this book. I feel like we could talk forever about that you have ande historical examples that you have and how it ties in to the present and especially all of the very interesting characters that make their way through the book. And my mouth dropped open a few times for some of the characters that i had. I was not familiar with. And so you know, again, thank you for writing it and i hope that everyone gets a chance to read so much and thank you for all that you do. Im inspired by your work as well tremendously so. Thankf9but we are here today and

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