Evolving attitudes

The recent report by Susan P. Phillips and Karen E. Ferguson [1] on the changes that occur in students' attitudes about women as they progress through their undergraduate medical curriculum is encouraging. However, because their novel assessment tool lacks normative data it is difficult to know how the attitudes of the students compare with those of the patients they will serve and the other health care professionals with whom they will work.

The sex role ideology scale of Kalin and Tilby [2] is a validated scale that defines prescriptive beliefs about behaviour appropriate to men and women. A study involving health care professionals in Manitoba [3] showed that physicians were at least as advanced in sex role ideology as the general population they served. However, there were striking differences between members of various health professions even after such variables as age and sex were controlled for. The most feminist groups were social workers and psychologists. The least feminist were registered nurses and licensed practical nurses. [3] Physicians were somewhere in between. In related studies, psychiatrists were found to be significantly more feminist than their other medical colleagues. [4, 5]

It is important to address this ideological gap in the training of health care professionals. Many of my patients teach me that I still have far to go in breaking free from patriarchy. For other patients, collaboration in care is an unfamiliar concept, and I must educate them that such collaboration will produce better outcomes.

Christel A. Woodward's editorial [6] in the same issue suggests that the changes in medical students' attitudes reflect the changes we see in society itself. The challenge for physicians is to deal with a diversity of attitudes and beliefs among our patients and our colleagues as we work with them to ensure a relationship that promotes the greatest health gains.

S.H. McNevin, MD

Kingston, Ont.