Culture and Social Construction

September 12, 2008
Posted by Jay Livingston

When it comes to gynecological exams, all I know is what I read in the papers – mostly, Joan Emerson’s classic 1970 article, “Behavior in Private Places, Sustaining Definitions of Reality in the Gynecological Examination.” The problem for the participants in the exam (patient, doctor, nurse, staff) is to maintain the definition that this is not a sexual situation but a medical one. Given the nudity, the touching and talk of sexual areas, it takes some work to create and sustain that definition.

Some routine practices simultaneously acknowledge the medical definition and qualify it by making special provision for the pelvic area. For instance, rituals of respect express dignity for the patient. The patient’s body is draped so as to expose only that part which is to receive the technical attention of the doctor. The presence of a nurse acting as “chaperone” cancels any residual suggestiveness of male and female alone in a room.

Maybe here. But in France, that’s not how it happens. Meg, a Kansas girl who wound up in Paris (was a tornado involved?) and blogging as La Blaguer à Paris*, writes about it with only sight exaggeration.

Here’s what to expect when you go for ze Exam:
Doc - Mme Blagueur? [offers ungloved warm hand] Please follow me.
You - Bonjour! [sits in chair at office desk] I am here for my annual poke.
Doc - Congratulations. Now take your clothes off [indicates table and returns to typing]. You - What here? Yes? Erm... [stands, removes everything south of waist, drapes clothes hastily over office chair while hiding bits behind computer monitor].
Doc - The top, too. You - Even the bra?!!
Doc - Your bra cannot save you, American.
You - I see . . .
Doc - Let’s begin. Do you mind if I smoke?

The error of cultural expectations goes both ways. Meg tells of a French woman going for an exam in Chicago. The nurse handed her what might have been a folded paper towel but which any American patient would immediately recognize as a “gown.”

The young American doctor, when he returned after a suitable interval, found a very hot French woman sitting buck naked on the table, a paper gown in her hand.

What really struck me in Meg’s story was the bottom line. When the exam is over,

there will be a quick exchange of insurance cards or, if you’re paying in cash, 28€.

That’s about $40. If you pay in cash. Otherwise it’s just the insurance card. And if you do pay cash, you then dip your card into a little machine at the doctor’s office, and the system immediately reimburses your bank account the government’s share (i.e., most) of the payment.** We Americans should be thankful that we have HMOs and insurance companies and that our medical system hasn’t been contaminated by European ideas like socialized medicine with its elaborate and inefficient bureaucracy.

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*It’s a trans-language pun. In French, to blaguer is to kid around, not to blog (though I often wonder with this blog, who do I think I’m kidding?)

** Commenters on Meg's blog put the cost closer to 80-100€, with about half that reimbursed.