Gendered Literacies: A Qualitative Study of Literacy Practices in an All Female OB/GYN Clinic

Introduction

Interaction Between Gendered Literacy Practices and Gender

There is no definite meaning of the word literacy because every Discourse¹ and its associated members practice their own type of literacy. For example, doctors can be seen as literate by the way they perform field specific tasks around the hospital such as reading charts, diagnosing patients, and using a specific lexis to communicate with their peers. If a doctor, however, tried to become financial advisor, they might have a hard time adjusting to the values, beliefs, language, and practices required to gain membership in the financial advising Discourse. The approach we take in understanding literacy practices in our professional Discourses reflects how we perform, critique, and reshape those practices. For instance, suppose a medical student observes their attending (i.e. medical supervisor) who is giving a medical update to a patient's family. The medical student notices the tone of voice, the content of the message, the body language, and the facial expressions of their attending. How the student interprets these practices will determine whether they will become successful in interacting with future patients in similar situations.

"Literacy practices are shaped by socially constructed rules or ideologies that regulate the order of who should and who should not perform these practices."

While shadowing doctors and observing literacy practices at an OB/GYN clinic, I became interested in the language, communication style, and professional performativity² of female OB/GYN physicians. Since the doctors who were interviewed and observed asked to remain anonymous, I will refer to them by pseudonyms. According to James Gee, Discourses use language with particular ways of being, doing, behaving, valuing, and thinking that categorize individuals as full members of a particular Discourse (Gee, 1989). Gendered Discourses then become a way of identifying how gender performances shed light on the gendered identities those members portray. Building from the previous work of sociologists Candice West and Don H. Zimmerman on how gender is accomplished, I focused on how these female doctors performed gendered practices through speech utterances, attitudes, behaviors, gestures, and personas to determine whether their literacy fit into a stereotypical gender norm to establish a gendered Discourse.

Along with that, I also observed how female doctors performed gendered practices that perturb the gender norm by establishing masculinity in their expected feminine persona to maintain authority in their gendered Discourse. Although much research has been done to conceptualize gender and gender performativity, there has not been much discussion about gender performance as a possible literacy practice that integrates ideologies with language use. Gender, like literacy practices, is greatly influenced by ideologies and is expressed through performativity in language and paralanguage usage.

Literary Review: Discourse and Gendered Literacy Practices

Language is not just how a person speaks, but it is also who that person is in a specific context and what they do when they speak (Gee, 1989). When using language, the speaker's social role must be considered in order to communicate with others and display the appropriate beliefs and values that complement the constructed persona. Dr. Gee refines the idea of Discourse by making note of primary and secondary Discourses. Primary Discourse can be seen as the blueprint of a group's core identity, which is realized simply by being a member of a kin group. Secondary Discourse, on the other hand, includes any of the kin group's institutions in which permission to become a member is given by members, masters or apprentices, of that Discourse. If we successfully become full members of a secondary Discourse, we gain access to the institution's privileges which can include money, recognition, and prestige (p. 458). Becoming a full participant of a Discourse can be challenging, since it involves the process of enculturation, which focuses on social practices and the interaction between the apprentice and the novice. In other words, these apprentices can be seen as gatekeepers that control how a novice learns a certain practice.

Gee (1989) notes that because we have already developed a core identity through our primary Discourse, we can never become full participants of a secondary Discourse because often we see conflict between the two. However, it is important to acknowledge that this conflict plays a key part in making changes to that particular secondary Discourse. Gee describes this conflict as a type of liberation or power because by comparing our primary and secondary Discourses we engage in a critical thinking process that requires us to analyze the bits that make up a Discourse. It is, in fact, this kind of higher-order thinking, which Gee terms metacognition, that enhances the awareness of novices to recognize literacy practices and also what it takes to learn (p. 489). Metacognition is a catalyst that triggers novices and members to constantly analyze the bits that define a Discourse. By continually comparing and critiquing these bits, novices and members become aware of the conflicts that are found within a Discourse. Being aware of various conflicts within a Discourse grants an advantage to novices, which allows them to become fully active participants who contribute to the evolution of literacy³ within that specific Discourse.

"In Gender Doing, West and Zimmerman define gender not simply as a fixed trait or biological feature but an accomplishment achieved through performance by the gender doer in social interactions."

Like Discourses, gender is a social construct as well. More specifically, gender is not a default way of being; instead, it is a social invention reproduced by subjects through the process of internalizing a gender identity that reflects the norm. The understanding of gender has progressed over time due to contributions made by various linguists, sociologists, and gender theorists (Eckert and Mcconnell-Ginet, 2003; Garfinkel, 1967; West & Zimmerman, 1987). For this case study, I used the works of sociologists Candace West and Don H. Zimmerman on redefining gender. In Gender Doing, West and Zimmerman (1987) define gender not simply as a fixed trait or biological feature but an accomplishment achieved through performance by the gender doer in social interactions (p. 126). One may advance their understanding of gender by analyzing how it affects one's social interactions and how certain social interactions affect their gender performances, which include identities, behaviors, attitudes, and speech utterances.

Gender construction begins as early as birth after which we assign the title of male or female to a newborn; however, with that title, we also begin to assume the kind of gendered performances that are expected from the baby as he or she grows up. For example, we stereotypically assume male children will grow up loving violent sports, swagger the streets, and talk in a deep and confident voice. (Eckert & McConnell-Ginet, 2003). By predicting these gendered performances based on sex categories, we begin to construct a gender binary within our society that defines male as being masculine and female as being feminine. Understanding this binary, one can observe gender as an ideology embedded in almost every institution in the social sphere. This ideology then forces us to negotiate our core identities, values, and beliefs for us to fit into various Discourses. In other words, people are required to act a certain way that conforms to the gender phenomenon. This conformity suggests that gender is a key element in social relations which means that we cannot help but conform to gender to make our actions legible, which can not only lead to social reproduction, but also contention with the gender norm. Resistance to the manipulation of the gender norm may come from an individual attempting to establish a new gender performance, which most times can be seen as abnormal in specific ideology-linked communities, which can affect the relationships we have with society.

The Determination of Literacy Practices Through Ideology

As mentioned before, gender-doing can be seen as a social practice. Brian Street, a sociolinguist and one of the founding fathers of New Literacy Studies (NLS), originally proposed the term social practice to be an integral part of the meaning of literacy (Street, 1984). Opposing previous theorists like Jack Goody, Street introduced the ideological model of studying literacy, which suggests that literacy practices are heavily loaded with ideologies that promote the propagation of assumptions that link literacy to various cultural and social contexts. Street's ideological model is significant because it introduces what James Gee calls the "social turn" of literacy (Gee, 1996). According to Street's model, to understand the essence of literacy, one must analyze how ideologies affect literacy practices and how they affect the process of understanding and acquiring those practices.

Gender ideologies evolve in our communities, and as we adopt those changes, we develop a new way of performing gender (e.g. a new way of being a girl or a boy). In other words, creating and learning a new way of doing gender or learning gendered practices can be seen as a metacognitive process, according to Gene. Although an ideology, gender can also be considered as a type of literacy or Discourse. It is a social construct that is constantly produced, reproduced, and even challenged by members' practices. To analyze how social and ideological complexities influence gendered practices and how gender practices contribute to the social reproduction of the gender norm, Gee's concepts of literacy, Discourse, and metacognition are used along with West and Zimmerman's gender-doing to redefine gender as a type of literacy practice. The question is also raised on how those practices can be mastered by a novice. Since these three theorists suggest that social doings help one recognize certain practices, identities, lexis, and attitude or behaviors of members of a particular Discourse, I focused on analyzing the situated interactions and behaviors of female professionals in the field of OB/GYN.

Materials and Methods

First, my observations were grounded in the stereotypical gender ideology that depicts women as being powerless in the workplace due to their dependent and emotional seeking personality, and men as powerful due to their aggressive and confident personality and language use (Jenkins, 2008). I examined each professional, especially while they engaged in various practices in the contexts of their professional field, to observe how cultural ideologies influence the language, attitude, and personas of these workers. In other words, how do cultural ideologies on gender construct the identity and the gendered practices of these female OB/GYNs, and, also, how do these invoked gendered practices reproduce, maintain, and sometimes even contest the identity allocated by the gender norm within this gendered Discourse?

Data were collected from an interview with a female OB/GYN physician, and observations which focused on the relationship among physicians, patients, and other professionals in the field. Since my main sources did not wish to be referenced using their actual names, I will identify them using pseudonyms relating to the terminology used in obstetrics and gynecology.

At the OB/GYN clinic, I interviewed Dr. Michelle Curry,⁴ who graduated with honors from the Kansas City University of Medicine. Dr. Curry currently works at a major hospital in Michigan, where she also practices minimally invasive surgical technique. The interview with Dr. Curry was conducted on February 12, 2013 at 4:30 p.m. in her office, which is located inside the clinic. Before meeting with Dr. Curry, I had previously written down a few key questions related to my intervention for the study. During the interview, I used the questions as a guide, and wrote down key words and phrases that were mentioned by Dr. Curry. Using the jotted notes in my notebook, I wrote detailed field notes as soon as the interview ended.

In order to analyze how gender-doings differ in various interactions, I decided to divide my observation into two parts. The first part focused on the interaction between an OB/GYN and a nurse. This observation took place on February 5, 2013 at 4:00 p.m. This particular time was chosen because the staff around the clinic are usually wrapping up last-minute patient appointments, and it allowed me to observe the interactions between professionals without the presence of patients. The second part of the observation focused on the interaction between an OB/GYN and a patient. To accomplish this, I took the role of a participant observer and scheduled an appointment as a first-time patient with Dr. Carrie Russ, an OB/GYN of 15 years, on February 15, 2013 at 4:15 p.m. The observation lasted about 20 minutes. On both occasions, the doctors were not aware that they were being observed. I chose this approach because I wanted to capture an honest outlook on the various interactions of these female OB/GYNs and not let my role as an observer affect the professionals' behavior when we interacted.

Results

In our culture, the ideal of a man is described as being accomplished and confident while that of a woman is seen as being sensitive and nurturing (Bagozzi,Wong, & Yi, 2010). These gendered ideologies coerce men and women to conform to traditional notions of masculinity and femininity, respectively. The following research data are divided into two sections: The first focuses on how a female OB/GYN constructs her identity and incorporates gendered practices that depict the field of OB/GYN as stereotypically feminine, and the second provides evidence for how, in some situated interactions, these female OB/ GYNs construct an identity that challenges the gender norm.

Feminine Discourse

In the United States, certain professions are overrepresented by women. Some stereotypical assumptions are that women usually work as secretaries, waitresses, or any other profession that involves interaction because women are seen as being the "socializing" gender or typically enjoy communication, talking, and gossiping (Unger, 290). The following paragraph is from my interview with Dr. Curry and her response when asked about the partnership:

Ira: Do you think that the partnership you seek with a patient plays any significant role in influencing women to choose female OB/GYNs over [a] male one?

Dr. Curry: I think in general all OB/GYNs have an advantage in means of expanding their clienteles because they only deal with women. And since the field of obstetrics and gynecology consists of mostly women, some are also mothers . . . It is easier for us [female OB/GYNs] to communicate with patients. We bond through "women stuff." If I leave a good impression on my patient, she will tell her friends, family, neighbor, or even coworkers how great her doctor is; that's why forming a partnership is important also (Online Appendix ).

From the example provided above, Dr. Curry shows that she is aware about the type of patients with whom she regularly engages, who only female patients. In other words, she views women as being more social; therefore, she works in constructing a type of identity that appeals to women. Throughout the interview Dr. Curry stressed the partnership doctors in the OB/GYN field seek with their patients. She mentions that when speaking with patients, especially new patients, it is important to "Turn your charm on" and make them feel comfortable (Online Appendix). One way to do this is by using icebreakers to start up a conversation as two women, not as doctor and patient.

Dr. Curry: The icebreakers are like stepping stones of forming the partnership. You could start talking about a certain topic…and [icebreakers] can start by being general and then move into being more personal, like talking about [the patient's] intimate relationship with their partner or specific "women stuff" that they're concerned about. (Online Appendix).

This quote extracted from the interview shows that Dr. Curry uses icebreakers to emotionally connect to her patients. The conversation about these topics resembles a typical conversation that women have with their friends. Personally bonding with patients conforms to the gendered assumption that identifies women as the gender that seeks emotional connections to others. To get a better sense of what Dr. Curry was saying in terms of forming a "partnership" with her patients, I observed a regular check-up visit from a patient's perspective. Volunteering at the clinic beforehand granted me an advantage as a first-time patient. I walked in relaxed, signed my name, and took a seat next to an expecting patient. After my name was called, the nurse directed me to the first examining room, where she took my vital signs. Before leaving the room, she left a gown by my side and, with a smile, assured me that the doctor would be in shortly. I put on the gown and took a seat on the exam table, which consists of two stirrups that can transform the table to a birthing chair. Right in front of the exam table, there were three posters hanging on the white walls, displaying the anatomy of the female reproductive system and the progression of the fetus in trimester stages. A few monitors and several pieces of cold metal diagnostic equipment surrounded the exam table. The cables of the monitors seemed to be all connected with each other like a spider web.

Dr. Carrie Russ walked in introducing herself full of enthusiasm. She definitely had "turned her charm on" as she constantly smiled and even complimented me a few times. Dr. Russ took a seat next to the exam table, and started asking specific questions about my medical history, primarily focusing on past medical family history. She transitioned to personal questions such the last day of my menstrual cycle, engagement in sexual intercourse, and birth control. I was surprised by the attention to detail of questions that concerned not only my physical but also psychological health. As Dr. Russ asked me numerous personal questions, I noticed that she was using Dr. Curry's icebreakers approach to connect with me on an emotional level.

After finishing the questions, she applied hand sanitizer and put on gloves, which signaled the starting point of the examination. Beginning with an upper body examination, Dr. Russ provided feedback by saying that everything sounded and felt normal. She took her seat again and sliding her chair next to me, she asked in a soft, quiet tone, "Have you ever done a breast exam?" Seeing that I shook my head, Dr. Russ reached for a pamphlet located near her computer. Folding the pamphlet on the section of breast examination, she began explaining each picture that represented different examination methods. Before beginning the breast exam, Dr. Russ encouraged me to try one of the methods. After congratulating me on my first breast exam, Dr. Russ directed her index finger at my face advising, "Every month, you will perform a breast exam. It is never too early to start detecting changes in your body." I was relieved when she followed the gesture with a smile because I briefly felt like my mom was giving me a warning.

"...are a few acts demonstrated by Dr. Russ that are characterized as stereotypical behaviors and practices of women."

The gesture and the advice given by Dr. Russ can be seen as gendered acts. Typically, women are seen as being more compassionate and nurturing. The advice given by Dr. Russ is similar to one usually given by a parent. Encouraging the patient, giving parent-like advice, and reassuring facial expressions such as smiling are a few acts demonstrated by Dr. Russ that are characterized as stereotypical behaviors and practices of women.

Feminine Discourse is Not So Feminine After All

In the first section, I observed how professionals in the field of OB/GYN constitute an identity where the expected gender-doings of women manifest; however, it is also important to analyze how, in some situations, these professionals constitute a persona that perturbs the female gender norm. For instance, while observing the interaction between an OB/GYN and a nurse, I recognized an identity shift in the OB/GYN that resembled that of a stereotypical man: assertive and intimidating. Since the male representation in OB/GYN is diminishing overall, I wanted to observe how female OB/GYNs portray masculine identity through gendered acts and practices. This masculine persona is also a representation of how the doctors display authority, especially with professionals found in the lower hierarchy such as medical assistants, nurses, and interns. For example, after Dr. Curry finished her last appointment, she sat in front of her computer with a Starbucks drink in one hand and a patient's chart on the other.

However, as one of the nurses, Kate, approached Dr. Curry to present a medical chart, Dr. Curry gestured her not to talk by placing her Starbucks down to hold her index finger up, indicating "one second." Kate took a step back and then one forward after seeing Dr. Curry's smile. She handed the chart to the doctor and started explaining the results of a diagnostic test that had just come from the hospital's laboratory. Dr. Curry's smile faded when she started to ask Kate about the other tests that were previously sent in the lab. Kate's voice seemed to break in the beginning, when using the phrase "I think"; however, it regained its volume when she started to justify that the results were not confirmed by the lab yet. Squinting her eyes, Dr. Curry stared at Kate for a few seconds, nodded her head, and said: "Hmmm . . . OK, thanks." Kate left the chart by Dr. Curry's side and resumed her work (Online Appendix).

Previously, Dr. Curry mentioned in her interview that as a doctor who interacts daily with women, she must act and look like a woman or "turn her charm on," but as she dismisses Kate, she seemed to be "turning her charm off." Her gesture is another act that represents Dr. Curry's authoritative persona. Without even speaking, her manual gesture forced Kate to step back and give Dr. Curry the time she needed. Kate's voice breaking shows how intimidated she may feel toward Dr. Curry. Her breaking voice and the phrase "I think" represent a lack of confidence, which may also be why Dr. Curry stared at Kate for a few seconds after reporting the lab results.

I mentioned that society's ideal woman is compassionate and nurturing. Although the patient observation and the interview represent evidence of how these female doctors cultivate a stereotypical feminine persona, while the second observation suggests that these doctors can manipulate their expected identity by constructing a stereotypical masculine identity. By displaying authority over Kate, Dr. Curry is simultaneously constructing an identity that fits the authoritative nature of a doctor and an identity that perturbs the stereotypical gender norm, which depicts women as being powerless. According to Eckert's model, Dr. Curry seems to establish a new way of being a woman by integrating an authoritative and confident nature, typically characterized by masculine behaviors, into her expected feminine identity (Eckert, 2003).

Discussion

Instead of looking at literacy as an isolated skill that can later be applied to social contexts, New Literacy Studies have focused on literacy practices that are deeply rooted in social forms of communication, in which people who engage in literacy practice use it to construct their identities, interact with others, and assign value to certain activities (i.e. setting social norms). Through literacy practices, we construct and enact our realities. How we portray our own identities through the use of speech and paralanguage are literacy practices done by subjects as a way to navigate through social contexts. Moreover, as the subject practices literacy, they are also seeking approval from society in means of legitimizing that particular act.

The literacy practices involved in the OB/GYN clinic include speech utterances, body gestures, attitudes, and behaviors that are all influenced by a social phenomenon. As discussed in the study, gender is a social construct, which begins affecting development and expectations as early as birth. It is since then that roles, preferences, and personality traits are depicted based on a sex category. When asked about the partnership the doctor develops with the patient, Dr. Curry mentioned that she "turns her charm on" (Online Appendix). Before asking about anything medical, Dr. Curry first tries to get to know the patient as a woman instead of as a patient. This includes talking about their favorite shows, department store, and even relationship issues. Dr. Curry has a stereotypical image of women, which includes being talkative and compassionate. She internalizes these traits and reproduces them, enforcing the female gender norm while simultaneously building a solid relationship with her patients. As she does her gender, she is also performing literacy practices that are essential in maintaining the success of the clinic and her reputation as a doctor.

The same duality can be seen when Dr. Curry interacted with the nurse, Kate. Here I saw a shift in identity, language, and attitude. Dr. Curry did not make eye contact often with Kate, and when she did, it was very serious and almost suspicious. She used her hands instead of her voice to give orders and spoke in a lower tone. This sort of paralanguage is used to maintain structure and authority in the clinic, and can be seen as stereotypically masculine (Hall, 1978). This paper shows how both genders are done through language, identity shifts, body gestures, attitudes, and behaviors, and also how all these gendered performances have implications in terms of membership. This situation exemplifies how gendered practices are literacy practices in that the clinic requires novices and members to learn and acquire in order to maintain the success of the clinic and also to legitimize the practices such that the practices become an unconscious activity done by the subject over time.

This case study should not be generalized to all OB/GYN clinics because gender performativity varies with social context. This study could be taken further by investigating gender performativity in other medical fields that are centered on a particular gender. It can also be used in determining a specific methodology in studying gender performativity as a literacy practice and how novices should navigate when introduced to professional Discourses that are heavily influenced by gendered practices or gender in general.

The appendix referenced in this article can be found on our website at case.edu/discussions/archives.html

Acknowledgements

I would like to give a special thanks to Professor LaToya Faulk for her guidance and for helping me with this paper. You have challenged me to step away from my comfort zone and expand my perspectives.

References

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Endnotes

1. Discourse with a capital "D" was coined by James Gee and is referred to as an identity tool box, containing a subject's values, beliefs, attitudes, lexes, and body language.
2. Performativity is defined as the acts that are embedded with the "bits" that define and structure a Discourse community (institution).
3. Performativity structures the literacy within a Discourse.
4. All the doctors in this essay have chosen to remain anonymous and will be referred to with a pseudonym.