Sexism in medical writing.

Medical writing needs exact and unambiguous language.'3 Perhaps one of the most neglected aspects ofambiguity is the use oflanguage that may be construed as sexist. The problem arises most often because English does not have neutral pronouns. Doctors, members of a profession still dominated by men, have thus tended to use he to include men and women. Often this will confuse, and sometimes it will offend: one BMJ reader wrote recently to complain about an article that used he for consultants and she for secretaries as by no means all consultants are men and nor are all secretaries women. Another example of presumably unintentional bias arose in the unedited version of a paper that appears in this issue (p 1656). The authors describe the "eyes closed sign" in which the patient with non-specific abdominal pain "keeps her eyes closed during the whole [abdominal] examinatiion while "the patient with serious intra-abdominal pathology concentrates all his attention on the face and hand of the examining surgeon." Writers usually use he assuming that readers will understand that both men and women are meant. Recent evidence suggests that they may be wrong in their assumption. In the distant past he and man were used generically to include both men and women. In Old English man meant both person and human being and covered men and women.4 By the eighteenth century man had come to mean primarily a male. A recent study showed that when they read the words man and he men thought of. themselves, but women did not think of themselves ; furthermore, women did not use he or man in relation to themselves.5 Another study showed that readers thought first ofmen when his was used as a supposedly gender neutral possessive pronoun.6 Spender has taken this further and argued that men use he or man because it includes them, but women try to avoid the words because they are excluded.5 Women often do not know whether they are included or not when he and man are used.5 They have to look for other clues-consider,-for example, the difficulty of interpreting "As for man, he is no different from the rest. His back aches, he ruptures easily, his women have difficulties in childbirth."4 Writers have made many attempts to avoid sex biased language, but some are far from elegant-for instance, using he or she, helshe, or slhe is awkward, as is using he in …