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In this introductory chapter, I discuss the rationale for this edited collection and the contribution it can make to advancing knowledge of gender inequalities and promoting social justice in the medical profession and medical education. I provide a short overview of and critique of popular debates in the medical community in the United Kingdom and I also discuss briefly research about women’s careers in the United Kingdom and globally. The introductory chapter provides a description of each chapter and its contribution to scholarship about gender, careers and inequalities in Medicine/Medical Education.

Women remain under-represented in leadership positions in both clinical medicine and medical education, despite a rapid increase in the proportion of women in the medical profession. This chapter explores potential reasons for this under-representation and how it can be ameliorated, drawing on a range of international literatures, theories and practices. We consider both the ‘demand’ for and ‘supply’ of women as leaders, by examining: how evolving theories of leadership help to explain women’s’ leadership roles and opportunities, how employment patterns theory and gender schemas help to explain women’s career choices, how women aspiring to leadership can be affected by the ‘glass ceiling’ and the ‘glass cliff’ and the importance of professional development and mentoring initiatives. We conclude that high-level national strategies will need to be reinforced by real shifts in culture and structures before women and men are equally valued for their leadership and followership contributions in medicine and medical education.

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional and hybrid theories that suggest that the individual relates with the surroundings by buffering the harmful effects of stressors. These acts or reactions are called coping strategies and are designed as protection from the stressors and adaptation to them. Failure to successfully adapt to stressors results in psychological distress. In some individuals, elevated levels of distress and failed coping are expressed in physical symptoms, rather than through feelings, words, or actions. Such “somatization” defends against the awareness of the psychological distress, as demonstrated in the psychosocial literature. The progression of behavior resulting from somatic distress moves from a private domain into the public arena, involving an elaborate medicalization process, is however less clear in sociological discourse. The invocation of a medical diagnosis to communicate physical discomfort by way of repeated use of health care services poses a major medical, social and economic problem. The goal of this paper is to clarify this connection by investigating the relevant literature in the area of women with breast cancer. This manuscript focuses on the relationship of psychological stress, the stress response of distress, and the preoccupation with one’s body, and proposes a new theoretical construct.

The healthcare system is undergoing rapid change as medical centers are confronted with constricted reimbursements for healthcare services while adapting to growth in medical knowledge, major technological advances in medical practice, and a changing regulatory environment. Academic medical centers thought themselves immune to the forces that shape most service enterprises but are forced to compete based on customer service and the efficiency, quality, and safety of medical care, while continuing to compete in the academic world. These challenges are not unique to academic medicine, but these institutions are, perhaps, least suited to the leadership challenges posed by this environment. Certain attributes of these centers raise barriers to successful adaptation to the changing healthcare environment. The need for systemic change in academic medicine requires commitment to programs that create change agents willing to assume leadership roles and to guide institutional evolution. In academic medicine, traditional one-on-one relationships between mentors and trainees do not provide the breadth of guidance needed in the complex environment of research, medical practice, and teaching. A structured system of “matrix mentorship” and structured evaluation will advance institutional values, provide leaders with an essential set of skills and values consistent with institutional goals, and provide competitive advantage for medical centers in academic healthcare.

A fundamental assumption by the Institute of Medicine (IOM) is that evidence-based medicine (EBM) improves the effectiveness of medical diagnosis and treatment and, thus, the safety of patients. However, EBM remains controversial, especially its links to patient safety. This chapter addresses three research questions: (1) How does EBM contribute to patient safety? (2) How and why is EBM limited in improving patient safety? and (3) How can patient safety be maximized, given the limitations of EBM? Currently, EMB contributes to patient safety both by educating clinicians on the value and use of empirical evidence for medical practice and via large-scale initiatives to improve care processes. Attempts to apply EBM to individual patient care are limited, in part, because EMB relies on biostatisical and epidemiological reasoning to assess whether a screening, diagnostic, or treatment process produces desired health outcomes for a general population. Health care processes that are most amenable to EBM are those that can be standardized or routinized; non-routine processes, such as diagnosing and treating a person with both acute and chronic co-morbidities, are cases where EBM has limited applicability. To improve patient safety, health care organizations should not rely solely on EBM, but also recognize the need to foster mindfulness within the medical professions and develop patient-centric organizational systems and cultures.

The chapter critically analyzes the concepts and the practices of surveillance in modern and postmodern societies along with their consequences. We show the changes in the systems, which are used to monitor individuals, and emphasize the transition toward soft surveillance systems, probably stimulated by digital technologies. This switch from top-down control to “lateral” monitoring systems encloses surveillance practices with suggestive names like interveillance, synopticon, and dataveillance. The dark side of digital health has a bright start. According to Topol’s (2016) vision of the future, we will soon be the “consumers,” the real protagonists, of the management of our health – thanks largely to the practically endless data about our bodies, behaviors, and lifestyles we will be able to collect and analyze. We will share our health information in real time with the doctors whom we will choose based on their score in clinical rankings (here, too, quantification rears its head). Yet, this simplified version of health makes it seem that there are always some solutions, which the algorithm can supply as long as it has enough information. Moreover, in the United States, some health-insurance companies have started to offer a discount on premiums to the members who agree to collect and share self-tracking data with them. Clearly, the discount is given only to the workers who have healthy habits. At first sight, this can seem as a win-win trade-off; however, what today is presented as an individual option can easily become a requirement tomorrow.

Purpose – To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate dependence in the United States – methadone and buprenorphine – in order to analyze the role of racial imagery and racial politics in the legalization and clinical promotion of their use.

Methodology/approach – Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone. Ethnographic methods of participant observation and semistructured interviews were used in researching buprenorphine.

Findings – Contrasting uses of racial imagery played a major role in shaping the current regulatory differences between the two treatments. The association of methadone with black and Latino heroin users has contributed to its increased federal regulation, while the association of buprenorphine with white, middle class prescription opioid users enabled its use in deregulated private physicians’ offices.

Originality/value of paper – Advocates of biomedicalization of behaviors and conditions thought of as social or moral, such as addiction, argue that biomedicalization reduces the stigma of the condition and imply that, in turn, it also reduces the racial inequalities associated with the condition. This study of the biomedicalization of treatment for opioid dependence indicates that the very process of biomedicalization depended on heightened racial imagery associated with each treatment and ultimately intensified, rather than reduced, the stigma of addiction for black and Latino low-income patients.

Throughout human history and around the world, co-sleeping was the context for human evolutionary development. Currently, most of the world’s peoples continue to practice co-sleeping with infants, but there is increasing pressure on families in the West not to co-sleep. Research from anthropology, family studies, medicine, pediatrics, psychology, and public health is reviewed through the lens of a developmental theory to place co-sleeping within a developmental, theoretical context for understanding it. Viewing co-sleeping as a family choice and a normative, human developmental context changes how experts may provide advice and support to families choosing co-sleeping, especially in families making the transition to parenthood. During this transition, many decisions are made by parents “intuitively” (Ball, Hooker, & Kelly, 1999), making understanding the developmental consequences of some of those choices even more important. In Western culture, families are making “intuitive” decisions that research has shown to be beneficial, but families are not receiving complete messages about benefits and risks of co-sleeping. Co-sleeping can be an important choice for families as they make the life-changing transition to parenthood, if individualized messages about safe infant sleep practices (directed toward their individual family circumstances) are shared with them.