You’ve probably heard stories – maybe you have your own story – of women’s health concerns being ignored or dismissed by their doctors.
Women’s pain is more likely to be ignored, the severity under-appreciated. Women wait longer in the ER for treatment and are more likely to be diagnosed with depression and anxiety, rather than the underlying physical ailment that is often causing them to be depressed or anxious.
Women of color have it even worse, dealing with both gender and racial biases, whether it be conscious or unconscious. Misogynoir, as Jazmine Joyner termed it in her article for Wear Your Voice magazine, is the very real concern that renders Black women – and their pain – invisible.
Women are seven times more likely to be misdiagnosed and sent home during a heart attack. Symptoms look different in women, and we’re more familiar with the signs of heart attack in men than we are in women, even though it’s the leading killer of women, just as it is men.
It wasn’t until 1990 that the National Institutes of Health created the Office of Research on Women’s Health, focused on including women in clinical trials. Previously, trials and studies had been populated by (and largely run by) men, and the resulting studies and recommendations were appropriate for men as a result.
The problem with that is women aren’t just smaller men. Prescriptions that are created for men and then simply reduced for lower body weight for women may be entirely inappropriate.
According to a 2014 article in Scientific American, women’s “different hormones, body composition and metabolism may make them more sensitive to certain drugs. Further, women are between 50 and 75 percent more likely to experience side effects.” Giving the same drugs to women as men, without regard for their very different physiology, is dangerous.
And in an opioid addiction crisis, we can’t afford to be cavalier about the fact that women respond differently to pain medications, becoming dependent on opioids more easily and more likely to relapse.
Antidepressants, which are often prescribed during perimenopause and menopause, are more potent for women, may absorb more quickly, and may persist longer in the body.
And menopause, which is, after all, a normal process and not a disease, may not seem like something doctors can or should medicate. That attitude, coupled with concerns about the safety of hormone replacement therapy (HRT), may result in an implicit “suck it up” attitude from doctors, many of whom will never experience the symptoms first hand.
The fact that menopause is normal and natural doesn’t make the symptoms any less difficult, nor does it remove the harmful effects of depleted estrogen on our brains, bones, and hearts.
There is reason to hope that this dismissal of women by the medical community is changing. All genders must be included in research studies unless there’s a compelling reason to focus on one and exclude others.
Until the medical establishment catches up to the realities of women’s physiology, pain, and symptoms, women will need to advocate for themselves. This does not mean replacing Dr. Google for your licensed physician – it means speaking for yourself and insisting on being heard.
This can be hard when you’re wearing a flimsy paper gown and socks and the doc has very recently been poking around in your privates, but remember the end goal: your better health.
1. Write down your symptoms and questions. Doctor’s appointments are notoriously brief in the US, and many of us feel obligated to meet the doctor’s pace and rush through the discussion. Having what you need to say or ask written down will help you remember it all in the heat and hurry.
2. Ask all the things. A doctor’s office is no place for embarrassment. She’s seen in all and then some, so there’s probably not much you could say to shock her. Talk about your period, your discharge, your lumps and sexual pain, if that’s what’s making your life harder. Your doc can’t help you if she doesn’t have a full and complete picture of the problem.
3. Insist on his full attention. Docs have a metric crap-ton of things to do and may be multi-tasking a bit more than you like. Ask him to put away the computer and the paperwork and listen to you. According to a study in the Journal of General Internal Medicine, patients get an average of 11 seconds to explain their situation before the doc interrupts (and what do you want to bet it’s less for women?) Front load your conversation but also insist on being heard, even if you have to go all the way to a full minute.
4. Bring a buddy. If you’re like me and find confrontation worse than at least the top four rings of hell, you might need a buddy who’s willing to be more assertive. Brief your buddy on what you want to accomplish and agree to stick it out until you are confident you know your options.
5. Dress. When the exam part is over, ask the doc to step out for a minute so you can dress. For some of us, it’s easier to assert ourselves in conversation when we’re wearing underwear.
6. Know what they need to know. You won’t be able to supply all the details, but the more prepared you are, the better use you’ll both make of your time together. If appropriate, know your last period. Know when the symptoms started, how severe they are at their worst, what seems to trigger them, any information that seems pertinent. Know your complete list of medications, including supplements, herbs, etc. Write it down before you go in, if you can.
7. Be honest and open to advice. After reading some of the articles I’ve linked to, you may be a bit less inclined to accept a doc’s advice, but that’s not great either. Be as open as you want them to be, even if you don’t like what you hear.
8. Get a new doc. If you just don’t feel like you and your doc are communicating, find a new one. That may be easier said than done for communities that simply have fewer doctors or when insurance makes it problematic, granted, but telemedicine is becoming a great resource for women in those situations.
9. Issue a complaint. In those rare cases when you feel you have a real grievance, there are several avenues to pursue, starting with complaining to the doctor him or herself, if appropriate.
Advocating for yourself, insisting on being heard, is easier for some women than others, whether that be because of temperament, socio-economic status, or belonging to a privileged or marginalized community.
But every woman who speaks up for herself may not only improve her own care, she may help educate a doctor and make the path easier for those women behind her.
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