Women, Beware Of Your Doctors
It saddens me that the majority of my practice are patients that have come to me as a last resort. While I would love to promote overall wellness and prevention of disease, the reality is, most people come in after they’ve seen multiple specialists and still don’t have the answers they are looking for.
The longer I’ve been in practice, the more certain I am of the existence of a deadly gender bias against women in medicine. The countless stories I have heard, of women having their symptoms downplayed, dismissed, or flat-out ignored floors me. While doctors take an oath to do no harm and bad doctors will always exist, that doesn’t account for the almost weekly tale I hear of a woman disregarded.
For an example, my sister recently related an experience she had in California, with her primary care physician. She had a list of labs I suggested to help further evaluate her health concerns. Her doctor declined to order these tests in a dismissive manner. She pressed the issue in a polite way, asking for clarification for his reasoning as she was “not certain what the harm is in having more information when looking at my overall health versus the standard tests.” She even advocated for herself while still acknowledging the doctor’s expertise, “ I’m not an expert by any means, but I know that there is something off in my body…”
One would hope that this would be met with acquiescence or at least an opportunity to engage in a deeper conversation. Unfortunately, he responded by denying her request with false reasoning as to why: stating ordering extra lab tests is why healthcare is so expensive (it’s not) and incorrectly explaining why certain lab tests would not be useful (ie leptin and weight; thyroid).
Sadly, I see examples of these kinds of upsetting experiences for women all too often in medicine. Women are not believed. Women are insisting “I know something is wrong” but it falls on deaf ears. And from my perspective as a doctor, these stories are not unique. More research is showing this bias exists leading to poorer healthcare outcomes for women across all specialties of medicine. This bias is greater when we consider other factors, like race or sexual orientation, which could fill up an entire article on it’s own.
Therefore, women, beware of your doctors.
So why does this bias exist? Why are doctors so quick to ignore or dismiss real symptoms that women experience?
With most things, there is no clear answer, but I would argue a large part is due to how little is actually known about women’s health, which is symptomatic of an oppressive patriarchal culture.
Up until fairly recently, studies were not required to include females. It wasn’t until 2016 that animal studies receiving grants from the National Institutes of Health (NIH) had to include sex as a variable. So up until 2 years ago, a study could be done on a non-human mammal and only use males and/or lump the data for females and males together.
And in 1993, NIH mandated the inclusion of women in federally supported phase III clinical trials. However, they did not require that analysis to be specific to sex. In other words, the vast majority of those researchers did not break down the results specific to men and women, they just looked at the overall trend. So if a drug had positive effects in men but little to no effect in women, that distinction was lost in the data.
We know from other research that men and women respond differently to medications and they can have different expressions of disease. For example, during a heart attack, both men and women experience chest pain or discomfort, women are more likely to also experience shortness of breath, nausea or vomiting and pain in their back or jaw. What may feel like the flu or heartburn to a woman, could in fact be a heart attack.
Why has this been the status quo for so long? For years, researchers have solely focused on males because females are too complicated. With our frequent hormonal fluctuations, we can make analysis too complicated when fewer variables are easier to analyze in research. And at one point in time, the FDA forbade women of child-bearing ages from participating in any clinical research because of the possible effects it could have on her future children. Even if the woman never planned on having children, they would not allow her to participate.
But this reasoning is exactly why we need to include females, particularly women, in research. Our complex nature makes it so much more important to understand how medications affect women differently than men or how diseases are expressed or form in women. For example, 75% of autoimmune diseases occur in women so why would we only study the minority of who is impacted? How can we expect better outcomes for women’s health when we are not including all types of women in this research?
Until the research catches up to the state of actual health issues affecting women, I wanted to provide some guidance on how to deal with and speak out against the bias now. Being aware that this bias exists can be helpful so you can more easily recognize if your doctor is dismissing you and your symptoms. It’s also important to be able to recognize if your doctor cares but is just advising from a place of misinformation.
You can use all of these or just one tip, but it is important to view and approach your relationship with your doctor differently than you have in the past if you want different results going forward.
It is okay to tell your doctor “no”. There is nothing in the rules or practice of medicine that states that you have to agree with everything your doctor tells you to do. You are getting their medical opinion, not a commandment. If your doctor doesn’t respect you politely saying “no”, find a new doctor. (Link to article on how to say no!)
It is okay to explore all of your options. It is okay to get a second, third, or even fourth opinion. Your doctor does not and can not know everything. It is okay to seek the advice of others. If your doctor doesn’t agree with this approach, find a new doctor.
It is okay to ask your doctor questions. Your doctor should take time with you to make sure you understand what the implications are (both positive and negative) of their recommendations, what your lab tests mean, and answer any other questions you may have. The origin of the word doctor, docere, means “to teach” so they are responsible for helping you learn about your body and your health. If your doctor seems annoyed by your questions or just refuses to answer them, find a new doctor.
It is okay to say, “let me think about it.” It’s okay to wait until the shock of a diagnosis has passed so you can make a better decision. It’s okay to weigh your options. It’s okay to ask your friends, family, parents, children, priest, rabbi, inner wisdom, or whoever and whatever you turn to regularly for guidance. The amount of time you can wait depends on the severity of the situation but if your doctor tells you that you must decide now, find a new doctor.
It is okay to disagree with your doctor. While a five-minute office visit may be enough time to label you with a (hopefully accurate) diagnosis, it is not nearly enough time to deeply know a person, inside and out. Their nuances, preferences, fears, and strengths. Doctors are experts in medicine but you are the expert on you. If your doctor thinks they are the expert on yourpersonal health and life experiences, find a new doctor.
Medicine is not an infallible science; it is an art. And art, is subjective. It’s even called the practiceof medicine. Nothing in medicine is ever black and white, even if some doctors want to mislead you otherwise.
Even if we knew all that we possibly could about women’s health, which we never will, it’s okay to tell your doctor “no” since it is important to recognize that you have power when it comes to your healthcare.
What has your experience been with bias in medicine? Are there any situations you are rethinking with this new context? How will you own your healthcare going forward?
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I could write a book on the many times I’ve felt degraded and disregarded by doctors over the years. I thought female doctors would be more understanding and knowledgeable about women’s health issues, but have found them to be condescending and demeaning, and extremely defensive when questioned. I was diagnosed with an extremely large fibroid at age 39. During the course of my ultrasound, the technician flippantly told me that a hysterectomy was my only option. My doctor hadn’t even seen the test results yet. When I returned to my doctor’s office, and told her I’d sought a second opinion, she became very angry and told me to leave her office and seek help elsewhere. Things only got worse from there. Since my hysterectomy in 2004, I’ve been battling menopausal issues ranging from mildly inconvenient to very serious. Each time I sought advice from a doctor, mostly females, I was treated with skepticism and irrelevance. Most of the time, they offered no advice whatsoever other than, “Women have gone through menopause since the beginning of time. Just deal with it.” Most never even made eye contact with me, looking down at a chart or computer while telling me my symptoms were no big deal and not life threatening. Whether it was my PCP or a specialist, they weren’t interested in listening to me, and all were defensive if questioned. As you said in this article, I turned to Naturopathic medicine as a last resort. How refreshing to find someone who actually listens to me and doesn’t lecture me. I got tired of hearing that women’s health issues are just too complicated.