Singularly discriminatory.

December 1, 2018 10:34 AM

"If you are divorced, widowed or never married and develop cancer, watch out. You may get less aggressive treatment than your married friends." Joan DelFattore on how the medical system quietly shortchanges single patients.
posted by Ralston McTodd (28 comments total)

The link doesn't work for me right now. There's an l missing from the very end, and adding that gets me the article.
posted by dilettante at 10:46 AM on December 1, 2018

Nevertheless, he doesn’t see a need to examine how often physicians recommend surgery or radiotherapy to married vs. unmarried patients. Even if such research revealed discrepancies that don’t seem justified by factors such as age, health and cancer status, he said: “You never know what goes into a decision. It could be justified.”

This is nauseating. Medicine is a cult formed by the immense & inhumane pressure that the system places on doctors from the first day they walk into medical school. The result is this “I’m a human and I make mistakes” attitude when it’s something they decide to acknowledge as a mistake. But otherwise they think they’re infallible and everyone else is to blame for everything. The same doctors who won’t treat your cancer will turn around and blame you for not getting better because you didn’t match some 1950s stereotype. It’s a sick system that is killing us.
posted by bleep at 10:58 AM on December 1, 2018 [19 favorites]

Also if I got cancer today I am married yes but that doesn’t mean I have the social support that you need to survive. I have one man, that’s it. See all the convos about emotional labor. What if we had a social safety net so it wasn’t even on individuals and their small families of varying quality and skill to band together to keep each other alive.
posted by bleep at 11:20 AM on December 1, 2018 [21 favorites]

One thing that gets me about the comments on the article (I know) is that there seems to be a debate between "my friends are just as supportive as a spouse/family so I should get the good medical treatment" and "there's no way your friends are as supportive as a spouse". What if you don't, in fact, have a particularly supportive local network of friends but would still like be offered the life-saving treatment?
posted by Ralston McTodd at 11:21 AM on December 1, 2018 [61 favorites]

I don't even have that social and extended family network that this person's talking about--that definitely shouldn't be relevant. Unpaid labor of people who are close to you should not be a required part of medical care. If the current best practice of evidence-based treatment is a program that will make it impossible for a person to live independently, then the care should be provided by paid caregivers and that should be included in the cost of treatment.

Like, I don't have family I can turn to. I do have friends, but many of them are themselves disabled or barely making ends meet. I'm okay with the fact that my life arrangement probably means I'm going to be looking at assisted suicide for the sake of my quality of life earlier, if things don't change--but I've come to terms with that meaning more like living to 75 instead of 85 or 95! Not having to ask hard questions about whether I'm going to be able to fight cancer in my fifties.
posted by Sequence at 11:26 AM on December 1, 2018 [31 favorites]

But otherwise they think they’re infallible and everyone else is to blame for everything.

What’s the difference between a doctor and God?

God doesn’t think He’s a doctor.
posted by Sangermaine at 11:29 AM on December 1, 2018 [14 favorites]

"...an oncologist, talking about what treatment to give me, asked if I have a spouse or children. When I said no to both, he looked genuinely concerned. “But how will you manage?” he asked. He then proposed to give me only one mild drug, although the standard of care was a much harsher — and more effective — combination chemotherapy. When I tried to describe my strong network of friends and extended family, he talked right over me."

WTH???
posted by KleenexMakesaVeryGoodHat at 11:48 AM on December 1, 2018 [25 favorites]

I think in the Rules for a Long Life book right after rule number 1 which is "don't talk to cops" rule 2 should be "don't choose a male doctor."
posted by seanmpuckett at 12:14 PM on December 1, 2018 [35 favorites]

After a scary and strong recommendation from a women's health center, I took myself to an oncologist who spent much of our first conversation denouncing the center, which was indeed known for over-diagnosing or suspecting cancer. Luckily, at the last moment, he decided to do a biopsy, which a few days later confirmed cancer. Equally lucky, the surgery and radiation went well and six years later, I am cancer free. But I often wonder if he had been, say, a little tired, or more annoyed than usual at that center whether he would have done the biopsy or how long it would have taken me to get back to a doctor who would do a biopsy without an argument.

Your life can hang on a whim.
posted by etaoin at 12:18 PM on December 1, 2018 [27 favorites]

I wonder how much of this is whether you go to appointments alone or have an advocate with you, because whenever I've NOT had an advocate about something serious, it's been . . . not good results. (I think that is part, not all, of the issue.)
posted by jeather at 12:26 PM on December 1, 2018 [4 favorites]

"don't choose a male doctor." My experience greatly differs; I have had mostly women doctors and nearly all were as talk-overy and smug as described here. One actually admitted that she deigned to explain her treatment reasoning to me because I was, inconveniently, smarter (i.e. more skeptical) than her usual patients.

It's not a gender thing, it's a don't-question-me-I'm-an-expert thing.
posted by zaixfeep at 1:14 PM on December 1, 2018 [7 favorites]

I do not have cancer but I have a condition that is a common pre-cursor and "a biopsy as often as I want it within reason" was part of my primary care interview process.

If you have good insurance (and I'm lucky that I do) I think more people should interview their doctors. I talked to about 5 of them before I picked my primary care physician. The first whiff of "I'm smarter than you are" was grounds for me walking out.
posted by Defective_Monk at 1:33 PM on December 1, 2018 [6 favorites]

I have had mostly women doctors and nearly all were as talk-overy and smug as described here.

My GP right now is female and terrible. She's also my dad's GP- my dad she treats like a god. Me not so much. It's funny. I've never had a good male doctor except my ankle surgeon. (And he's not white which is another data point.) But the ratio of terrible to good female doctors I've had is more like 50:50. So I agree with don't choose a male doctor- just be ready to walk out of a female doctor's waiting room too I guess.
posted by Homo neanderthalensis at 1:53 PM on December 1, 2018 [11 favorites]

When I was doing my dissertation research, a graduate student colleague was doing qualitative research on hospital care and found that staff tended to provide more care to patients who seemed connected to other people - that is, they had people who visited them, whether those people were family or friends. The researcher said based on her observations and interviews it wasn't conscious, nor was it worry about accountability; it was just that having connections to other people seemed to make people stand out more to them.

That was why when my mother moved into the life care facility I showed up every week, feeling guilty that I couldn't be there every day, and when she died the head nurse in the skilled nursing floor told me that most of the patients had nobody.

And it was why I spent the night in my husband's room when he had pneumonia and got him out of there as fast as I could.
posted by Peach at 2:02 PM on December 1, 2018 [23 favorites]

Absolutely whenever possible I will choose a doctor who is an immigrant. That applied when I lived in Europe as well as in the US. Ideally someone who went to medical school overseas. If that's not possible I choose someone as rural as possible. A lot of urban first world country doctors treat patients as some kind of other. People who grew up outside that system seem to be capable of knowing it's just a job and their patients as humans. The best doctors I've ever had were from Ghana, Cuba and India. The best US doctor I had was an old guy from a really rural area. It's like they see you as people and their job as helping you or something crazy like that.

Race, gender, age, etc I don't care much about. But given the choice I'd always take someone who went to medical school elsewhere.
posted by fshgrl at 2:29 PM on December 1, 2018 [16 favorites]

Yeah...fortunately I'm healthy enough to pretty much avoid doctors these days. (As an American, I'm just uncertain enough about my health care coverage that I'd rather not incur costs unless truly necessary. My plan is through the Obamacare marketplace, so I'm pretty sure they have to cover most serious stuff? At least there's that...)

That said, I'm amused to see that I'm not the only one who tries to "game" my way into finding a doctor who takes my health concerns seriously. My worst doctors have been an elderly man in New Orleans (who tried to convert me to Christianity during my exam, and no it was not a religious practice) and a early middle-aged woman at my university hospital (she was so mean to me, oh my gosh, I was too young to realize it). Both were American. My best doctors were born (and often educated) in another country. They seemed to be better at listening to what I was saying. (They've also never told me to lose weight; American doctors always tell me that I should lose 5-10 pounds.)

Normally I think of doctors as not being great at considering a person's lifestyle when they recommend treatment. How...interesting that the ones that actually do try to think about it do it in such a way that they might be condemning their patient to an early death.
posted by grandiloquiet at 2:47 PM on December 1, 2018 [5 favorites]

I saw a cardiologist for chest pains a few days ago (spoiler alert: it appears to be nothing) and had to bring my small child to the appointment. The (female) cardiologist flat out said they were running every test possible to rule out anything because I was a mother to young children and I needed to live a long and healthy life. I remember thinking...what if I didn't have kids, is it more acceptable then to just shrug your shoulders and move on? In fact every medical appointment I've had of significance since having children, it's been commented on that I need prompt care so I can get back to the family (yay me!).

I also find the assumption that if you have cancer, because you have a partner, you'll automatically have someone to take care of you somewhat laughable. Maybe if you're a man with cancer, but research has proven if you're a woman, you're more likely to find yourself with cancer and divorced as so many men find a sick wife too much to bother with.

Maybe the question they should be asking is, do you have a DECENT partner who can help you? Or heck, why not try the moral response, it doesn't matter if you have support or not, you deserve the best treatment possible even if you're single and we'll find you some support.
posted by Jubey at 3:01 PM on December 1, 2018 [49 favorites]

I just changed PCPs. My previous one just seemed to not pay attention to things I told him and didn't respond to the insurance company promptly (which is a problem when you have been diagnosed on a chronic condition, the pharmacy needs him to reply to fill a prescription and he doesn't reply, which is why I'm changing to someone who might give me the Androgel I need or not have to redo my schedule so that I have to fight like hell to get my insulin).

This one, though... he seemed mostly going through the motions, especially about blood tests for my Androgel (I have very low testosterone levels, which leads to things like brittle bones in men), and he didn't seem to care until I mentioned my wife, at which point he told me all the things that low testosterone level can cause in "your marital work" and ordered it immediately, along with a few more tests I didn't think I needed. But really, the moment I mentioned that "my wife was worried" it was like I was suddenly that much more interesting and important to the world.

I just wonder how much those tests are going to cost now. I know he has the results, but I haven't been able to go and see him, as I spent this past week in recovery from food-induced gastroenteritis.

Protip: I don't care anymore what my mom taught me, three days and gone on those damn leftovers!
posted by mephron at 4:44 PM on December 1, 2018

All your “my female doctor is awful” and “gender is irrelevant” anecdata is nowhere near as compelling to me as actual studies showing I’ll live longer with a female doctor.
posted by greermahoney at 5:22 PM on December 1, 2018 [38 favorites]

I’m a cancer survivor (married but childless) and my family status was never discussed in the course of making treatment decisions. I went to most appointments alone. My medical oncologist is male; my radiation oncologist and surgeon are both female. They are all excellent across the board. I’ve had nothing but a fantastic experience (you know, except for the having cancer part).

I say this because stories like this are so commonplace these days - doctors talking over patients, making snap treatment decisions without allowing for questions or second opinions - that I think we are almost coming to see it as normal. It isn’t normal, or at least it doesn’t have to be, and it makes me sad and mad when I see patients frustrated with their shitty doctors who continue to accept bad behavior because they think there isn’t anything better. There is something better. It’s okay to switch doctors. It’s okay to demand better care. I don’t know how we educate patients to question their doctors, but it’s very much needed.

That said - I’m also very fortunate to live in a city with several major research university hospitals. In the course of my treatment I met many patients who drove hours each way to get to the doctor. It’s very understandable how single people living in remote rural areas would receive less care - the standard of care for most breast cancer is seven weeks of radiation. Imagine driving three hours every single day for seven weeks to have a five minute radiation treatment, and doing it as a single mother or someone who is the sole source of income for your household - I’m sure many people simply aren’t able to do it.
posted by something something at 6:18 PM on December 1, 2018 [9 favorites]

Associations can be interesting and hypothesis-generating. The association between social isolation (more common in unmarried people, but possible in any patient) and worse outcomes is often shown in large-scale databases such as SEER. Such databases are subject to a great deal of confounding and cannot answer the question, "do doctors discriminate against people who are single?"

My advice to patients (if anyone's interested) is that if your doctor will not explain their decisions, if their decisions are not backed up by discussion in a multidisciplinary meeting in the cancer centre, and if your questions are neither respected nor answered - change doctors.

I speak both as a doctor, and as someone with a divorced relative who died of cancer having received inadequate (though not insufficiently aggressive) care.
posted by 1head2arms2legs at 6:29 PM on December 1, 2018 [8 favorites]

Glad you're doing well, something something. Agree with you entirely.

Just a small point, the standard of care for breast radiotherapy has changed to a shorter treatment course. The USA was late to this change, although it has been standard in universal healthcare countries like Canada and the UK for some time.
posted by 1head2arms2legs at 7:04 PM on December 1, 2018

Yes, I actually had the shorter course myself, but I’m literally the only person I know who did out of dozens of now-friends diagnosed at the same time (2015). Again, though, I think this is a benefit of having research university doctors who keep abreast of the most up to date recommendations. And also I was fortunate to be Stage IA.
posted by something something at 7:32 PM on December 1, 2018 [1 favorite]

In her view, medical providers are justified in giving significant weight to marital status, “because unmarried patients are unlikely to do well, and they want to take patients who will do well.”

What an actual fucking monster.
posted by We put our faith in Blast Hardcheese at 7:42 PM on December 1, 2018 [21 favorites]

I am reminded of advice I read on social media, which suggested you say, "You are choosing not to have me tested/give me this treatment. Put it in my medical record that you have refused to do so, and I would like a copy of that page of my medical records before I leave."

I have no idea if that's effective or works, but it does seem like a good way to document malpractice, or make the doctor second guess from the perspective of a possible medical malpractice lawsuit.
posted by gryftir at 7:53 PM on December 1, 2018 [17 favorites]

Gryftir, I am a member of a bunch of fat positive groups and have heard from several folks that using that same script works magic when fat folks are denied tests because the doctor assumes that losing weight will cure all things. It seems to have come from someone with chronic health conditions so it’s a great script for anyone to use with a doctor, I certainly wish I had heard of it before this year.

This is all so depressing to me. I have had exactly one doctor take me seriously and she is the doctor I have right now, thank god, but I’m pissed that now I have an actual health condition that other doctors didn’t catch because they spent every visit lecturing me about eating healthy and exercising and then being skeptical/downright condescending when I told them that I was doing those things but could we please focus on my symptoms. I guess I am pleased that I’m in a long term relationship with good community because I don’t need another reason for the medical community to stigmatize me as a fat dyke.
posted by the thorn bushes have roses at 10:27 PM on December 1, 2018 [10 favorites]

The longer you deal with a disease, the less likely it is you'll have a social network left to depend on.
posted by MrVisible at 6:26 AM on December 2, 2018 [13 favorites]

I'm single, but I feel like I was pushed into more aggressive cancer treatment than I wanted or needed. I think everyone going through it should have access to as much objective counseling on the matter as they need.
posted by The Underpants Monster at 2:59 PM on December 2, 2018 [3 favorites]