Medical Gaslighting
April 27, 2022 7:48 AM Subscribe
When doctors dismiss concerns of women/POC/nonbinary people, what can we do about it? A serious problem that's starting to get the attention it deserves.
Women Are Calling Out ‘Medical Gaslighting’
The toxic power dynamics of gaslighting in medicine
Women are sharing their ‘medical gaslighting’ stories. Now what?
Patients are calling out 'medical gaslighting,' saying doctors deny their symptoms and misdiagnose serious illnesses
... and of course, many more.
May someday soon we all get competent and respectful health treatment.
Women Are Calling Out ‘Medical Gaslighting’
The toxic power dynamics of gaslighting in medicine
Women are sharing their ‘medical gaslighting’ stories. Now what?
Patients are calling out 'medical gaslighting,' saying doctors deny their symptoms and misdiagnose serious illnesses
... and of course, many more.
May someday soon we all get competent and respectful health treatment.
This post was deleted for the following reason: Poster's Request -- loup
It's worth noting that this has been a known issue for so long that The Golden Girls did a whole story arc on it.
The problem here is that the solution is both simple and complex - doctors who gaslight need to face professional sanction for doing so, up to and including loss of licensure. The problem with that is that the same one we have with the legal profession - we've allowed doctors to self-police, with all the attendant repercussions.
posted by NoxAeternum at 8:04 AM on April 27, 2022 [31 favorites]
The problem here is that the solution is both simple and complex - doctors who gaslight need to face professional sanction for doing so, up to and including loss of licensure. The problem with that is that the same one we have with the legal profession - we've allowed doctors to self-police, with all the attendant repercussions.
posted by NoxAeternum at 8:04 AM on April 27, 2022 [31 favorites]
The late Erin Gilmer wrote quite a bit that is worth reading about this issue, which also affects disabled people but especially disabled women, disabled people of color, and queer/trans/nonbinary disabled people. I'd start here but everything she writes about trauma informed care is worth looking at.
posted by gauche at 8:08 AM on April 27, 2022 [9 favorites]
posted by gauche at 8:08 AM on April 27, 2022 [9 favorites]
In addition to women, POC, queer and disabled people, I'd add fat people to the list of people who are routinely disregarded by their doctors.
posted by jacquilynne at 8:32 AM on April 27, 2022 [82 favorites]
posted by jacquilynne at 8:32 AM on April 27, 2022 [82 favorites]
I think we just need many more doctors & nurses than we have, and we need it to be less physically & financially grueling to become one. I feel like one of the roots of the problem, in addition to the every day racism & misogyny we all grow up with, doctors & nurses don't have enough hours in their day to give everyone a proper diagnosis & treatment plan. So who falls in the cracks - the people we've already been preconditioned to devalue. If there were more of them to go around, if it wasn't tantamount to becoming a religious ascetic in order to practice, we'd have more people who were working who would see themselves more in their patients & have time to help them.
posted by bleep at 8:56 AM on April 27, 2022 [44 favorites]
posted by bleep at 8:56 AM on April 27, 2022 [44 favorites]
Archive.is version of that WaPo link.
posted by fight or flight at 9:02 AM on April 27, 2022 [1 favorite]
posted by fight or flight at 9:02 AM on April 27, 2022 [1 favorite]
from what I understand, some of this is being addressed in modern-day medical school/residency programs. my partner and I talked about the grand rounds speakers who spoke to this issue a few times (she's in psychiatry) and, on the whole, her co-residents were fairly open-minded and receptive to these ideas
fwiw and ymmv, I tend to think the younger the doctor is, the more modern their education is, and thus the further away they are from utilizing medical knowledge as a form of biopower and the higher the probability is that their philosophy veers towards patient-centered care. then again, of the doctor friends my partner does have outside of psychiatry, there are a fair few who seem... less politically inclined to be open-minded to patient's lived experiences, and seem to already be jaded, especially if they're in private practice and are around older doctors who talk to them about how patients will just abuse their trust and etc
it also likely matters a lot what kind of medicine they go into - surgeons, on the whole, are the finance bro-types of the medical field, valuing status and wealth over anything else, radiologists+anesthesiologists are the nerdy, socially awkward types, etc. for family med, there are a lot of good people going into the field but it's also one of the fields most prone to burnout because of our horrible medical system in the US - 15 min patient visits, surface level care, along with some of the worst paid in the profession for the most emotionally laborious, patient-facing work
posted by paimapi at 9:03 AM on April 27, 2022 [5 favorites]
fwiw and ymmv, I tend to think the younger the doctor is, the more modern their education is, and thus the further away they are from utilizing medical knowledge as a form of biopower and the higher the probability is that their philosophy veers towards patient-centered care. then again, of the doctor friends my partner does have outside of psychiatry, there are a fair few who seem... less politically inclined to be open-minded to patient's lived experiences, and seem to already be jaded, especially if they're in private practice and are around older doctors who talk to them about how patients will just abuse their trust and etc
it also likely matters a lot what kind of medicine they go into - surgeons, on the whole, are the finance bro-types of the medical field, valuing status and wealth over anything else, radiologists+anesthesiologists are the nerdy, socially awkward types, etc. for family med, there are a lot of good people going into the field but it's also one of the fields most prone to burnout because of our horrible medical system in the US - 15 min patient visits, surface level care, along with some of the worst paid in the profession for the most emotionally laborious, patient-facing work
posted by paimapi at 9:03 AM on April 27, 2022 [5 favorites]
Dentists need to be added into this discussion. They really need to embrace trauma informed care.
Having lived thru domestic violence, being in a chair where I cannot easily get up or defend myself, with someone doing shit outside of my peripheral vision and then having them do things to my face the usually causes unexpected pain puts me in crisis mode. I’ve gone so far as to present my dentist with a letter explaining the issue with a list of three things they could do to help me get thru even a cleaning — with zero actual effect.
Comparing this to the deeply trauma-informed care I’ve received at Planned Parenthood is night and day.
I think this might be a slight derail, but damn — let’s press this conversation across the range of medical professions.
posted by Silvery Fish at 9:06 AM on April 27, 2022 [61 favorites]
Having lived thru domestic violence, being in a chair where I cannot easily get up or defend myself, with someone doing shit outside of my peripheral vision and then having them do things to my face the usually causes unexpected pain puts me in crisis mode. I’ve gone so far as to present my dentist with a letter explaining the issue with a list of three things they could do to help me get thru even a cleaning — with zero actual effect.
Comparing this to the deeply trauma-informed care I’ve received at Planned Parenthood is night and day.
I think this might be a slight derail, but damn — let’s press this conversation across the range of medical professions.
posted by Silvery Fish at 9:06 AM on April 27, 2022 [61 favorites]
Silvery Fish I totally agree, FWIW. Pelvic exams and dental work are so similar in that way.
posted by wellred at 9:19 AM on April 27, 2022 [13 favorites]
posted by wellred at 9:19 AM on April 27, 2022 [13 favorites]
Trauma-informed training for pelvics is a thing in NP school FWIW, and I agree with paimapi's assessment that younger medical professionals are /at least exposed/ to training in better ways of doing things.
It still very much sucks to see how older/more conservative practitioners do things around weight and marginalized folks!
posted by sibboleth at 9:31 AM on April 27, 2022 [1 favorite]
It still very much sucks to see how older/more conservative practitioners do things around weight and marginalized folks!
posted by sibboleth at 9:31 AM on April 27, 2022 [1 favorite]
then again, of the doctor friends my partner does have outside of psychiatry, there are a fair few who seem... less politically inclined to be open-minded to patient's lived experiences, and seem to already be jaded, especially if they're in private practice and are around older doctors who talk to them about how patients will just abuse their trust and etc
This is why education is not enough - the older doctors who have come to the conclusion that patients are the enemy are happy to teach that to the younger ones. Which is why we need to tell them that they can either change their tune, or not be doctors anymore.
posted by NoxAeternum at 9:33 AM on April 27, 2022 [8 favorites]
This is why education is not enough - the older doctors who have come to the conclusion that patients are the enemy are happy to teach that to the younger ones. Which is why we need to tell them that they can either change their tune, or not be doctors anymore.
posted by NoxAeternum at 9:33 AM on April 27, 2022 [8 favorites]
This is a cause of Climate Change, as well.
Sicknesses from the US Department of Energy's oil export hub in St James are routinely ignored. Here's Geraldine Mayho's complaint in 2017.
Black districts of St James Parish, Louisiana are currently the target of multiple Methanol export and Plastics export facilities, as well as Carbon Sequestration wells, all of which will contribute major new sources of CO2e into the upper atmosphere, and will likely cause the USA to miss its Paris Accord obligations.
But before it goes up into the atmosphere, the pollution passes through the lungs of environmentalist women like Geraldine.
RIP Geraldine.
I know metafilter generally does not support the earth day climate action at the supreme court, but stories like Geraldine's are the reason to have more compassion.
posted by eustatic at 9:43 AM on April 27, 2022 [9 favorites]
Sicknesses from the US Department of Energy's oil export hub in St James are routinely ignored. Here's Geraldine Mayho's complaint in 2017.
Black districts of St James Parish, Louisiana are currently the target of multiple Methanol export and Plastics export facilities, as well as Carbon Sequestration wells, all of which will contribute major new sources of CO2e into the upper atmosphere, and will likely cause the USA to miss its Paris Accord obligations.
But before it goes up into the atmosphere, the pollution passes through the lungs of environmentalist women like Geraldine.
RIP Geraldine.
I know metafilter generally does not support the earth day climate action at the supreme court, but stories like Geraldine's are the reason to have more compassion.
posted by eustatic at 9:43 AM on April 27, 2022 [9 favorites]
I’ve been advocating (fruitlessly) for counting missed diagnoses as medical errors for years. Seems like accountability (not blame!) when patients see multiple providers or come to the ED multiple times for the same undiagnosed complaint would help in changing the culture of gaslighting.
posted by shesdeadimalive at 9:50 AM on April 27, 2022 [10 favorites]
posted by shesdeadimalive at 9:50 AM on April 27, 2022 [10 favorites]
Silvery Fish I totally agree, FWIW. Pelvic exams and dental work are so similar in that way.
@wellred - I hadn’t made that connection before. You’re right. Thank you for seeing me.
posted by Silvery Fish at 9:51 AM on April 27, 2022 [8 favorites]
@wellred - I hadn’t made that connection before. You’re right. Thank you for seeing me.
posted by Silvery Fish at 9:51 AM on April 27, 2022 [8 favorites]
It’s also a “joke” among my nursing friends and my healthcare-adjacent friends that there’s no point in going to the ED if you’re a woman with abdominal pain
posted by shesdeadimalive at 9:52 AM on April 27, 2022 [16 favorites]
posted by shesdeadimalive at 9:52 AM on April 27, 2022 [16 favorites]
Being trans means getting this from both sides. Doctors who don't understand trans medical care (which is most of them ime) think all of my problems are due to me being on HRT. Doctors who read me as a woman think all of my problems are because I'm possibly pregnant/fat/lying. Trans men seeking care often have to face misogynistic gaslighting that also causes dysphoria, making it extra traumatic.
Fun fact: in the UK, GPs are not required to go through training on how to help trans patients despite being the first point of call for many, a problem that's so concerning that the RCGP recognised correcting it as an "urgent need". I doubt that's going to change any time soon.
posted by fight or flight at 10:01 AM on April 27, 2022 [14 favorites]
Fun fact: in the UK, GPs are not required to go through training on how to help trans patients despite being the first point of call for many, a problem that's so concerning that the RCGP recognised correcting it as an "urgent need". I doubt that's going to change any time soon.
posted by fight or flight at 10:01 AM on April 27, 2022 [14 favorites]
Silvery Fish, I don't think that's a derail at all. You sharing your experience is a gift, and I've known about this problem but I know and understand this problem more deeply now, thanks to you.
I'm so sorry the people providing your dental care haven't treated you with the respect and understanding you deserve.
I so appreciate all the people who have shared their experiences - in the articles linked here, and especially the heartbreaking and infuriating stories I've read here on MetaFilter through the years.
I had hoped there might be some good proposed solutions, especially evidence-based approaches.
I'm still hoping.
posted by kristi at 10:04 AM on April 27, 2022 [7 favorites]
I'm so sorry the people providing your dental care haven't treated you with the respect and understanding you deserve.
I so appreciate all the people who have shared their experiences - in the articles linked here, and especially the heartbreaking and infuriating stories I've read here on MetaFilter through the years.
I had hoped there might be some good proposed solutions, especially evidence-based approaches.
I'm still hoping.
posted by kristi at 10:04 AM on April 27, 2022 [7 favorites]
Yeah. Makes me want to cry, really. Because my friend showed up -- repeatedly -- with persistent belly issues, in her early 50s, eastern European Jewish heritage, and was told "change your diet" and "it's menopause" and "it's just the way it is in middle age" and of course it was actually stage IV ovarian cancer. She showed up with all the classic symptoms and risk factors and still wasn't diagnosed until it was too late. She had "good doctors" and excellent insurance, and it didn't help her.
(Actually how she got diagnosed: after getting no traction with any of her docs, a friend suggested she try acupuncture. The acupuncturist who was "good with belly issues" said "I won't treat you unless you have a pelvic ultrasound first." And ten seconds into the ultrasound she could tell the tech had seen something major.)
A few weeks ago I was having belly issues. I went to my doc and I explicitly said "My friend wasn't taken seriously, and I want you to take me seriously and diagnose this aggressively." Two hours later I was having a CT scan. Two hours after that I had my diagnosis, and it was something that could be fixed. Thank god. But my situation feels like luck, and an anomaly in our current system.
posted by BlahLaLa at 10:18 AM on April 27, 2022 [57 favorites]
(Actually how she got diagnosed: after getting no traction with any of her docs, a friend suggested she try acupuncture. The acupuncturist who was "good with belly issues" said "I won't treat you unless you have a pelvic ultrasound first." And ten seconds into the ultrasound she could tell the tech had seen something major.)
A few weeks ago I was having belly issues. I went to my doc and I explicitly said "My friend wasn't taken seriously, and I want you to take me seriously and diagnose this aggressively." Two hours later I was having a CT scan. Two hours after that I had my diagnosis, and it was something that could be fixed. Thank god. But my situation feels like luck, and an anomaly in our current system.
posted by BlahLaLa at 10:18 AM on April 27, 2022 [57 favorites]
Oh, medical misogyny and racism is one of my soapboxes! There have been some very good books about it written by white women, and if anyone knows of any written by non-binary people or BIPOC, let me know.
but it's also one of the fields most prone to burnout because of our horrible medical system in the US - 15 min patient visits, surface level care, along with some of the worst paid in the profession for the most emotionally laborious, patient-facing work
I work in a family medicine clinic in Canada and it's not much better, tbh. 30 min appointments, get them in and out, and sometimes you get to sit in on meetings where management discusses people as billable time. I mean, I have a family doctor who is also a woman and I routinely have to advocate for myself. I requested a ADHD assessment referral--and I am aware that can take months, it's fine--but she accused me of seeing that ADHD was "very trendy on social media, all sorts of people think they have it." It took TWO appointments to convince her just to send the damn referral in.
posted by Kitteh at 10:24 AM on April 27, 2022 [12 favorites]
but it's also one of the fields most prone to burnout because of our horrible medical system in the US - 15 min patient visits, surface level care, along with some of the worst paid in the profession for the most emotionally laborious, patient-facing work
I work in a family medicine clinic in Canada and it's not much better, tbh. 30 min appointments, get them in and out, and sometimes you get to sit in on meetings where management discusses people as billable time. I mean, I have a family doctor who is also a woman and I routinely have to advocate for myself. I requested a ADHD assessment referral--and I am aware that can take months, it's fine--but she accused me of seeing that ADHD was "very trendy on social media, all sorts of people think they have it." It took TWO appointments to convince her just to send the damn referral in.
posted by Kitteh at 10:24 AM on April 27, 2022 [12 favorites]
if anyone knows of any written by non-binary people or BIPOC,
Harriet Washington's Medical Apartheid is an incredible, harrowing, intense, rage-inducing historical overview about this very topic
posted by paimapi at 10:57 AM on April 27, 2022 [13 favorites]
Harriet Washington's Medical Apartheid is an incredible, harrowing, intense, rage-inducing historical overview about this very topic
posted by paimapi at 10:57 AM on April 27, 2022 [13 favorites]
because of our horrible medical system in the US - 15 min patient visits
People outside of the US please share your experiences, but according to this article, doctors in the US spend more time per visit (about 21 minutes, see figure) than any country except Sweden. In many European countries it's about 10-15 minutes, and in Bangladesh it's 48 seconds. That doesn't mean it's not a problem in the US, just that it seems to be a problem everywhere. And of course physicians provide only a small portion of all medical care.
posted by Mr.Know-it-some at 10:59 AM on April 27, 2022 [3 favorites]
People outside of the US please share your experiences, but according to this article, doctors in the US spend more time per visit (about 21 minutes, see figure) than any country except Sweden. In many European countries it's about 10-15 minutes, and in Bangladesh it's 48 seconds. That doesn't mean it's not a problem in the US, just that it seems to be a problem everywhere. And of course physicians provide only a small portion of all medical care.
posted by Mr.Know-it-some at 10:59 AM on April 27, 2022 [3 favorites]
I still think of this tweet from time to time:
When a doctor dismisses my symptoms, I say I want it noted in my chart -- while I wait -- that *they've chosen* not to run any tests. They then run tests. I recommend this approach to anyone facing discrimination instead of diagnostics. (I have 2 autoimmune disorders.)posted by fings at 11:04 AM on April 27, 2022 [54 favorites]
Dentists need to be added into this discussion. They really need to embrace trauma informed care.
Having lived thru domestic violence, being in a chair where I cannot easily get up or defend myself, with someone doing shit outside of my peripheral vision and then having them do things to my face the usually causes unexpected pain puts me in crisis mode. I’ve gone so far as to present my dentist with a letter explaining the issue with a list of three things they could do to help me get thru even a cleaning — with zero actual effect.
I'm curious what those three things are.
posted by drstrangelove at 11:04 AM on April 27, 2022
Having lived thru domestic violence, being in a chair where I cannot easily get up or defend myself, with someone doing shit outside of my peripheral vision and then having them do things to my face the usually causes unexpected pain puts me in crisis mode. I’ve gone so far as to present my dentist with a letter explaining the issue with a list of three things they could do to help me get thru even a cleaning — with zero actual effect.
I'm curious what those three things are.
posted by drstrangelove at 11:04 AM on April 27, 2022
Oh, and I constantly tell women in my life to aggressively advocate for their health. The tweet above about asking your doctors to document their refusal or dismissal of symptoms/tests/referrals? Absolutely do this. It's not easy for those of us who aren't used to being adamant or are anxious (it me) but it does work.
posted by Kitteh at 11:53 AM on April 27, 2022 [5 favorites]
posted by Kitteh at 11:53 AM on April 27, 2022 [5 favorites]
I'm curious what those things are.
Here's the letter. I've presented it to three dentists' offices now -- the initial reaction when I've presented it has been sympathetic, but the two things I did not have control over (the non-NO2 items) were never actually acted on, which just makes things worse. This is a high-vulnerability issue for this little fish, but am open and interested to gentle suggestions for strengthening the letter.
IMPORTANT PATIENT INFORMATION – PLEASE KEEP WITH MY FILE
Dear [Dentist name] and Staff –
Please keep this letter with my records.
As a survivor of domestic violence, I find dental care extremely difficult, because it echoes some of the aspects of the trauma I experienced –
-- I am “stuck” in a semi-prone position that I am unable to get out of quickly or easily;
- activity is happening in my peripheral vision that isn’t familiar to me;
- and then activity “comes from behind me,” and happens to my face that may lead to sudden pain.
Over the years, I have identified ways to manage my trauma-based fears, and ways in which my dental caretakers can help me feel safe.
• I ask that you tell me what you are going to do before you do any action involving my face or mouth. This one is key. I find that knowing what is going to happen before it happens helps me manage my fear.
• I do require nitrous oxide for all dental procedures beyond cleanings.
• I also use a deep breathing / meditation routine while procedures are being performed. It is very helpful to keep small talk to a minimum when I am reclined in the chair to allow me to stay focused on my calming breathing.
On occasion, our combined best efforts may still not enough, and I might tear up. Please do not be alarmed if this happens. I will always tell you if something hurts. One previous dentist I had, who knew my history, would simply grab a gauze, gently dab up any escaped tears, and continue her work. It was an action that conveyed both dignity and care.
I ask that you share this letter with all staff who will be working with me. My goal is to create a trusting relationship with my dental caretakers so I can resume consistent and proactive dental care. I offer my profound thanks in advance for helping me in these efforts.
With kindest regards,
posted by Silvery Fish at 12:16 PM on April 27, 2022 [60 favorites]
Here's the letter. I've presented it to three dentists' offices now -- the initial reaction when I've presented it has been sympathetic, but the two things I did not have control over (the non-NO2 items) were never actually acted on, which just makes things worse. This is a high-vulnerability issue for this little fish, but am open and interested to gentle suggestions for strengthening the letter.
IMPORTANT PATIENT INFORMATION – PLEASE KEEP WITH MY FILE
Dear [Dentist name] and Staff –
Please keep this letter with my records.
As a survivor of domestic violence, I find dental care extremely difficult, because it echoes some of the aspects of the trauma I experienced –
-- I am “stuck” in a semi-prone position that I am unable to get out of quickly or easily;
- activity is happening in my peripheral vision that isn’t familiar to me;
- and then activity “comes from behind me,” and happens to my face that may lead to sudden pain.
Over the years, I have identified ways to manage my trauma-based fears, and ways in which my dental caretakers can help me feel safe.
• I ask that you tell me what you are going to do before you do any action involving my face or mouth. This one is key. I find that knowing what is going to happen before it happens helps me manage my fear.
• I do require nitrous oxide for all dental procedures beyond cleanings.
• I also use a deep breathing / meditation routine while procedures are being performed. It is very helpful to keep small talk to a minimum when I am reclined in the chair to allow me to stay focused on my calming breathing.
On occasion, our combined best efforts may still not enough, and I might tear up. Please do not be alarmed if this happens. I will always tell you if something hurts. One previous dentist I had, who knew my history, would simply grab a gauze, gently dab up any escaped tears, and continue her work. It was an action that conveyed both dignity and care.
I ask that you share this letter with all staff who will be working with me. My goal is to create a trusting relationship with my dental caretakers so I can resume consistent and proactive dental care. I offer my profound thanks in advance for helping me in these efforts.
With kindest regards,
posted by Silvery Fish at 12:16 PM on April 27, 2022 [60 favorites]
Being trans means getting this from both sides.
Trans misogyny towards trans men is a very real thing. And it's also one of the first 'affirmations' that trans women get to experience - particularly in health care. The state of research on long term care for HRT, or post-op, is still lacking. Trying to get solid answers from even a gender affirming care doc on what the best course of action is long term on HRT is very hard... And trying to get help with post op issues is tough too.
posted by Flight Hardware, do not touch at 12:33 PM on April 27, 2022 [3 favorites]
Trans misogyny towards trans men is a very real thing. And it's also one of the first 'affirmations' that trans women get to experience - particularly in health care. The state of research on long term care for HRT, or post-op, is still lacking. Trying to get solid answers from even a gender affirming care doc on what the best course of action is long term on HRT is very hard... And trying to get help with post op issues is tough too.
posted by Flight Hardware, do not touch at 12:33 PM on April 27, 2022 [3 favorites]
Silvery Fish--
Thank you. I was curious because I am a dentist and didn't find anything you requested to be unreasonable or honestly even much of an inconvenience to the flow of treatment. Some offices don't have nitrous, of course, but I'm sure this is something you looked into before going there.
Have you considered sedation dentistry? Often the dentists who provide that service are typically more sympathetic to people's needs than other dentists simply because they often have to talk deeply fearful people off of a ledge in order to help them get necessary treatment. Often these people were tortured by previous dentists who didn't care if they were hurting them.
posted by drstrangelove at 12:43 PM on April 27, 2022 [5 favorites]
Thank you. I was curious because I am a dentist and didn't find anything you requested to be unreasonable or honestly even much of an inconvenience to the flow of treatment. Some offices don't have nitrous, of course, but I'm sure this is something you looked into before going there.
Have you considered sedation dentistry? Often the dentists who provide that service are typically more sympathetic to people's needs than other dentists simply because they often have to talk deeply fearful people off of a ledge in order to help them get necessary treatment. Often these people were tortured by previous dentists who didn't care if they were hurting them.
posted by drstrangelove at 12:43 PM on April 27, 2022 [5 favorites]
perhaps include that you're non-negotiably looking for a dentist who will follow all your stipulations & if this dentist does not, you'll be changing dentists?
possibly also mention you're a strong advocate for the disabled/trauma survivor community online & have an obligation to leave a review of the dentist based on whether they met your completely reasonable not much to ask for at ALL, I include as commentary needs?
very sorry they don't just listen to you the first time & make a point to do the dang thing
on the larger subject this is one of my pet issues as well; my personal experiences are less bad than others' but I'll never forget the urgent care doctor who burst into the room & without asking any questions angrily shouted at me that I had stomach flu & should stop wasting his time (I know what stomach flu looks like & at that point in my life only went to the doctor when I legitimately thought I was dying)
or the gastroenterologist who rolled his eyes at me & said "tell me about your so-called diarrhea"
idk I think it's a combination power trip plus whatever that drive is people have to be the anti-malingering police, like you're Hercule fucking Poirot if you "catch" someone who "shouldn't" be using a cane/wheelchair/accessible parking pass, & your worldview is so skewed you think these people are everywhere
like less time with patients isn't not an issue but I think mostly it's shitty mental frameworks &/or just sucking as a person
posted by taquito sunrise at 12:57 PM on April 27, 2022 [8 favorites]
possibly also mention you're a strong advocate for the disabled/trauma survivor community online & have an obligation to leave a review of the dentist based on whether they met your completely reasonable not much to ask for at ALL, I include as commentary needs?
very sorry they don't just listen to you the first time & make a point to do the dang thing
on the larger subject this is one of my pet issues as well; my personal experiences are less bad than others' but I'll never forget the urgent care doctor who burst into the room & without asking any questions angrily shouted at me that I had stomach flu & should stop wasting his time (I know what stomach flu looks like & at that point in my life only went to the doctor when I legitimately thought I was dying)
or the gastroenterologist who rolled his eyes at me & said "tell me about your so-called diarrhea"
idk I think it's a combination power trip plus whatever that drive is people have to be the anti-malingering police, like you're Hercule fucking Poirot if you "catch" someone who "shouldn't" be using a cane/wheelchair/accessible parking pass, & your worldview is so skewed you think these people are everywhere
like less time with patients isn't not an issue but I think mostly it's shitty mental frameworks &/or just sucking as a person
posted by taquito sunrise at 12:57 PM on April 27, 2022 [8 favorites]
I didn't listen to the program, but it seems worth noting that the link in the FPP does not mention non-binary people and adding us perpetuates the whole "non-binary people are all afab and have woman-adjacent genders" thing, which is, in fact, an obstacle in and of itself to getting medical care.
posted by hoyland at 12:58 PM on April 27, 2022 [15 favorites]
posted by hoyland at 12:58 PM on April 27, 2022 [15 favorites]
Here's the letter.
I wonder if it would help to insist, at the start of each appointment, that the provider read the letter out loud to you, or even just read out loud the three bulleted items. My experiences are leading me to believe that many medical providers either can't be bothered to read the stuff in one's file or are actually functionally illiterate.
posted by heatherlogan at 1:40 PM on April 27, 2022 [4 favorites]
I wonder if it would help to insist, at the start of each appointment, that the provider read the letter out loud to you, or even just read out loud the three bulleted items. My experiences are leading me to believe that many medical providers either can't be bothered to read the stuff in one's file or are actually functionally illiterate.
posted by heatherlogan at 1:40 PM on April 27, 2022 [4 favorites]
For writing by BIPOC folks, I highly recommend Inflamed by Dr. Rupa Marya.
posted by gingerbeer at 1:43 PM on April 27, 2022 [7 favorites]
posted by gingerbeer at 1:43 PM on April 27, 2022 [7 favorites]
Have you considered sedation dentistry?
That gets complicated. It requires someone to drive you to and from the appointment, and I do not have family near by.
I am also currently an hourly employee with limited sick leave hours, and the sedation option means a half day instead of a long lunch hour.
I wonder if it would help to insist, at the start of each appointment, that the provider read the letter out loud to you,
I like this. Reading it to them is kinda out of the question because I start crying: it kicks open the trauma box, and I feel like such a goddam idiot for having to ask in the first place because trauma is complicated and vulnerable and makes you feel small, and it makes me angry that I even have to disclose stuff to people who have no framework to grok all of this in the first place, and then I’m a mess for the rest of the appointment.
It would be so, so nice to walk in and say, “I’m one of your patients that needs your trauma protocols” and THEY get it, and I don’t have to talk about the details. I mean, self-advocating is one thing, and I’m good for that. But I am having to TEACH them. That should not be on me to do.
posted by Silvery Fish at 2:21 PM on April 27, 2022 [18 favorites]
That gets complicated. It requires someone to drive you to and from the appointment, and I do not have family near by.
I am also currently an hourly employee with limited sick leave hours, and the sedation option means a half day instead of a long lunch hour.
I wonder if it would help to insist, at the start of each appointment, that the provider read the letter out loud to you,
I like this. Reading it to them is kinda out of the question because I start crying: it kicks open the trauma box, and I feel like such a goddam idiot for having to ask in the first place because trauma is complicated and vulnerable and makes you feel small, and it makes me angry that I even have to disclose stuff to people who have no framework to grok all of this in the first place, and then I’m a mess for the rest of the appointment.
It would be so, so nice to walk in and say, “I’m one of your patients that needs your trauma protocols” and THEY get it, and I don’t have to talk about the details. I mean, self-advocating is one thing, and I’m good for that. But I am having to TEACH them. That should not be on me to do.
posted by Silvery Fish at 2:21 PM on April 27, 2022 [18 favorites]
I am acquainted with too many younger doctors/residents/medical students to believe that it's a solely a problem of older doctors. Very few of them are particularly empathetic. I'd say arrogance is more common than not.
posted by Peach at 3:12 PM on April 27, 2022 [10 favorites]
posted by Peach at 3:12 PM on April 27, 2022 [10 favorites]
I agree that the best solution is just more doctors, both so they have more time with patients and hopefully so doctors see themselves a little less like wizards and a little more like partners to patients. Let more people into medical school and stop training doctors to think they're so special.
posted by ssg at 4:11 PM on April 27, 2022 [4 favorites]
posted by ssg at 4:11 PM on April 27, 2022 [4 favorites]
I know someone whose children were molested via sedation dentistry. That is not the answer. I told the intake nurse, I was a sexual assault victim in a medical setting. I did not want to find myself going under anesthesia alone, in a room full of males. The anesthesiologist was making fun at me as he took me down, he did agree to no benzos, I was naked in a paper gown that barely closed, and there were six other guys there, not one female. The anesthesia report was like a lifesaving class, they dropped my body temp so low it became an emergency, etc, etc, etc.
The surgeon did a great job, but I had to make him. I told him I needed my shoulder repaired like a collehe kid, who wants to pitch for The Dodgers. He said that the gold standard of care for someone that age was much different than for a woman of my age. I said," Careful." I cook with cast iron, do my own plumbing, hang my clothes on the line, and shoot with a heavy, hand held camera. He said that he would see what was there to work with. That would determine his approach. He did a great job. I had to insist. You have to be the most adept consumer when it comes to medical care, even with Medicare, or Medicaid. You make it better for everyone if you are direct. (He said I had fine, delicate bones, but my muscles and tendons were huge, there was plenty to work with.)
posted by Oyéah at 5:15 PM on April 27, 2022 [12 favorites]
The surgeon did a great job, but I had to make him. I told him I needed my shoulder repaired like a collehe kid, who wants to pitch for The Dodgers. He said that the gold standard of care for someone that age was much different than for a woman of my age. I said," Careful." I cook with cast iron, do my own plumbing, hang my clothes on the line, and shoot with a heavy, hand held camera. He said that he would see what was there to work with. That would determine his approach. He did a great job. I had to insist. You have to be the most adept consumer when it comes to medical care, even with Medicare, or Medicaid. You make it better for everyone if you are direct. (He said I had fine, delicate bones, but my muscles and tendons were huge, there was plenty to work with.)
posted by Oyéah at 5:15 PM on April 27, 2022 [12 favorites]
Yes, it's important to advocate for yourself. Marginalized folks do, regularly, and it does make a difference. The disparities still happen, even after self-advocacy. And that effort and time and energy is another drain on folks who are generally already burdened in many other ways.
We also try to route around the BS, or work through it, and help each other. We pass around doctor names, this one has good top surgeries, this one accepted a letter from my therapist for a hysterectomy before I was 30, and more general info, a list of red flags like requiring letters in excess of WPATH requirements, links to insurance formularies, legal guides, etc. But that's finding the helpful doctors, not changing the shitty ones. It's marking a safe walking path when we need someone to actually clear the land mines from the road.
The real solution is changing the systems that perpetuate inequities. Self-advocacy is a meager substitute for having medical professionals who understand, and people to advocate for you. It may move the dial for you, but it does little to nothing for the next person.
I hope more people, when they hear about a problem with a system like medical gaslighting, will start to think, "how can we change this system" rather than just, "how can I suggest someone deal with this themselves."
posted by Chrysopoeia at 10:20 PM on April 27, 2022 [11 favorites]
We also try to route around the BS, or work through it, and help each other. We pass around doctor names, this one has good top surgeries, this one accepted a letter from my therapist for a hysterectomy before I was 30, and more general info, a list of red flags like requiring letters in excess of WPATH requirements, links to insurance formularies, legal guides, etc. But that's finding the helpful doctors, not changing the shitty ones. It's marking a safe walking path when we need someone to actually clear the land mines from the road.
The real solution is changing the systems that perpetuate inequities. Self-advocacy is a meager substitute for having medical professionals who understand, and people to advocate for you. It may move the dial for you, but it does little to nothing for the next person.
I hope more people, when they hear about a problem with a system like medical gaslighting, will start to think, "how can we change this system" rather than just, "how can I suggest someone deal with this themselves."
posted by Chrysopoeia at 10:20 PM on April 27, 2022 [11 favorites]
I’m not sure about the US, but in the UK, Special Care Dentistry is a separate specialty (deals with patients who can’t access standard dental care due to dental phobia, learning disability, physical disability, mental illness, sensory issues, etc). They would absolutely see somebody with PTSD from DV triggered by dental care.
posted by tinkletown at 12:20 AM on April 28, 2022 [4 favorites]
posted by tinkletown at 12:20 AM on April 28, 2022 [4 favorites]
I had a conversation with a doctor last year where he told me that I had to strongly advocate for myself in order to receive good medical care. A few minutes later, after I let him know that I'd put off taking a particular medication he'd prescribed so I could check with a pharmacist for complications involving my complex medication regime, he told me that of course he'd checked for counterindications, and that I really shouldn't second-guess him.
I didn't bring up the contradiction because at that point, why bother?
You know who's not good at advocating for themselves? Sick people. People in pain. People in the midst of mental health crises. The fact that we expect people to advocate for themselves in order to navigate a health care system that will take advantage of them at every opportunity, will deny them care if they don't speak up for themselves, is monstrous. The fact that they have to do so when going through pain and illness and grief and loss, the fact that this responsibility is on us even when we're unconscious, is appalling.
I have an appointment with a new surgeon... soon? And hopefully, he'll operate, because ow. And I realized today that I'm more worried about the interactions with the medical staff that I'll have to navigate than I am about the surgery, or the pain after the surgery. Because so far, as a chubby asocial gay guy, I have not been very successful in advocating for myself. I think perhaps the difficulty of advocating for oneself is a variable, and it's very much dependent things like the patient's skin color and the bigotry level of the medical personnel. And I think that perhaps, if advocating for oneself is so vital to navigating something as important as health care, that maybe they should teach some classes in how to do that. Put out a flyer or something. Because no matter how I try advocating for myself, it never seems to help much.
I'm sick and tired of advocating for myself. The only time I've made progress with any of this is when a doctor finally believed me (usually after being presented with ridiculous amounts of documented evidence) and advocated for me. When did doctors stop being our advocates and become our adversaries?
posted by MrVisible at 1:54 AM on April 28, 2022 [15 favorites]
I didn't bring up the contradiction because at that point, why bother?
You know who's not good at advocating for themselves? Sick people. People in pain. People in the midst of mental health crises. The fact that we expect people to advocate for themselves in order to navigate a health care system that will take advantage of them at every opportunity, will deny them care if they don't speak up for themselves, is monstrous. The fact that they have to do so when going through pain and illness and grief and loss, the fact that this responsibility is on us even when we're unconscious, is appalling.
I have an appointment with a new surgeon... soon? And hopefully, he'll operate, because ow. And I realized today that I'm more worried about the interactions with the medical staff that I'll have to navigate than I am about the surgery, or the pain after the surgery. Because so far, as a chubby asocial gay guy, I have not been very successful in advocating for myself. I think perhaps the difficulty of advocating for oneself is a variable, and it's very much dependent things like the patient's skin color and the bigotry level of the medical personnel. And I think that perhaps, if advocating for oneself is so vital to navigating something as important as health care, that maybe they should teach some classes in how to do that. Put out a flyer or something. Because no matter how I try advocating for myself, it never seems to help much.
I'm sick and tired of advocating for myself. The only time I've made progress with any of this is when a doctor finally believed me (usually after being presented with ridiculous amounts of documented evidence) and advocated for me. When did doctors stop being our advocates and become our adversaries?
posted by MrVisible at 1:54 AM on April 28, 2022 [15 favorites]
I know someone whose children were molested via sedation dentistry. That is not the answer.
Silvery Fish has already given reasons why sedation dentistry isn't an option but to simply dismiss the entire discipline out of hand due to an extreme outlier like the case you mentioned is not particularly helpful.
I’m not sure about the US, but in the UK, Special Care Dentistry is a separate specialty (deals with patients who can’t access standard dental care due to dental phobia, learning disability, physical disability, mental illness, sensory issues, etc). They would absolutely see somebody with PTSD from DV triggered by dental care.
We have this in the United States although very often it is either affiliated with a dental school.
posted by drstrangelove at 3:26 AM on April 28, 2022 [2 favorites]
Silvery Fish has already given reasons why sedation dentistry isn't an option but to simply dismiss the entire discipline out of hand due to an extreme outlier like the case you mentioned is not particularly helpful.
I’m not sure about the US, but in the UK, Special Care Dentistry is a separate specialty (deals with patients who can’t access standard dental care due to dental phobia, learning disability, physical disability, mental illness, sensory issues, etc). They would absolutely see somebody with PTSD from DV triggered by dental care.
We have this in the United States although very often it is either affiliated with a dental school.
posted by drstrangelove at 3:26 AM on April 28, 2022 [2 favorites]
Also, I think it's perfectly reasonable to have a frank discussion with the dentist (and their assistant before the dentist enters the room) about the letter you sent and if those things can be accommodated. If they can't, I'd just find another dentist.
But... believe me, making them read the letter, as though they were a child, is not going to be well-received in a busy office. The skills and energy required to provide dentistry in the first place is extremely taxing and patient interactions are extremely draining. I don't know a single dentist who doesn't suffer from extreme anxiety. I have friends who were extroverted, outgoing life-of-the-party types when we started school together who quickly became hermits who avoided all interactions outside of the workplace after a few years in practice.
posted by drstrangelove at 3:33 AM on April 28, 2022 [1 favorite]
But... believe me, making them read the letter, as though they were a child, is not going to be well-received in a busy office. The skills and energy required to provide dentistry in the first place is extremely taxing and patient interactions are extremely draining. I don't know a single dentist who doesn't suffer from extreme anxiety. I have friends who were extroverted, outgoing life-of-the-party types when we started school together who quickly became hermits who avoided all interactions outside of the workplace after a few years in practice.
posted by drstrangelove at 3:33 AM on April 28, 2022 [1 favorite]
But... believe me, making them read the letter, as though they were a child, is not going to be well-received in a busy office.
Wow. Maybe you should unpack that a bit.
*I* should be thinking about how *I* might be annoying *you* when I am struggling to find a way to communicate to *you* a need I have to get through an experience without shaking or crying, when *you* don’t even have enough of a framework to understand the issue that I have to draw the lines between how the standard setup of dental practices mimics physical aspects of an abuse situation, and the letter was a last-ditch effort to do so because *nobody remembers from appointment to appointment* and it is infuriating and humiliating share this stuff over and over again ?
You own the”like a child” bit. That is some interesting framing that deserves some compassionate unpacking on your end.
If you (as a dentist in general, not you personally) do not have a framework that includes empathetic understanding of how A can mimic B, and a mechanism for having a default method in place for having this noted in a patient’s chart and acted on every time, actual protocols, then maybe that’s where you should be looking to suggest better ways for having and documenting these discussions — at your industry. It’s not as if we’re a small part of the population.
And from the rest of your comment, it sounds like dentistry should be having a serious conversation about empathetic care across the board.
And I also think your framing and tone in the last part of your comment is part of the reason why we are here, having this conversation, in the first place.
So, I am empathetic to you as a person who is stuck in an industry that is designed to eat you up from the inside. I am not empathetic to your suggestion that I, as a person paying you for care, and who holds up my part of the contract by being kind, friendly, on time for my appointments, understanding when you are running late, and pay the day of service, ALSO manage the emotional health issues caused by your job. I can’t do both - not when I am in your chair.
posted by Silvery Fish at 4:38 AM on April 28, 2022 [20 favorites]
Wow. Maybe you should unpack that a bit.
*I* should be thinking about how *I* might be annoying *you* when I am struggling to find a way to communicate to *you* a need I have to get through an experience without shaking or crying, when *you* don’t even have enough of a framework to understand the issue that I have to draw the lines between how the standard setup of dental practices mimics physical aspects of an abuse situation, and the letter was a last-ditch effort to do so because *nobody remembers from appointment to appointment* and it is infuriating and humiliating share this stuff over and over again ?
You own the”like a child” bit. That is some interesting framing that deserves some compassionate unpacking on your end.
If you (as a dentist in general, not you personally) do not have a framework that includes empathetic understanding of how A can mimic B, and a mechanism for having a default method in place for having this noted in a patient’s chart and acted on every time, actual protocols, then maybe that’s where you should be looking to suggest better ways for having and documenting these discussions — at your industry. It’s not as if we’re a small part of the population.
And from the rest of your comment, it sounds like dentistry should be having a serious conversation about empathetic care across the board.
And I also think your framing and tone in the last part of your comment is part of the reason why we are here, having this conversation, in the first place.
So, I am empathetic to you as a person who is stuck in an industry that is designed to eat you up from the inside. I am not empathetic to your suggestion that I, as a person paying you for care, and who holds up my part of the contract by being kind, friendly, on time for my appointments, understanding when you are running late, and pay the day of service, ALSO manage the emotional health issues caused by your job. I can’t do both - not when I am in your chair.
posted by Silvery Fish at 4:38 AM on April 28, 2022 [20 favorites]
as though they were a child,
Yeah, this is interesting, and I suspect part of the reason why we are here talking about this.
I imagine you believe I am female, and have run the context of my letter through that filter, and without realizing it defaulted to a mother/child framework.
The only dentist who “got” this issue when I talked to her about it said she also hears this from her patients who have PTSD from combat experiences. The same set of reactions to being in the chair, and who ask for similar accommodations.
As a thought exercise: if a man came in and handed you a similar letter tho referencing combat rather than domestic violence, would you still feel like you were being talked to like a child? Or would you interpret it as a bravely vulnerable person who has Seen Some Shit who is trying to communicate something difficult and personal in a way that protects their dignity?
posted by Silvery Fish at 5:23 AM on April 28, 2022 [21 favorites]
Yeah, this is interesting, and I suspect part of the reason why we are here talking about this.
I imagine you believe I am female, and have run the context of my letter through that filter, and without realizing it defaulted to a mother/child framework.
The only dentist who “got” this issue when I talked to her about it said she also hears this from her patients who have PTSD from combat experiences. The same set of reactions to being in the chair, and who ask for similar accommodations.
As a thought exercise: if a man came in and handed you a similar letter tho referencing combat rather than domestic violence, would you still feel like you were being talked to like a child? Or would you interpret it as a bravely vulnerable person who has Seen Some Shit who is trying to communicate something difficult and personal in a way that protects their dignity?
posted by Silvery Fish at 5:23 AM on April 28, 2022 [21 favorites]
and handed you a similar letter
The "as though they were a child" is in response to being told to read the letter out loud, not to being handed the letter. Here is what that person said about the letter itself:
Also, I think it's perfectly reasonable to have a frank discussion with the dentist (and their assistant before the dentist enters the room) about the letter you sent and if those things can be accommodated.
It's pretty clear from this that the person is OK with being handed the letter and would expect to read it and discuss it with the patient. The problem is clearly with being asked to read the letter out loud, which is what is referenced as treating the dentist like a child. That is the only part of the request that is being questioned.
posted by FencingGal at 8:02 AM on April 28, 2022
The "as though they were a child" is in response to being told to read the letter out loud, not to being handed the letter. Here is what that person said about the letter itself:
Also, I think it's perfectly reasonable to have a frank discussion with the dentist (and their assistant before the dentist enters the room) about the letter you sent and if those things can be accommodated.
It's pretty clear from this that the person is OK with being handed the letter and would expect to read it and discuss it with the patient. The problem is clearly with being asked to read the letter out loud, which is what is referenced as treating the dentist like a child. That is the only part of the request that is being questioned.
posted by FencingGal at 8:02 AM on April 28, 2022
I mean - imagine someone writing an Ask saying my boss gives me instructions and insists that I read them to her out loud. Everyone would say that's a horrible boss and a toxic workplace and the person needs to get out.
I get that people really need a dentist to understand and work with trauma issues. Discussing the contents of the letter with the dentist seems like a good idea, and no one has objected to that. Asking the dentist to read the letter out loud will almost certainly be taken as offensive, and I would not say the dentist is wrong to feel that way.
posted by FencingGal at 8:11 AM on April 28, 2022 [1 favorite]
I get that people really need a dentist to understand and work with trauma issues. Discussing the contents of the letter with the dentist seems like a good idea, and no one has objected to that. Asking the dentist to read the letter out loud will almost certainly be taken as offensive, and I would not say the dentist is wrong to feel that way.
posted by FencingGal at 8:11 AM on April 28, 2022 [1 favorite]
Asking the dentist to read the letter out loud will almost certainly be taken as offensive, and I would not say the dentist is wrong to feel that way.
FencingGal, thank you for pointing out that I read too, too quickly and completely missed that important part of the context.
DrStrangelove, I owe you an apology. I read too quickly and I reacted to and responded to my misreading of your comment. This stuff is kicking up stuff for both of us. You have stepped in to gently try to understand and offer suggestions during the conversation, and I torpedoed the boat. I hope you can accept my apology and my acknowledgment that I missed the important context. Yes, I can see where reading it out loud wouldn’t work for you, and why it wouldn’t feel comfortable for you.
posted by Silvery Fish at 8:22 AM on April 28, 2022 [11 favorites]
FencingGal, thank you for pointing out that I read too, too quickly and completely missed that important part of the context.
DrStrangelove, I owe you an apology. I read too quickly and I reacted to and responded to my misreading of your comment. This stuff is kicking up stuff for both of us. You have stepped in to gently try to understand and offer suggestions during the conversation, and I torpedoed the boat. I hope you can accept my apology and my acknowledgment that I missed the important context. Yes, I can see where reading it out loud wouldn’t work for you, and why it wouldn’t feel comfortable for you.
posted by Silvery Fish at 8:22 AM on April 28, 2022 [11 favorites]
I go to a family dentistry, and everything in your letter is normal operating procedure. The nitrous request is even handled, ie: they give you different sedative alternatives depending on how much you are willing to pay/covered by insurance.
posted by The_Vegetables at 9:24 AM on April 28, 2022 [1 favorite]
posted by The_Vegetables at 9:24 AM on April 28, 2022 [1 favorite]
I mean - imagine someone writing an Ask saying my boss gives me instructions and insists that I read them to her out loud. Everyone would say that's a horrible boss and a toxic workplace and the person needs to get out.
You're right - in that context, we would see such behavior as toxic and demeaning.
But we're not talking about that context, though. We're talking about the context of a profession where patient needs and requests are routinely ignored by practitioners - in fact, where practitioners routinely view and treat the patient as the enemy, and their requests as lies. And in that context, the point of making the practitioner read such a note detailing the patient's specific requests is much the same as having a legal contract read out - to get everyone on the same page and to make sure that there are no misunderstandings.
At this point, I no longer have have any patience with the medical profession (and yes, I include dentists in that measure) and complaints over patients forcing practitioners to do their fucking job and support the people they are ostensibly caring for because of the utter failure the profession has had at doing so. If the idea of a patient making a practitioner read out their specific requests so that they can feel safe in receiving treatment bothers you - then perhaps you should work to clean up the profession so that patients don't feel they need to do that.
posted by NoxAeternum at 9:24 AM on April 28, 2022 [9 favorites]
You're right - in that context, we would see such behavior as toxic and demeaning.
But we're not talking about that context, though. We're talking about the context of a profession where patient needs and requests are routinely ignored by practitioners - in fact, where practitioners routinely view and treat the patient as the enemy, and their requests as lies. And in that context, the point of making the practitioner read such a note detailing the patient's specific requests is much the same as having a legal contract read out - to get everyone on the same page and to make sure that there are no misunderstandings.
At this point, I no longer have have any patience with the medical profession (and yes, I include dentists in that measure) and complaints over patients forcing practitioners to do their fucking job and support the people they are ostensibly caring for because of the utter failure the profession has had at doing so. If the idea of a patient making a practitioner read out their specific requests so that they can feel safe in receiving treatment bothers you - then perhaps you should work to clean up the profession so that patients don't feel they need to do that.
posted by NoxAeternum at 9:24 AM on April 28, 2022 [9 favorites]
So you may check for a dentist that regularly sees children. They will be much more careful.
posted by The_Vegetables at 9:24 AM on April 28, 2022
posted by The_Vegetables at 9:24 AM on April 28, 2022
> So you may check for a dentist that regularly sees children. They will be much more careful.
This statement seems pretty suspect to me considering how many people develop lifelong dental phobias due to the experiences they had at child dentists.
posted by threementholsandafuneral at 11:36 AM on April 28, 2022 [4 favorites]
This statement seems pretty suspect to me considering how many people develop lifelong dental phobias due to the experiences they had at child dentists.
posted by threementholsandafuneral at 11:36 AM on April 28, 2022 [4 favorites]
This statement seems pretty suspect to me considering how many people develop lifelong dental phobias due to the experiences they had at child dentists.
This research paper says that the number of non-painful (ie: regular checkups) vs painful (cavities filling/tooth extraction)dental visits increases dental anxiety among children, so regular checkups help. The giant needle jammed into your face (for local anesthetic injection) was another source, parental fears about dentistry communicated to children, and finally other trauma [assault and gag reflex], and other anxieties are the main predictors of dental phobia in children.
Several of these things are parents can help with. Others not so much.
posted by The_Vegetables at 1:58 PM on April 28, 2022
This research paper says that the number of non-painful (ie: regular checkups) vs painful (cavities filling/tooth extraction)dental visits increases dental anxiety among children, so regular checkups help. The giant needle jammed into your face (for local anesthetic injection) was another source, parental fears about dentistry communicated to children, and finally other trauma [assault and gag reflex], and other anxieties are the main predictors of dental phobia in children.
Several of these things are parents can help with. Others not so much.
posted by The_Vegetables at 1:58 PM on April 28, 2022
And in that context, the point of making the practitioner read such a note detailing the patient's specific requests is much the same as having a legal contract read out - to get everyone on the same page and to make sure that there are no misunderstandings.
I haven't been in a situation where a legal document was read out loud either - perhaps that happens, just not to me. In general, I feel that people are more likely to go out of their way for me if I treat them with the same kind of respect I want to be treated with - and I think saying "you have to read this out loud" feels disrespectful. And I'm not saying that because I think people have to respect doctors - I'm talking about general respect for human beings.
I've met a lot of patients who have signed consent forms they clearly didn't read - they'll say they were never told some possible side effect that had to have been on the form. Yet if a doctor dealt with that by saying I had to read a consent form out loud, I'd be furious. I even hate it when nurses have to read lengthy info on cancer drugs out loud to me. The power dynamics are different, of course, but it's a big "I don't trust you" statement, and I don't feel that my treatment will be improved if the first thing I do is piss off my doctor.
At the same time, I nearly died from being misdiagnosed, my first oncologist was awful for all kinds of reasons, and I've had two doctors flat out lie to me to get me to change my mind about treatment, so I do understand rage at the medical profession. I just feel that carrying that rage into new encounters can be counterproductive.
posted by FencingGal at 5:31 PM on April 28, 2022 [1 favorite]
I haven't been in a situation where a legal document was read out loud either - perhaps that happens, just not to me. In general, I feel that people are more likely to go out of their way for me if I treat them with the same kind of respect I want to be treated with - and I think saying "you have to read this out loud" feels disrespectful. And I'm not saying that because I think people have to respect doctors - I'm talking about general respect for human beings.
I've met a lot of patients who have signed consent forms they clearly didn't read - they'll say they were never told some possible side effect that had to have been on the form. Yet if a doctor dealt with that by saying I had to read a consent form out loud, I'd be furious. I even hate it when nurses have to read lengthy info on cancer drugs out loud to me. The power dynamics are different, of course, but it's a big "I don't trust you" statement, and I don't feel that my treatment will be improved if the first thing I do is piss off my doctor.
At the same time, I nearly died from being misdiagnosed, my first oncologist was awful for all kinds of reasons, and I've had two doctors flat out lie to me to get me to change my mind about treatment, so I do understand rage at the medical profession. I just feel that carrying that rage into new encounters can be counterproductive.
posted by FencingGal at 5:31 PM on April 28, 2022 [1 favorite]
A dear friend of mine recently started her nursing Ph.D., and her dissertation will be on improving outcomes in mental health care for BIPOC women, whose access to care and quality of treatment is markedly below white women and men generally. It's deeply informed by her mother's attempts to access mental health care, and the barriers she faced in doing so, and how often her mother's serious depression was dismissed as her being an "angry Black woman." We proofread for each other, so I've been learning a lot as I proofread her papers for her coursework and her literature reviews, etc., as she works towards structuring her dissertation. It's all so infuriating; part of me wonders how she can bear to immerse herself in the research and data every single day.
I went 20 years with a serious undiagnosed autoimmune disorder being repeatedly pushed off by doctors for being female, overweight, etc. The one that really stands out in my mind was about four years ago (I was diagnosed about 18 months ago now, so things were pretty bad 4 years ago) and I explained to the doctor I was having terrible problems with breathlessness, the inhaler was making me sick and didn't help with the breathlessness, and I was starting to lose sensation in my fingers and toes. He said, super-casually, "Well, you're so out of shape and overweight, it's probably just pre-diabetes." (Which, fucko, loss of sensation in your toes is pretty advanced diabetes, I feel like that was covered in med school.) He asked me to run down my diet for him, and I did, and he said, "Well, you're obviously lying about that, so we'll just run some blood tests." (He was convinced I ate a ton of sugar and carbs, which I do not! And he was running through all kinds of specific sugary foods looking for the magic bullet he could tell me to lay off eating that and feel like he'd fixed the problem. "Store-bought bread." "I don't really eat bread." "Salad dressing is full of sugar --" "I make it at home, and I don't add sugar." Like, I specifically avoid a lot of secretly-sugary processed food not because of any special virtue but because I don't have a sweet tooth (it's a salt tooth), so I don't eat very much sugar, so it all tastes SO offputtingly sweet to me.)
So he ran the blood tests, they came back that I was not anywhere near diabetic, and when I attempted to follow up and said I was still having numbness in my fingers and toes, he basically said, "Well, it's not diabetes, so you're probably just imagining it." Fast forward 18 months and I ended up hospitalized during a goddamn pandemic with extensive neurological symptoms for what was finally diagnosed as a super-easily-treatable autoimmune disorder.
(I did complain about the diabetes doctor to both the medical licensing board and on local social media, where a bunch of other middle-aged women chimed in, and basically the dude's entire medical school training appeared to consist of looking at a middle-aged woman, saying, "You're fat," and telling her to stop eating sugar. No female-presenting people who commented had EVER been diagnosed with ANYTHING by him, including strep throat. "Oh, it's probably heartburn because you're overweight." "ALL OF MY CHILDREN HAVE STREP I NEED AN ANTIBIOTIC." "Strep isn't circulating right now, it's heartburn." Like, what exactly was this guy's gynecology rotation, and why did it involve so much sugar? Was it at a bakery or something? Did he think these cakes were people?) (Of course several men chimed in to be like, "Oh, he's great, he really helped with my knee pain!" Good thing you had male-presenting knees or he would have been like IT'S THE SUGAR.)
posted by Eyebrows McGee at 9:04 PM on April 28, 2022 [14 favorites]
I went 20 years with a serious undiagnosed autoimmune disorder being repeatedly pushed off by doctors for being female, overweight, etc. The one that really stands out in my mind was about four years ago (I was diagnosed about 18 months ago now, so things were pretty bad 4 years ago) and I explained to the doctor I was having terrible problems with breathlessness, the inhaler was making me sick and didn't help with the breathlessness, and I was starting to lose sensation in my fingers and toes. He said, super-casually, "Well, you're so out of shape and overweight, it's probably just pre-diabetes." (Which, fucko, loss of sensation in your toes is pretty advanced diabetes, I feel like that was covered in med school.) He asked me to run down my diet for him, and I did, and he said, "Well, you're obviously lying about that, so we'll just run some blood tests." (He was convinced I ate a ton of sugar and carbs, which I do not! And he was running through all kinds of specific sugary foods looking for the magic bullet he could tell me to lay off eating that and feel like he'd fixed the problem. "Store-bought bread." "I don't really eat bread." "Salad dressing is full of sugar --" "I make it at home, and I don't add sugar." Like, I specifically avoid a lot of secretly-sugary processed food not because of any special virtue but because I don't have a sweet tooth (it's a salt tooth), so I don't eat very much sugar, so it all tastes SO offputtingly sweet to me.)
So he ran the blood tests, they came back that I was not anywhere near diabetic, and when I attempted to follow up and said I was still having numbness in my fingers and toes, he basically said, "Well, it's not diabetes, so you're probably just imagining it." Fast forward 18 months and I ended up hospitalized during a goddamn pandemic with extensive neurological symptoms for what was finally diagnosed as a super-easily-treatable autoimmune disorder.
(I did complain about the diabetes doctor to both the medical licensing board and on local social media, where a bunch of other middle-aged women chimed in, and basically the dude's entire medical school training appeared to consist of looking at a middle-aged woman, saying, "You're fat," and telling her to stop eating sugar. No female-presenting people who commented had EVER been diagnosed with ANYTHING by him, including strep throat. "Oh, it's probably heartburn because you're overweight." "ALL OF MY CHILDREN HAVE STREP I NEED AN ANTIBIOTIC." "Strep isn't circulating right now, it's heartburn." Like, what exactly was this guy's gynecology rotation, and why did it involve so much sugar? Was it at a bakery or something? Did he think these cakes were people?) (Of course several men chimed in to be like, "Oh, he's great, he really helped with my knee pain!" Good thing you had male-presenting knees or he would have been like IT'S THE SUGAR.)
posted by Eyebrows McGee at 9:04 PM on April 28, 2022 [14 favorites]
I have a million things I want to say about this subject, but a lot of them have been said well already, so let me just say WOW YES THIS SILVERY FISH! I've never heard anyone else talk about the dentist being hard for them the way it is for me before.
posted by mostlymartha at 11:45 PM on April 28, 2022 [4 favorites]
posted by mostlymartha at 11:45 PM on April 28, 2022 [4 favorites]
For those of us who are both doctors and women of color, we navigate a very difficult space in these conversations. Sometimes I think some patients chose to come to me because we share a common language (not necessarily the actual words coming out of our mouths, but the "language" of being marginalized). And there's some data (though very mixed) to suggest that identity concordance between patient and clinician is associated with better health outcomes.
But at the same time, there's also data (not mixed) that women doctors, and doctors of color, are routinely rated as less competent by everyone -- professors, peers, and patients. At my institution, we get a monthly Yelp score (it's called a star rating, but it's really a Yelp score). There is talk of tying merit increases to the Yelp score. Which sounds great on one level -- incorporating feedback from the people who actually matter -- but on the other hand, it's a great way to exacerbate existing inequity in pay and promotion.
Not to mention that daily patient care is sorely undervalued when it comes to career advancement. I was talking to a colleague at a different institution recently who said that their version of a sabbatical meant you "get to" close your clinic for 6 or 12 months so you can get other work done (papers, grants, presentations i.e. the things that actually matter for promotion). Who is taking care of your patients during that time? A locum?
This all starts very early, too. Medical students come in at high rates of empathy compared to the general population, and while that wavers a little in the preclinical years it really plummets during clinical rotations and does not recover. The process of education and training in medicine (can't speak to dentistry) is extremely damaging to one's psyche -- long hours, little support. I've called it a Milgram experiment before, because it is.
Over the last several years, I've taken on a larger role in med ed, and I've seen a lot of bright-eyed, energetic, change-the-culture students get absolutely chewed up during their rotations. I'm not talking about naivete, either. Some of these students did emotionally difficult work before coming to medical school -- Planned Parenthood, methadone clinics, EMTs. One and all, medical school destroys them, because the culture of medical school (and residency) is one where the suffering is the point. So then that gets passed on to patients, to continue the cycle of abuse.
I don't want to turn this into a "poor doctors" derail. Just want to provide a little perspective on how the sausage gets made. I am honestly not sure that even expanding the numbers or types of students who go into medicine will help; the meat grinder will continue to grind.
(Also, I was at the University of Virginia and serving as resident representative on the GME subcommittee for education, when Dr. Oliver's study on racial bias in pain management (referenced by bq, above) came out. Institutional response was not "OMG that is fucked up, we need to address this in our students and trainees and attendings [because where the hell do you think the students are learning this shit from]." It was "OMG we look like monsters, let's have all IRB approvals involving students/trainees go through extra scrutiny from now on." Those proposals are already flagged as "vulnerable subject" because of the nature of hierarchy. So this was definitely not scrutiny about protecting students/trainees; it was a PR move to save an institution that I love but sometimes acts like it really doesn't deserve saving. Let's just say there is a reason that Norm Oliver -- one of my very favorite clinicians -- is no longer at UVa. And neither, frankly, am I.)
posted by basalganglia at 6:34 AM on April 29, 2022 [20 favorites]
But at the same time, there's also data (not mixed) that women doctors, and doctors of color, are routinely rated as less competent by everyone -- professors, peers, and patients. At my institution, we get a monthly Yelp score (it's called a star rating, but it's really a Yelp score). There is talk of tying merit increases to the Yelp score. Which sounds great on one level -- incorporating feedback from the people who actually matter -- but on the other hand, it's a great way to exacerbate existing inequity in pay and promotion.
Not to mention that daily patient care is sorely undervalued when it comes to career advancement. I was talking to a colleague at a different institution recently who said that their version of a sabbatical meant you "get to" close your clinic for 6 or 12 months so you can get other work done (papers, grants, presentations i.e. the things that actually matter for promotion). Who is taking care of your patients during that time? A locum?
This all starts very early, too. Medical students come in at high rates of empathy compared to the general population, and while that wavers a little in the preclinical years it really plummets during clinical rotations and does not recover. The process of education and training in medicine (can't speak to dentistry) is extremely damaging to one's psyche -- long hours, little support. I've called it a Milgram experiment before, because it is.
Over the last several years, I've taken on a larger role in med ed, and I've seen a lot of bright-eyed, energetic, change-the-culture students get absolutely chewed up during their rotations. I'm not talking about naivete, either. Some of these students did emotionally difficult work before coming to medical school -- Planned Parenthood, methadone clinics, EMTs. One and all, medical school destroys them, because the culture of medical school (and residency) is one where the suffering is the point. So then that gets passed on to patients, to continue the cycle of abuse.
I don't want to turn this into a "poor doctors" derail. Just want to provide a little perspective on how the sausage gets made. I am honestly not sure that even expanding the numbers or types of students who go into medicine will help; the meat grinder will continue to grind.
(Also, I was at the University of Virginia and serving as resident representative on the GME subcommittee for education, when Dr. Oliver's study on racial bias in pain management (referenced by bq, above) came out. Institutional response was not "OMG that is fucked up, we need to address this in our students and trainees and attendings [because where the hell do you think the students are learning this shit from]." It was "OMG we look like monsters, let's have all IRB approvals involving students/trainees go through extra scrutiny from now on." Those proposals are already flagged as "vulnerable subject" because of the nature of hierarchy. So this was definitely not scrutiny about protecting students/trainees; it was a PR move to save an institution that I love but sometimes acts like it really doesn't deserve saving. Let's just say there is a reason that Norm Oliver -- one of my very favorite clinicians -- is no longer at UVa. And neither, frankly, am I.)
posted by basalganglia at 6:34 AM on April 29, 2022 [20 favorites]
Returning to this thread because Thursday I went to urgent care for a problem and was lectured by the on-duty doctor at length, barely pausing (with noticeable irritation) (when I contradicted him and explained an incorrect assumption he made) before resuming his canned speech and prescribing a condition I most probably don't have because none of the symptoms fit what he's saying. I have had no appreciable reaction to the medication since then, but the side effects aren't a problem.
My primary emotion honestly was pity, because he was so clearly socially awkward, in over his head, and working at an urgent care because he couldn't get a job anywhere else. I've had good ressults at that urgent care before with different physicians, so I won't rule out the place, but good lord we don't train doctors well to deal with human beings.
posted by Peach at 6:35 AM on May 2, 2022 [3 favorites]
My primary emotion honestly was pity, because he was so clearly socially awkward, in over his head, and working at an urgent care because he couldn't get a job anywhere else. I've had good ressults at that urgent care before with different physicians, so I won't rule out the place, but good lord we don't train doctors well to deal with human beings.
posted by Peach at 6:35 AM on May 2, 2022 [3 favorites]
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/incoherent shrieking
posted by bq at 8:03 AM on April 27, 2022 [15 favorites]