Hearts a mess
March 26, 2015 11:24 PM   Subscribe

A recent study suggests younger women who have heart attacks may hesitate to get help because they’re afraid of being labeled hypochondriacs. But the bigger problem is just how justified that fear really is. - Is medicine's gender bias killing young women? [Pacific Standard]

Some of the most popular cardiac misdiagnoses that heart attack survivors have told me about include physician guesses like indigestion, menopause, stress, gall bladder issues, exhaustion, pulled muscles, dehydration and more. But perhaps the most distressing misdiagnosis to trip from the lips of an Emergency Department physician is “anxiety”.
- When your doctor mislabels you as an “anxious female” [Heart Sisters]


"Women may experience a combination of things they don't always associate with a heart attack," Lichtman says. "Maybe we need to do a better job of explaining and describing to the public what a heart attack looks and feels like."
- Younger women hesitate to say they're having a heart attack [NPR]

“We need to move away from the image of an older man clutching his chest, when we think about acute coronary syndrome,” which includes heart attacks and angina, study researcher Dr. Louise Pilote, director of the Division of General Internal Medicine at McGill University Health Centre, says. “The reality is that chest pain, age and gender are no longer the definers of a heart attack.”
- Heart attack symptoms differ in young women [American Heart Association]

Despite the fact that half of the 17.3 million deaths from cardiovascular disease (CVD) each year happen in females , women are still discriminated against when it comes to the management and treatment of this disease. Women are more likely than men to be under-diagnosed and under-treated, mostly because the presentation, progression and outcomes of the disease are different and less understood in women than in men.
- Heart to heart: experts call for an end to gender bias in cardiovascular disease [World Heart Federation]

Cardiovascular disease (CVD) is the most common cause of death in American women and accounts for a full one-third of all deaths.1 Although the common perception may be that CVD affects mainly men, there is equal prevalence of this disease between the genders by the age of 40, and by the age of 60 more women than men are affected. More women than men have died from CVD causes on a yearly basis since the mid 1980s, and whereas the CVD mortality has steadily declined in men over the past 30 years, it has remained steady in women until very recently when CVD mortality was noted to decrease for both genders.
- Status of women in cardiovascular clinical trials [Arteriosclerosis, Thrombosis, and Vascular Biology]

“I attended an FDA workshop five years ago where the agency seemed receptive to mandating that more women be included in medical device trials,” Redberg said. “But that still hasn’t happened. The perception among industry sponsors who attended this workshop was that it’s harder and more expensive to enroll women in these trials.”
- Medical research still lags on women [Boston Globe]

Previously.
posted by supercrayon (93 comments total) 69 users marked this as a favorite
 
Good post! I gotta admit, it shocked me when I learned a few years ago that all the "signs of a heart attack" are general signs for men suffering a heart attack and the signs for women tend to be drastically different.
posted by flatluigi at 11:42 PM on March 26, 2015 [4 favorites]


“Labeling drugs that have not been adequately tested in women would incentivize both companies and the FDA to conduct evaluations to determine gender differences,” said report coauthor Susan Wood, director of the Jacobs Institute of Women’s Health in Washington. Such labels exist for drugs not tested in children, as mandated by Congress. Legislation may also be necessary to require labels based on gender, said Wood, who used to work for the FDA.

Necessary. Excellent idea.
posted by cotton dress sock at 12:50 AM on March 27, 2015 [4 favorites]


When has it not? When will it stop?
posted by lazycomputerkids at 1:11 AM on March 27, 2015


I won't go into it (i did here), but I almost died from a heart problem because it was dismissed as anxiety. I'm now an advocate for my own health in ways that are slightly embarrassing because I know that if I don't care, no one will.
posted by stoneweaver at 2:27 AM on March 27, 2015 [21 favorites]


The newest generation of heart monitors will allow the electrical pattern to be captured. With this "big data" someone's masters or PHD paper is waiting to be written on this topic.
posted by rough ashlar at 4:28 AM on March 27, 2015 [1 favorite]


And if you're fat good luck getting them to even care enough to suggest a diagnosis at all rather than that you're fat.
posted by winna at 5:01 AM on March 27, 2015 [39 favorites]


My experience with medical people jives with the articles. The number of women friends (I'm in my mid-forties) who have gone to docs to get help with assorted "female problems" and been patted on the head and told that they're "just getting older" exceeds the number of fingers and toes I have. I do not have fainting violet friends who Make Shit Up for Special Attention from doctors. I believe my friends and most of them have them have gone back, again, with the same complaint and gotten actual treatment eventually.

I'm not as tolerant of pooh-pooh-ing as they are. If I am paying eighty freaking dollars for an office visit, I have an actual problem and I would like to please be taken seriously. So, I waited a long time with uterine fibroids (Mom had 'em, aunt had 'em, grandma had 'em... I kinda knew they were coming) before seeing a doctor because if I showed up to complain about 'heavy periods' and 'excessive cramping' and got patted on the head and told I was making it up or just getting older I would have killed the doctor. You're not allowed to kill doctors even if they're stupid and don't listen to you...

Before I sought out a doctor for this issue, I journaled, for three months, the amount of pads, tampons, and bleed-through, the number of times per month I got out of bed at night with sheets soaked with blood, etc. I documented the hell out of it. (At that point in my life, I was not in need of birth control pills, had never had an abnormal PAP, and was not having babies so I saw no reason to show up every year for no purpose.) And then the doc was all "Wow, why did you wait so long?" and I was like "So that you would believe me the first time." Doctor's feelings were hurt.

*sigh*

The thing with women is a bias in medicine and it's not just heart attacks. It's damn near everything except, y'know, gapingly obvious wounds and bones sticking through the flesh. If they can't *see* it right away, you're making it up or exaggerating it for effect or some other form of malingering.
posted by which_chick at 5:37 AM on March 27, 2015 [35 favorites]


As the first article in the FPP mentions, time to diagnosis of auto-immune diseases is significantly longer for women than for men. I first had the hallmark symptom of my auto-immune disease when I was 15. I was 31 when I was diagnosed. This is not even a little bit rare. When my husband strained his back at work, he was given muscle relaxers and narcotic pain relievers. When my inflammatory back pain became so bad I could no longer work, I was told by a board-certified rheumatologist at a world-renowned medical center to take naproxen and "Most women I see with these problems have a traumatic history in their past, usually sexual abuse. Be a big girl and get help for your past trauma." (I have no past trauma. I am a woman, not actually a big girl.) He was not the first person to suggest mental illness was causing my intense, debilitating inflammatory pain and fatigue, just the person with the fanciest credentials who was also far and away the most condescending.

The awesome rheumatologist who diagnosed me, took me seriously, and treated me appropriately including immune-modifying drugs and physical therapy, was a woman my age who had just finished her fellowship. I am thankful every day for her.
posted by hydropsyche at 5:44 AM on March 27, 2015 [26 favorites]


How is this a gender difference and not a sex difference? Gender is behavior. Sex is anatomical. Furthermore, signs of a heart attack tend not to vary greatly between men and women but between individuals as well.

Finally, here are some links for signs of a heart attack:

Warning Signs of a Heart Attack

Heart Attack Symptoms in Women
posted by enamon at 5:48 AM on March 27, 2015 [1 favorite]


As a woman with PTSD I'm undaignosable. I have too bring someone with me and that person has to emphasise I'm differenet and that whatever is a change. Even then I'll still get told it is my trauma even though I have worked on my trauma and been in therapy for like 15 years. I also don't run to the doctor unless I need too. Besides, I have medicine for anxiety and I take it when I'm anxious!

Hell I've been told I'm pretending to weaze at the ER even though my oxygen was a liitle low. I also was told a common medication was special and I couldn't get it from my primary doctor because they thought I was mentally ill just wrote me off. She wouldn't even tell me the name of the medicine.

My wife had to get the information from the ER doctor.
I called my PCP and the script was filled with no problems.
posted by AlexiaSky at 6:00 AM on March 27, 2015 [8 favorites]


The information about doctors asking women about stress (and then dismissing their symptoms) was interesting to me, because I'm a man who has regular recurring bouts of costochondritis which causes fairly bad chest pain. I've been to the doctor a few times because of it now, and at no point have I been asked about stress. It just doesn't come up. The doctor says "it's probably this, but let's run an EKG to be safe," the EKG comes back clear and they send me on my way with a prescription for ibuprofen.
posted by Bulgaroktonos at 6:21 AM on March 27, 2015 [3 favorites]


How is this a gender difference and not a sex difference? Gender is behavior. Sex is anatomical.

The answer is given in the articles. It's a gender difference because women are routinely disbelieved, discounted, dismissed, infantilised, and patronised by health professionals, resulting in inappropriate or withheld treatment. It's a gender issue because the gender of the patient is a direct factor in why more women die of heart disease and heart attacks than do men. Because men presenting symptoms are taken seriously and referred to cardiologists and receive treatment for their heart conditions, whereas women - even when those symptoms are identical - are patted on the head and told that they're just anxious and making it all up and should stop wasting the doctor's time. It's got nothing to do with anatomical differences and everything to do with the assumptions and gender bias of health professionals who fail to learn how to recognise heart disease in women and fail to adequately diagnose and treat their female patients.
posted by talitha_kumi at 6:21 AM on March 27, 2015 [45 favorites]


I know I've yammered on this subject before on metafilter, but this subject is the entirety of my life right now, and the petty humiliation and the wasted TIME still put me in a rage-place every damn day.
When my health spun into a fast downward spiral, it took the local medical establishment two years to admit that things might actually be going physically pear-shaped - and that was with a pre-existing autoimmune diagnosis. The highlight of the process was when a doctor sat me down, told me I was a beautiful young lady, but that I had had an awful lot of medical visits in the past year, all for unresolved complaints. So many unresolved complaints my dear - he shook his head and told me that clearly, the problem wasn't physical. What I needed was a psychiatrist.
I looked at him and thought about saying "Possibly, they are unresolved because you haven't resolved them?"
But he forestalled me by saying that I was too beautiful and too young to let myself be this sick -
So i left him, and started bringing my husband along to medical appointments so the doctors had someone to listen to.
That champion chump actually got topped by another specialist - the man who had diagnosed me with my pre-existing condition 10 years earlier and had been my primary care physician ever since - I mean, this man knew me. But he looked at me as I slumped sideways in a chair, physically unable to open my eyes and groaning with pain when i moved my head, and told me that I'd managed to stay alive for 10 years and I'd managed to get myself a husband, so why was I complaining about my quality of life?
My husband and I dropped our primary-care system, and after much effort and many many conversations with many many women, we found our way into the most extraordinary network of neurologists who listen to their female patients, and as a courtesy, pass around recommendations for listening doctors in all sorts of other specialties as well! I now have a legitimate diagnosis and a functional course of treatment, and I am working hard to recover from two years of unsustainable physical battering, and I'm working harder not to hold a grudge against the doctors who cost me those two years - and the years I'm told it will take to earn back the ground I lost.
And I am pretty cross about all of it.

(Basic medical competence should not require a secret handshake. But things being the way they are, if there's anyone in Santiago, Chile, who needs a good female-listening doctor, memail me. I know a few.)
posted by tabubilgirl at 6:35 AM on March 27, 2015 [16 favorites]


Furthermore, signs of a heart attack tend not to vary greatly between men and women but between individuals as well.

Why do you think this is relevant.
posted by MisantropicPainforest at 6:37 AM on March 27, 2015 [5 favorites]


And if you're fat good luck getting them to even care enough to suggest a diagnosis at all rather than that you're fat.

As a woman with PTSD I'm undaignosable.


Yup! I'm overweight and I have bipolar and so I just don't go to doctors unless I am in so much pain I am having trouble getting through the day. I've recently been working VERY hard and lost about 30 pounds (for a number of reasons, personal and health-related) and, although I'm still overweight, for the first time since I was a kid I was not completely terrified of going to the doctor because I knew that when they told me to lose weight I could say "I am! See, I'm making progress! Take me seriously!". I was taken seriously as a patient when I was CHILD, but now that I am a GROWN WOMAN I'm not believed about my own body. Never mind that the weight is, in part, from a combination of hypothyroidism, PCOS, and Zoloft, ACTUAL MEDICAL ISSUES, instead of talking about how these factors have affected my weight and what else might be going on I just get lectures on how I need to lose weight. Not strategies, not information about how my body works, not other aspects of my health, I just go in for lectures on weight loss. Uh, no thanks, I could visit an MRA website for that and not have a copay.
posted by Mrs. Pterodactyl at 6:41 AM on March 27, 2015 [21 favorites]


Sorry, I should have been more clear. What I meant was the difference in symptoms exhibited are not a gender difference but a sex difference. Thus a man (sex) who identifies as female (gender) will still, more likely, exhibit symptoms that are typical of men (sex) having a heart attack. The same goes for a woman (sex) who identifies as male (gender), as they will still exhibit symptoms related to their sex and not gender.
posted by enamon at 6:46 AM on March 27, 2015 [1 favorite]


“Labeling drugs that have not been adequately tested in women would incentivize both companies and the FDA to conduct evaluations to determine gender differences,” said report coauthor Susan Wood, director of the Jacobs Institute of Women’s Health in Washington. Such labels exist for drugs not tested in children, as mandated by Congress. Legislation may also be necessary to require labels based on gender, said Wood, who used to work for the FDA.

This sounds like a good idea on the surface, but I'd be concerned that insurance companies might use this as a way to cover these meds for men, but not women, since that might technically make prescribing to women an off-label use. Is that overly paranoid of me?
posted by pie ninja at 6:57 AM on March 27, 2015 [1 favorite]


I recently went to a doctor about endometriosis pain. She said that surgery would not be a treatment despite my last surgery giving me years of great functionality because "if you know it is endo, you don't do surgery". She then suggested that my pain came from "hidden depression" -- but I thought we already knew it was endometriosis? Hmm.

She refused to give me any help with pain that is so bad I can't sleep some nights, and told me I needed to see a psychiatrist. She then told me that I probably didn't have negative mood effects from hormonal birth control, (now I'm so crazy that I'm imagining being crazy!)

To give it that extra frisson of condescension that OB/GYNs are known for, she thinks the best treatment would be removing my ovaries but she wouldn't do it because I was too young to stop having kids. Without asking me how I felt about having more kids.

I've also has seriously concerning medical issues completely brushed off as stress because I'm a single parent. We don't get medical problems, apparently, just stress.
posted by internet fraud detective squad, station number 9 at 7:08 AM on March 27, 2015 [14 favorites]


In addition to what talitha_kumi noted,

How is this a gender difference and not a sex difference? Gender is behavior. Sex is anatomical.

I'd be happy to be corrected if this really is common, but do you really think there are many transfolks who just plum forgot that their physiology differs from cis men and women?
posted by ROU_Xenophobe at 7:10 AM on March 27, 2015 [5 favorites]


I'm a woman, and I think I present on the cute-and-bubbly side of the spectrum. Even when I'm sick, even when I'm in a lot of pain. And I have had so much trouble with doctors not taking me seriously over the years. So much.

My bad gall bladder could've been diagnosed YEARS earlier if, when I called the doctor about horrible ongoing bowel problems, he hadn't said with obvious and extreme reluctance, "but then we'd have to take a stool sample," like that was the most impossible thing in the world. And as a young woman with a healthy obedience to authority, I correctly read that as "I don't care about this problem you're having, it's not important," and dropped the issue.

And then there was the time I told my doctor I was having difficulty with anxiety and panic attacks. (Like, losing entire work weeks to doing nothing but breathing and trying to stop my heart from racing.) "You should have your boyfriend take you out to dinner," he told me. ...I'd been married ten years and had two children. Who we had been talking about five minutes earlier. Yeahhh. That time, I went into the parking lot and cried my eyes out and couldn't bring myself to seek out new treatment for six months. Turns out I get terrible anxiety as a symptom of my vitamin D deficiency. Such an easy fix, such a waste that it took so long to get it.

I seem to have a great new doctor now who listens to me, suggests a course of action, and then has me come in a month later to *see how it is working* and it is so, so, so good. I hadn't realized medicine could even be like this.
posted by Andrhia at 7:11 AM on March 27, 2015 [9 favorites]


The main reason I love my doctor is because we are on the same page with a lot of my treatment plans, she's reachable by email, and she's just generally approachable and awesome.

The fact that she's also a woman is probably something that helps as well.
posted by EmpressCallipygos at 7:34 AM on March 27, 2015


Last night one of my best friends, who's already had two heart attacks, went to the ER with a bad kidney stone. She told the ER doc about the blood coming from her urethra and he challenged her. Said how did she know she wasn't getting her period. Mind you, she had a hysterectomy 5 years ago and had told him as much. He kept on saying she couldn't possibly know where the blood was coming from until she actually told him she'd shoved her finger there to check. The nurse got in some serious eyerolling at dummy resident then, but thankfully nurse pulled rank and got his supervisor after he refused to give her Benadryl with the morphine drip after she told him it makes her break out in hives without.

Yeah, don't get me started on how they keep misdiagnosing her heart problems, even though that's the topic of TFA. The best one was when they accused this late 40s mother of two autistic children who doesn't drive of being a cocaine addict. Yeaaaaahhh. Ok.
posted by bitter-girl.com at 7:48 AM on March 27, 2015 [6 favorites]


And, obviously, once you have a diagnosis of anxiety on your chart forget about there ever being another reason for anything ever again. Endometriosis? Anxiety! Tachycardia? Anxiety! Vulvar pain? Anxiety!

I'm currently having persistent gastro issues and the going diagnosing is... gastritis due to stress! Stress that I'm not under and with a negative h pylori test, but sure. Let's call it gastritis.
posted by lydhre at 7:50 AM on March 27, 2015 [13 favorites]




I'm currently having persistent gastro issues and the going diagnosing is... gastritis due to stress! Stress that I'm not under and with a negative h pylori test, but sure. Let's call it gastritis.


Beats having your weird gastric bloating issues being recognized as a quality of life issue because if you go out to lunch and the other women look slimmer than you, that affects your quality of life.

(Yes, I quote. To be fair, that inane judgement was in the nature of a swift recovery after i stood up, presented my swollen 6-month-pregnant-looking-belly to him in profile and hissed "does this look psychosomatic to you?"
On the other hand, once he'd decided my problem was all about surviving social engagements with some mythical cocktail set, he stuck to it. No Irritable Bowel Syndrome anywhere in this room, No Sir.)
posted by tabubilgirl at 8:01 AM on March 27, 2015 [2 favorites]


And if you're fat good luck getting them to even care enough to suggest a diagnosis at all rather than that you're fat.
posted by winna at 5:01 AM on March 27 [16 favorites +] [!]


In 25 years I've never seen, heard, or been aware of this personally or from the mouths of hundreds of candid encounters and discussions with colleagues, and though I expect you are sincere your hyperbole is a gross oversimplification. I've watched countless times and seen the patient written complaints when any mention of a patient's weight is brought up in discussion of treatment or evaluation. It is why the obesity epidemic is so hopeless. You can talk to a patient about anything but mention weight as a possible factor in symptoms and you have tapped into a well of insecurity, anger, and preconceived hostility so deep that it's a wonder anyone even touches it (answer: because sometimes it needs to be explored). I know the medical establishment has failed the overwhelming number of the Metafilter community. If it is of any consolation, there is a concerted movement in place to train new and existing doctors in the fine art of simply listening and not being assholes, like a finishing school for intractable pricks.

Every doctor I know is terrified of misdiagnosing a heart attack or unstable angina. There are reams of continuing ed on the subject of how not to make this mistake. It is unbelievably challenging. Unfortunately, like so many medically critical issues, the patient often does better when they stand their ground and challenge the doctor, or simply demand a basic stress test or cardiac consultation. If you are concerned, press for more evaluation.

In any case, as others have mentioned, if you can, bring someone, anyone, to your visit and have them simply sit quietly in the corner alert and observant. It keeps bad doctors a little more on their toes.
posted by docpops at 8:02 AM on March 27, 2015 [3 favorites]


Yeah, basically the takeaway is, if your records at a given place don't already mention anxiety issues, don't bring them up under any circumstances. And, you're fine as far as stress goes, cool as a cucumber, nothing to see here. Be as stoic as possible when you speak to them. Silo off your mental health issues and get them dealt with by a practitioner outside of your general healthcare ecosystem. (On the huge assumption your records aren't already linked - they're not all so far, where I live. Which will probably mean you can afford to pay for therapy etc. out of pocket. I can't, personally, I have to count on people not digging too deeply into my file.)
posted by cotton dress sock at 8:04 AM on March 27, 2015 [2 favorites]


> What I meant was the difference in symptoms exhibited are not a gender difference but a sex difference

Do they not teach this in med school or residencies? I'm pretty sure I learned that cardiac events can present differently in men and women from the TV show ER sometime in its early seasons.
posted by rtha at 8:20 AM on March 27, 2015 [1 favorite]


I've watched countless times and seen the patient written complaints when any mention of a patient's weight is brought up in discussion of treatment or evaluation. It is why the obesity epidemic is so hopeless.

Obesity is prevalent and persistent because of an obesogenic environment and (some have argued) near-permanent metabolic changes that occur once a person is obese. I don't think it's because of people having issues with their doctors' bedside manner.
posted by cotton dress sock at 8:22 AM on March 27, 2015 [7 favorites]


Be as stoic as possible when you speak to them.

Having been told that my inflammatory arthritis was in my head enough times, I was very stoic when I met the aforementioned rheumatologist. My "flat affect" was mentioned in his notes as further evidence of my (non-existent) mental illness.
posted by hydropsyche at 8:22 AM on March 27, 2015 [6 favorites]


If it is of any consolation, there is a concerted movement in place to train new and existing doctors in the fine art of simply listening and not being assholes, like a finishing school for intractable pricks.

I don't care that much about my doctor listening and being polite. I care a great deal more about whether they are believing my account of my experience and taking it seriously. (I've had some very polite doctors who disregarded everything I had to say. I also had a doctor who had very little rapport with me diagnose something tricky that other doctors had missed.)

If you are concerned, press for more evaluation.

Well, sure, that's certainly one option open to women with the basic medical literacy to know what to ask for. But that's not 100% of patients.

As noted in the first linked post, this argument just pushes responsibility for the medical establishment's failure to diagnose women as well as they diagnose men onto the women who are not being properly diagnosed.

As for bringing a friend -- I shouldn't have to bring a dude to my medical appointments to be taken seriously, any more than I should need to bring a dude to the car dealership to get a good deal on a car.
posted by pie ninja at 8:24 AM on March 27, 2015 [16 favorites]


In 25 years I've never seen, heard, or been aware of this personally or from the mouths of hundreds of candid encounters and discussions with colleagues, and though I expect you are sincere your hyperbole is a gross oversimplification.

You're expecting to hear from your colleagues about how their treatment of patients is terrible? You've definitely heard about it here from patients describing their own experiences, not just in this thread but in others before. The fact that you don't consider their descriptions of their experiences part of what you've "seen, heard, or been aware of" could, broadly speaking, be described as "the problem."
posted by Bulgaroktonos at 8:26 AM on March 27, 2015 [57 favorites]


docpops, there are a couple of things I would like to address in your comment:
You can talk to a patient about anything but mention weight as a possible factor in symptoms and you have tapped into a well of insecurity, anger, and preconceived hostility so deep that it's a wonder anyone even touches it (answer: because sometimes it needs to be explored)
I think that when people, especially women, react this way, it may be because we have been trained, through experience, to realize that whenever a doctor mentions our weight it means other, deeper conversations about our health are over. A few months ago I had a UTI that led to stomach pain and I waited a week to go to the doctor because if I go to the doctor with stomach pain I have learned from experience that instead of getting treatment I will be told I am fat. I have lost weight and am still working to lose weight and, while this is relevant to my health, it is not the only thing that is relevant to my health. Doctors talk to me about my weight far more than about, say, family history of diseases or medicines I'm taking.

You also say:
In 25 years I've never seen, heard, or been aware of this personally or from the mouths of hundreds of candid encounters and discussions with colleagues
You are seeing this from a very different position than that of an overweight female patient, and you do not have experience going to doctor after doctor looking for help from professionals and being dismissed. Of course none of them have ever told you they feel this way! A bunch of them probably don't know themselves! I don't think any of my doctors, even the really unhelpful ones, have ever thought "this is a fat woman. I will not help her." I think they'd be appalled if they realized that the effect of their treatment of a lot of their patients was them not getting the help they need. The fact that they don't believe this is happening does not make it not true.

I don't want to be mean or rude or attack you, but the way you, as a representative of the medical profession, are acting in this very thread is representative of what I'm talking about. A lot of women have come in and said they are not taken seriously. You respond to this by, well, not taking THAT complaint seriously. You are demonstrating the act of not listening to issues female patients are reporting they have (albeit an issue with doctors instead of an issue with their health). You are using this dismissal of complaints and experiences as a way to claim they are not legitimate instead of recognizing that your reaction is in fact a demonstration of the very thing you are denying. I don't think you are doing it on purpose, but it is very frustrating and it is part of the reason that I do not like going to doctors.
posted by Mrs. Pterodactyl at 8:26 AM on March 27, 2015 [59 favorites]


I love the idea of bringing a friend to a gynecology appointment. Who wouldn't dig seeing me in various states of undress while hearing about my bowel movement frequency and consistency? Hell, I could charge for it.

Just to be clear, lolololololol wtf no
posted by internet fraud detective squad, station number 9 at 8:28 AM on March 27, 2015 [21 favorites]


winna > And if you're fat good luck getting them to even care enough to suggest a diagnosis at all rather than that you're fat.

docpops > In 25 years I've never seen, heard, or been aware of this personally or from the mouths of hundreds of candid encounters and discussions with colleagues, and though I expect you are sincere your hyperbole is a gross oversimplification.

First you dismiss winna's concerns, implying that her actual experience didn't happen, since you claim not to have seen it happen...

but mention weight as a possible factor in symptoms and you have tapped into a well of insecurity, anger, and preconceived hostility

...then you misconstrue her as having a grievance against something reasonable, since you disbelieve that her experience has been as unreasonable as she says.

Is it not more likely that winna, and the many other people here, have actually been treated unfairly, time and again? Isn't it probable that winna is open to reasonable and relevant concern about her weight, but has actually had unrelated concerns dismissed because her doctors are unable to look beyond it, as she's said?

there is a concerted movement in place to train new and existing doctors in the fine art of simply listening and not being assholes

I certainly hope so! I appreciate your overall acknowledgement of the problem, but you're doing the thing right now.
posted by gilrain at 8:33 AM on March 27, 2015 [14 favorites]


You're expecting to hear from your colleagues about how their treatment of patients is terrible? You've definitely heard about it here from patients describing their own experiences, not just in this thread but in others before. The fact that you don't consider their descriptions of their experiences part of what you've "seen, heard, or been aware of" could, broadly speaking, be described as "the problem."
posted by Bulgaroktonos at 11:26 AM on March 27 [+] [!]


Well, this was much shorter and more direct than what I said and sums it up better. Thank you for understanding and taking this seriously; it means a great deal to me.
posted by Mrs. Pterodactyl at 8:33 AM on March 27, 2015 [8 favorites]


Yes, I completely get this. I have a long history of cardiac arrythmia. Most of the time it’s not a big deal and I live with it (it's really only an issue when I'm sick or very tired), but the whole thing is indisputable since I’ve seen some really good cardiologists and have extensive cardiac stress test results, etc in my medical records.

Last year my boyfriend and I were on vacation when I suddenly felt like I was being kicked in the chest and I couldn’t breathe. I told my boyfriend I didn’t feel so great and he looked at me in alarm and told me my face was turning blue. I didn’t end up going to the hospital because of out-of-town issues with my insurance, but I’m not gonna lie, it was one of the more terrifying moments of my life.

After I got back from vacation, I was still having a lot of problems (my fingers and toes were still blue! my heart kept skipping! I was constantly dizzy!) so eventually my boyfriend forced me to go to the ER. I went in and the nurses started panicking because my blood pressure was extremely low. Eventually I get to see the doctor, and the doctor tells me -- to my face -- that I was making up things for attention, that I should not have told the nurse anything about my past medical history because it created false drama, and that I was “faking” a heart attack to “waste everyone’s time”. When I told him that I had better things to do with my life than come into the hospital and get a bunch of tests run on me, I think he felt a little guilty so then he told me that of course he didn't think I was faking it maliciously, I was too young to have a heart attack, maybe it was just in my head because I was stressed out at work and I should drink more water because I was probably dehydrated ...

I just want to add that I’m young and “skinny” by conventional standards, and that after a couple weeks I was ok. But I don't know what would have happened if I were having an actual heart attack.
posted by angst at 8:47 AM on March 27, 2015 [14 favorites]


and I should drink more water because I was probably dehydrated ...

Oh man, "probably dehydrated" -- I have gotten this so many times.

The other one I loved was the doctor who wrote out a prescription for an over-the-counter med (one I wasn't familiar with, so I didn't realize it was OTC) so I would feel like I was being "taken seriously". Sorry, dude, that just made me feel EVEN MORE like you were patronizing me. If that's the kind of etiquette lessons new doctors are getting, they are backfiring!
posted by pie ninja at 9:02 AM on March 27, 2015 [4 favorites]


This sounds like a good idea on the surface, but I'd be concerned that insurance companies might use this as a way to cover these meds for men, but not women, since that might technically make prescribing to women an off-label use. Is that overly paranoid of me?
posted by pie ninja at 6:57 AM on March 27 [+] [!]


Yes.

The other one I loved was the doctor who wrote out a prescription for an over-the-counter med (one I wasn't familiar with, so I didn't realize it was OTC) so I would feel like I was being "taken seriously". Sorry, dude, that just made me feel EVEN MORE like you were patronizing me. If that's the kind of etiquette lessons new doctors are getting, they are backfiring!
posted by pie ninja at 9:02 AM on March 27 [+] [!]


This is done routinely for several reasons that aren't intended to make you feel like a patronized victim. Insurance will often pay for an OTC md if it is written in Rx form. From a medicolegal standpoint writing any medication down on paper without specific instructions can result in a lawsuit, even if it is OTC. In many cases if we can conclude that a patient is well served by an OTC med we do write it down, and the better doctors do so as if it is an Rx, since,in truth, it is, whether it's mucinex, vitamin d, or tylenol. It results in better compliance and treatment.
posted by docpops at 9:17 AM on March 27, 2015


Unfortunately, like so many medically critical issues, the patient often does better when they stand their ground and challenge the doctor, or simply demand a basic stress test or cardiac consultation. If you are concerned, press for more evaluation.

In any case, as others have mentioned, if you can, bring someone, anyone, to your visit and have them simply sit quietly in the corner alert and observant. It keeps bad doctors a little more on their toes.


Notwithstanding the things people have said, this advice is meant well, I think. It's just unclear to me how it would work in practice. Fatigue and back pain are indicators for women. We're supposed to self-advocate with those on the table?
posted by cotton dress sock at 9:20 AM on March 27, 2015 [1 favorite]


This is done routinely for several reasons that aren't intended to make you feel like a patronized victim. Insurance will often pay for an OTC md if it is written in Rx form. From a medicolegal standpoint writing any medication down on paper without specific instructions can result in a lawsuit, even if it is OTC. In many cases if we can conclude that a patient is well served by an OTC med we do write it down, and the better doctors do so as if it is an Rx, since,in truth, it is, whether it's mucinex, vitamin d, or tylenol. It results in better compliance and treatment.

The OTC med in question was LITERALLY saline water.
posted by pie ninja at 9:22 AM on March 27, 2015 [3 favorites]


WWhat I meant was the difference in symptoms exhibited are not a gender difference but a sex difference. Thus a man (sex) who identifies as female (gender) will still, more likely, exhibit symptoms that are typical of men (sex) having a heart attack. The same goes for a woman (sex) who identifies as male (gender), as they will still exhibit symptoms related to their sex and not gender.

Ok, two points.

1) I don't care what you've been told is "more scientific" or whatever — it is not acceptable to call trans women "men" or trans men "women." Do not do that.

2) The medical situation is not as simple as you think it is. Many of the medical differences between cis men and cis women are, at bottom, hormonal differences — including ones that you wouldn't expect to be hormone-linked. When I changed over from running on testosterone to running on estrogen, my senses of taste and smell changed, as did my threshold of pain, which I think is relevant to the current conversation about heart attack symptoms. I read recently about a study showing that show oral estrogen affects markers of inflammation and clotting factors. We know that for a large number of diseases that affect the sexes differently, trans women's odds are closer to those of cis women than to those of cis men. (For that matter, think of all the medically important differences between pre- and post-menopausal cis women. Hormone levels are implicated in so many purely physiological processes.)

Now, I haven't been able to find any research on heart attack symptoms in trans men or women. (Which is itself a problem! We need people to be studying this stuff!) But given the pervasive systemic effects of HRT, it makes no sense to just assert that trans women will exhibit the "male" symptoms, or trans men the "female' ones.
posted by nebulawindphone at 9:38 AM on March 27, 2015 [13 favorites]


I was thinking about this thread while I was having lunch and the differences in how Bulgaroktonos and I responded to docpops' initial comment. I spend a while writing mine because I wanted to make sure that it sounded calm and reasonable and not ax-grindy so it was more likely to be heard. Bulgaroktonos wrote something pithy and a little snarky (NOT A CRITICISM! I loved that comment). I realized that the reason I put that care into my comment was because, docpops, respectfully, you have demonstrated a dismissiveness of women's comments in the past and I wanted to make sure that I was not giving you any excuses to disregard mine. Bulgaroktonos, who is male, did not need to take that same amount of care (again, not a judgement, just an observation).

Even in conversations where we talk about how women are treated by doctors, it seems like men and women at least feel like they have different standards for how to communicate. If I am not very calm and logical, I am pretty sure no one will take what I have to say seriously. Bulgaroktonos can just say what he's thinking without as much explanation or softening of the language. Do you maybe see how even brief exchange is representative of differences in how men and women need to deal with their medical care? He can just say what he thinks is happening. I have to explain it and make sure I don't seem defensive or hysterical because I know that, if I'm not very careful, no one will take me seriously.
posted by Mrs. Pterodactyl at 9:42 AM on March 27, 2015 [57 favorites]


I think it is really important to note the serious consequences that doctors dismissing symptoms have on women and why this is such an emotional topic. Heart attack misdiagnosis leads to death. Women's pain is routinely dismissed especially if it is gynecological or part of the GI tract. Things that have treatment don't happen for a long time if ever. This ends up costing women thousands of dollars in medical bills and reduced quality of life. Economic consequences such as losing a job happen. Not only do we have a second shift and get paid less we are expected to do it suffering. Complicated rarer things often take multiple doctors and years because defaulting to stress or somatic systems or mental health or attention seeking or fatness is very real.

I mentioned some of my experiences but I've had more. And most women I know have had some problems. It isn't easy. It is part of our medical experience from the time we start menstruating.
posted by AlexiaSky at 9:55 AM on March 27, 2015 [14 favorites]


The elephant in the room when it comes to emergency medicine is that an ER doc (or PA or NP) in a busy hospital probably sees well over a hundred patients a day and interacts with more than that, and a lot of those--in a big, busy, hospital, anyway--are ... to put it politely: not really medically acute cases. The ER has become a social dumping ground where other systems shove people they don't want to deal with. Homeless and panhandling where you shouldn't be? Hospital ER. Yelling at the voices in your head in public? ER. Lonely because you're in a nursing home and your kids haven't called in three weeks and the Medicaid-funded staff is tired of listening to you? They'll be more than happy to send you down to the ER. Out of Oxycodone and your dealer won't answer? Might as well try to hit up the ER. Hungry but too drunk for the church kitchen to let you in? Have a seat on their front steps and before you know it, you'll be ... in the ER. Really hungover but your boss is a dick and told you you're fired if you show up late one more time without a doctor's note? ER.

And that's not counting the medically legitimate but kinda-not-really-classically-ER-worthy (as in, not really life-threatening/emergent) stuff that shows up, because most people don't really have 'regular doctors' that they can go to and/or aren't familiar with stuff like PromptCare or can't pay for it, when they've got a fever or a sore throat or bad cough or just generally feel shitty; the options remaining are "do nothing" or "go to the ER". So, not unreasonably, they go to the ER.

The upshot is that if you're someone who is seriously sick, but yet you don't have something obvious like a compound fracture, you're working uphill against an entire system which has been tuned to be suspicious and minimizing. The interaction with the doctor, sizing you up in the fifteen seconds or so in which they are going to make a judgement call and decide how to treat you, is actually the last barrier. (And, in a lot of cases, is probably a fait accompli based on stuff like how you arrived, what people in Triage might have noted on the chart, degrees of eye-rolling as you get passed from person to person, etc.)

So when you walk in, you go in with a history of going to the ER which is basically, "100% of the time I've come here, I've been really goddamn sick"; the ER staff, on the other hand, may have seen 100 patients before you, and most of them weren't. So that interaction is being approached from two very different angles. And it's self-reinforcing, as people who are legitimately sick avoid going to the hospital because they know they're going to have to go through the stupid dance of convincing everyone, starting with triage on up, that they're not bullshitting.

I'm not saying that there aren't physicians who are pretty shitty in how they can treat patients (particularly when it comes to something measurable, like male/female outcomes given the exact same symptoms), but there's an entire system that drives the cynical shittiness in people who probably didn't get into emergency medicine in order to give other people a hard time.

The biggest things you could do to improve ER experiences, IMO, actually aren't inside the hospital at all, they're things like mental health and drug legalization and community healthcare. And as a result, although I think changing how doctors interact with patients is definitely laudable, there's likely to be something of a hard ceiling on how good that experience is ever going to get when it occurs in the ridiculously fucked-up context of the US healthcare system.
posted by Kadin2048 at 9:55 AM on March 27, 2015 [8 favorites]


I think that's all kind of irrelevant, Kadin2048, because we're talking about discrepancies in care here. White men who go into the emergency room are more likely to get correct treatment for their heart attacks than white women or people of color of any gender. That's not because emergency room docs are overworked. That's because emergency room docs, despite their best efforts, have some unconscious biases.
posted by ArbitraryAndCapricious at 9:59 AM on March 27, 2015 [23 favorites]


My doctor, who has put me thousands of dollars into debt with his bright ideas ("surely you have sleep apnea, for you are fat! this is why you have had migraines almost every day for 8 weeks! ... cue thousands of dollars in tests, and the sleep doctor wondering why the hell he'd sent me in the first place, since I have absolutely no problems in that department whatsoever) decided it would be SUPER FUN this Monday to tell me I could have HEART FAILURE, and send me for a chest X-ray when I went in to ask about the persistent sinus problems I've been having.

These symptoms seem to clear up when I go out of state for work, so I wanted to know if the asthma-like symptoms I've been having could be allergy related. I live in the flight path of a large airport, so who knows what's in the air here? Instead I get the "OMG you are so fat that your heart is probably failing, so I'm sending you to the hospital lab!" treatment, and also why aren't you on a CPAP, fatty? Your heart's gonna explode! (Umm, because the sleep specialist you sent me to thought it was ok?)

Docpops, there's a reason I resisted going in even though I've been sick almost constantly since December. I am tired of being on the financial hook for these dumb theories of his, and I am tired of him telling me my only problem is that I eat too much and work out wrong. (A Cleveland Clinic dietician, who has SEEN my food and workout diaries, unlike him, disagrees).

I'm tired of seeing doctors argue with my friends that they don't know the basic facts of how their bodies work. (Unless uteri spontaneously grow back, I'm thinking once you have a hysterectomy, bleeding from the vagina is no longer a Thing unless you've got something way worse than a kidney stone brewing).

I'm not defensive about my weight. I know I'm overweight. I also know what I'm doing to address that, and I'm sick of doctors with simplistic ideas about how I can fix it by "just." Just do this, just eat that... it doesn't work the same way for everyone.

In fact, if you summarized the article and a lot of the things in the thread, "it doesn't work the same way for everyone" is a pretty good takeaway, and it would probably behoove medical professionals to remember that when they're treating people.
posted by bitter-girl.com at 10:14 AM on March 27, 2015 [14 favorites]


To add on to what ArbitraryandCapricious says: It's also worth noting that very few of the stories being told in this thread mention the ER in particular. It's a problem that manifests throughout the healthcare system, not just in the ER.
posted by Andrhia at 10:19 AM on March 27, 2015 [8 favorites]


On the gender/sex thing, one of the studies mentioned in the first article made it clear that it is a gender thing:
The researchers also gave the patients a personality test gauging how closely they adhered to traditional gender roles and found that both men and women with more stereotypically feminine traits faced more delays [in obtaining access to cardiac testing and care] than patients with masculine traits.
posted by jaguar at 10:24 AM on March 27, 2015 [6 favorites]


I mean the thing is that, apart from pain in the back/arms and chest - neither of which are necessary for the presence of heart attack, and don't correlate with severity, according to the articles - the symptoms do look, exactly, like a panic attack. Like it's a 90% correlation.

And, the reality is that anxiety and panic disorders are more common in women (for very good reasons, could go there now but won't).

So, question to medical peeps reading - is there a test that can handily exclude panic in an ER setting? Or is it down to triage nurses remembering the algorithm they learned in an online CPD module?

It can't be incumbent on women patients to figure it out. Well, it can, but it probably means more will die.
posted by cotton dress sock at 10:24 AM on March 27, 2015 [1 favorite]


(And actually I think pain in the arms and chest are sometimes symptomatic of a panic attack.)
posted by cotton dress sock at 10:26 AM on March 27, 2015


Though now I'm realizing the extent of the idiocy of the double standard: The stoic manly-man is probably very powerful and therefore stressed, which may trigger a heart attack! The mewling girly types cannot possibly be having heart attacks, because they are simply stressed!
posted by jaguar at 10:28 AM on March 27, 2015 [8 favorites]


So, question to medical peeps reading - is there a test that can handily exclude panic in an ER setting? Or is it down to triage nurses remembering the algorithm they learned in an online CPD module?

I'm not a medical peep, but yes, there are tests that can test for a heart attack.
Diagnosing a heart attack

The way you rule out a heart attack is by testing for a heart attack. Dismissing symptoms as "just" a panic attack is what should happen after life-threatening conditions like heart attacks have been ruled out.

ER staff manage to test men who show up at the ER with heart attack symptoms. There is no excuse for them failing to do so for women.
posted by talitha_kumi at 10:52 AM on March 27, 2015 [12 favorites]


And the idea that there are so so so many people out there who have undiagnosed panic disorders is just ugh. Seriously people generally notice when they have severe anxiety that dehabilitates them or costs them money. They also exhibit have different indicators like showing up to the ER often.
posted by AlexiaSky at 10:57 AM on March 27, 2015 [1 favorite]


Of course, AlexiaSky - I was just thinking through ways of circumventing the bias problem. (Thanks, talitha_kumi for sparing me the Google search I should have done :/ ) If an ECG can be done (cheaply, and within ten minutes), maybe it makes sense for those machines to be placed right at the triage desk, and maybe they ought to be performed on women showing up with symptoms conforming to either a panic attack or heart attack as a matter of course, along with BP measurements etc.
posted by cotton dress sock at 11:03 AM on March 27, 2015


Oh my god. Haven't read the whole thread yet or even all the articles, but I'm a 24 year old woman currently trying to figure out what is up with my breathing and heart rate since I have literally never been able to run more than about 30 seconds without being completely unable to breathe, and oh this is true even if you make me, and the heart rate monitors in gym kept going up to 190 instead of the 120 we were told to aim at when I would walk (as fast as I could, trying to catch my breath) and run straggling behind everyone else in gym class...

...and my preliminary intake visit to have this discussed a few weeks ago, even with those numbers, even with a peak flow count which was consistently about 75% of what I was told to aim for, dealt so heavily with a RNP who clearly thought I was just lazy and out of shape. Like, asking if I regularly exercised when I mentioned going hiking every week and walking to and from work, because faster exercise means I can't breathe, and then snapping at me that 'oh, you don't exercise, none of that counts.' And insisting I should go to a nutritionist. And just, fucking hell, this shit is so fraught and I am having so many issues even saying clearly that there is anything wrong, and that if there is it's not some kind of personal failing, and--it's a sore spot, is what I'm saying, and it would be so easy to just not go back ever. I'm justifying why I think this needs looking at even now, because there's a part of me that thinks I'm being unreasonable, this is just what life is like, and I need to stop being so precious about it.

Well. Thank you for posting this, okay? It means a lot right now. And now I'm going to go read everything you've linked and the thread and hold it in the back of my mind when I call and schedule the appointments with the cardiologist and pulmonologist I'm supposed to set up this month.
posted by sciatrix at 11:12 AM on March 27, 2015 [19 favorites]


And I'm not even fat--I can't imagine the shit that women who are heavier than I am have to deal with. Jesus christ.
posted by sciatrix at 11:18 AM on March 27, 2015 [2 favorites]


I learned a lot about the different presentation for women from Rosie O'Donnell's description of her own heart attack.

The full video is here.
posted by blurker at 11:27 AM on March 27, 2015 [1 favorite]


sciatrix - woman to woman, find another doctor. Keep trying another doctor until you find one that listens to you and is willing to advocate on your behalf.

I have an autoimmune disorder that was dismissed for several years until I finally found a doctor that listened to me.
posted by zug at 11:57 AM on March 27, 2015 [3 favorites]


So i left him, and started bringing my husband along to medical appointments so the doctors had someone to listen to.

We ended up having to do this, and it is so angering that it routinely takes me sitting in the room to get doctors to take my partner seriously. We've also had to learn to be ruthless in firing doctors -- one episode of being dismissive and we move to the next, no second chances. It has worked ok, but what is someone who doesn't have a male partner supposed to do? Rent some random guy off the street corner to sit there and keep an eye on how the doctor interacts?

We could write a saga similar to hydropsyche's above, but it's just different details. The big picture of women getting dismissed and having serious medical issues trivialized is the constant in all of these, and it points to a systemic blindspot in many medical practices, regardless of the genders of the doctors.
posted by Dip Flash at 12:20 PM on March 27, 2015 [9 favorites]


This is so awful and exactly my experience. I had a bad gallbladder for 7 years (it was necrotic by the time it was removed) and I had a doctor once tell me "honey, I don't think you understand what heartburn feels like" when I went to the ER because of pain during one of the hundreds of attacks I had before I found a doctor who listened to me and actually analyzed my symptoms. I didn't go to the doctor for years because I was so used to being dismissed.
posted by Nimmie Amee at 12:31 PM on March 27, 2015 [7 favorites]


In 25 years I've never seen, heard, or been aware of this personally or from the mouths of hundreds of candid encounters and discussions with colleagues, and though I expect you are sincere your hyperbole is a gross oversimplification.

This is.....wow. This is you illustrating the problem.
posted by almostmanda at 12:46 PM on March 27, 2015 [21 favorites]


Unfortunately, like so many medically critical issues, the patient often does better when they stand their ground and challenge the doctor, or simply demand a basic stress test or cardiac consultation. If you are concerned, press for more evaluation.

Seriously, have you ever dealt with a doctor who didn't take major offense at being challenged? Doctors hate that!

In any case, as others have mentioned, if you can, bring someone, anyone, to your visit and have them simply sit quietly in the corner alert and observant. It keeps bad doctors a little more on their toes.

That a doctor would advocate such a gross invasion of privacy is disgusting.
posted by bleep at 12:56 PM on March 27, 2015 [7 favorites]


Challenging doctors can also get you labeled as having hypochondria / facetious disorder / malingering / munchausen's / a personality disorder (not that doctors can tell these things apart, nor will they refer you to someone who can actually diagnose them)
posted by internet fraud detective squad, station number 9 at 1:05 PM on March 27, 2015 [14 favorites]


I go to most of my wife's doctor appointments; I bring along my little notebooks, and I take a lot of notes.

When she is talking to a doctor I will double-check past dates/times/dosages, or I will go through the list of questions that we work out the night before. I am not there as A Man to intervene on her behalf, but only as a partner in her care plan and as a back-up to her memory. (Though with a few male doctors I have had to stick up for her, which is fun because I listen carefully and learn their jargon and then use it against them.)

Yesterday a medical student was sitting in on the appointment, and she said to us how she thought it was so great that my wife had someone to take notes. Doctor, you shouldn't be surprised, you should instead be wondering why there isn't a summary of every appointment sent to the patient as soon as they leave. I mean, the notes are right in the hospital's records, and goodness knows they verify our address twice per visit…and in fact, as we left yesterday, the lady booking appointments handed us four pages of notes. Yay!

Hospital web portals can be clunky, but they also let read the actual visit notes. These let you review what your doctor thinks is going on as many times as it takes for you to understand them, and also to look for mistakes.
posted by wenestvedt at 1:06 PM on March 27, 2015 [5 favorites]


Challenging doctors can also get you labeled as having hypochondria / facetious disorder / malingering / munchausen's / a personality disorder (not that doctors can tell these things apart, nor will they refer you to someone who can actually diagnose them)

And once you get any of those judgements sullying your notes, you've lost any chance of being taken seriously by a doctor for anything ever again.
posted by talitha_kumi at 1:08 PM on March 27, 2015 [12 favorites]


Oh, hey, I had to get a male mouthpiece to get medical care once too!

I had severe iron deficiency anemia as a result of heavy bleeding from fibroids, but when I went to see a doctor after I'd nearly fainted in the shower, I made the mistake of confirming that yes, I was anxious about the heart palpitations and the whole "almost fainting in the shower" thing, so I was sent home with strict orders not to take such hot showers, drink plenty of liquids, and try to relax. And it was so obvious that this guy was not going to listen to me, I just said, "Fine," got out of there as fast as I could, and continued to live with it.

I hate going to doctors in the first place, and after that experience, I wasn't inclined to keep going back. But a few months later, I tried to get out of bed and couldn't. My boyfriend was there, and he told me I was gray and cold to the touch, and he dragged me back to the doctor. When HE told them something was wrong, they finally decided to do a blood test, which revealed that if my iron levels had been any lower, I would have needed a blood transfusion.

I finally ended up getting 'emergency' surgery, after years of seeking help myself and not getting it. (It was kind of funny how panicked everyone was as soon as they understood that what I had been telling them for years was true.)

But you don't get to just remove a diagnosis from your records, even if you can clearly show that it was a result of medical negligence, so it still says that I was treated for anxiety and stress, and that I went to a doctor for unspecified 'malaise,' all pretty much dogwhistle for hysteria. This still affects my access to medical care, because no matter what I see a doctor for, that guy's notes tell them to ignore me.

And that is why, whenever I hear a medical professional talking about hypochondriacs and attention seekers, I think there's about a 90% chance they're just telling me stories about times they got away with gross malpractice.
posted by ernielundquist at 1:09 PM on March 27, 2015 [33 favorites]


Actually now I’m curious: in the ER event I described above, I felt so bad that I requested my boyfriend come into the doctor’s office with me, but was not allowed to bring him (he came in with me, but was asked to leave and wait outside). The doctor told me that this was because we were not married, and would be a violation of my privacy. I offered to sign a legal waiver because I would have felt a lot more comfortable with someone else present, but they said that it was a matter of policy and nobody was allowed to be with me unless they were a parent, child or a spouse.

Is this a hospital-specific thing or an actual federal HIPAA-related law? (The hospital in question was in the northeast USA.)
posted by angst at 1:43 PM on March 27, 2015


I guess I shouldn't be surprised that this thread went down the exact same path as the other one. I quote myself:
Doctors act like women are children all the time. In ways that you don't see because you are a man. Sure, we're just broken parts, but we're also not capable of understanding the way in which we're broken so it needs to be explained in very small words with as condescending a tone of voice as possible. You're not seeing it because it happens behind close doors in exam rooms where women are alone and no one is there to see how poorly we're treated. Alternately, it's happening right there on the floor in front of your eyes, but you're too busy to notice. You saying that it doesn't happen doesn't make it so. It just makes you wrong.
posted by stoneweaver at 2:08 PM on March 27, 2015 [8 favorites]


That is total bullshit angst. HIPAA allows you to share your own medical information with whoever you like. Hospital policy is very regressive in that case. I'd consider writing a letter to the hospital complaining (politely) about this policy. The more people that speak out, the better.
posted by latkes at 2:09 PM on March 27, 2015 [5 favorites]


For some reason I found the first link hard to read, even though I was interested in what it had to say. Anyone else have trouble with it? I was glad it was written but found it hard to follow.
posted by latkes at 2:11 PM on March 27, 2015


Doctors act like women are children all the time.

Hope I don't appear to be blaming the victim, but you need to find different doctors, ones that aren't assholes. They're out there, but they might be hard to find in your particular locale.
posted by Mental Wimp at 2:40 PM on March 27, 2015


Hope I don't appear to be blaming the victim, but you need to find different doctors, ones that aren't assholes.
That's sometimes easier said than done, when you need to find doctors in particular specialties, who are in-network for your insurance, and who are accepting new patients. I'm actually totally delighted with my current doctors, but there have been times when I've had no choice but to stick with doctors who treated me like a not-so-bright child.
posted by ArbitraryAndCapricious at 2:46 PM on March 27, 2015 [9 favorites]


Seriously, have you ever dealt with a doctor who didn't take major offense at being challenged? Doctors hate that!

Fun fact: In my last pregnancy, I was yelled at in front of an entire waiting room full of patients and the front office staff by my OB after I questioned why he was recommending weekly visits for tests that I knew to be medically unnecessary. I was 27wks pregnant. Seriously - who does that?
posted by vignettist at 2:52 PM on March 27, 2015 [2 favorites]


Finding doctors who are not assholes can be difficult in an industry where part of the training is being "taught to be on the lookout for hysterical females who come to the emergency room."

I once asked my boyfriend how many times a medical professional has asked him if he was anxious or depressed, or otherwise implied that his medical issues might be psychological. He said it had never happened to him. The only times I haven't been asked that was when I've had a visible wound to show them.

If it ever happens, I'll probably stick with the doctor who doesn't try to gaslight me, but now that I am not only female but also middle aged, it seems increasingly unlikely.
posted by ernielundquist at 3:23 PM on March 27, 2015 [15 favorites]




Actually now I’m curious: in the ER event I described above, I felt so bad that I requested my boyfriend come into the doctor’s office with me, but was not allowed to bring him (he came in with me, but was asked to leave and wait outside). The doctor told me that this was because we were not married, and would be a violation of my privacy. I offered to sign a legal waiver because I would have felt a lot more comfortable with someone else present, but they said that it was a matter of policy and nobody was allowed to be with me unless they were a parent, child or a spouse.

I've run into odd rules at the ER before, apparently because of all the problems they have with drug seeking people. (And at least once I've been told to wait outside while they asked screening questions to make sure that I wasn't the cause of my then-girlfriend's injuries, but was allowed back in after.) If either of those was even a remote possibility, then it might have been ok, but it really sounds like they were being awful and inappropriate.
posted by Dip Flash at 4:35 PM on March 27, 2015


Finding a good GP for my wife was next to impossible because she wanted a female doctor. So I sent a friend a message -- who is herself an MD married to an MD -- and she agree that there was a paucity of GPs, much less good ones, to say nothing of good female ones. She said that they even had trouble finding one, and they are in the business!
posted by wenestvedt at 7:43 PM on March 27, 2015


I work in coronary care and I find this topic really interesting because one of the criteria for admission to CCU is that you have to have had a heart attack. So I only see the people who have been let past the gate, I don't see all the ones who are misdiagnosed in ED, or ignored in primary care, or who are admitted to hospital for some other thing and have a heart attack while they're there and yet still don't receive appropriate treatment.

I've tried not to thread-sit but I've read all the comments here with interest (and in some cases growing outrage at poor medical care while doing this), but I thought I might comment on a few things.

How is this a gender difference and not a sex difference? Gender is behavior. Sex is anatomical.
posted by enamon


It's a gender difference because the problem is not "women present with different signs of a heart attack compared to men and people don't know what to look for". It's "young women don't present at all when they're having heart attacks because they've been conditioned to avoid medical care because of past experiences, and further when they do present they're not likely to be correctly diagnosed, have the correct diagnostic tests performed, or even to get referred to a cardiologist." and this is specifically a gendered problem.

In 25 years I've never seen, heard, or been aware of this personally or from the mouths of hundreds of candid encounters and discussions with colleagues, and though I expect you are sincere your hyperbole is a gross oversimplification.
posted by docpops


Quite a few people have contradicted this, so I don't want to pile on, but this is just wrong. This is a well documented phenomenon, and if you don't think people here are accurate there are lots of studies about doctors and weight discrimination you can have a look at. I know that being overweight can lead to lots of health problems, but overweight people still have a right to be fit and well and to receive good care. Given that there's always a knowledge and power imbalance between physicians and patients it's not really on the patient to have to advocate for themselves against discriminatory behavior, or to try and be psychic and play 8-dimensional chess with clinicians while they try and guess what's driving their thought process. It's on clinicians to practice respectfully and safely and to actually listen to their patients. We should reflect on our own practice and experiences so we don't repeat the same mistakes and prejudice ourselves against our patients.

So, question to medical peeps reading - is there a test that can handily exclude panic in an ER setting? Or is it down to triage nurses remembering the algorithm they learned in an online CPD module?
posted by cotton dress sock


Third Universal Definition of Myocardial Infarction is the actual diagnostic criteria, but in a nutshell: yes there are tests to tell if someone is having a heart attack versus a panic attack, specifically a really good history taking along side an ECG and blood tests for cardiac biomarkers (specifically troponin). And more importantly, the correct and safe approach is to treat anything that could be a heart attack as a heart attack until it's ruled out.

Well. Thank you for posting this, okay? It means a lot right now. And now I'm going to go read everything you've linked and the thread and hold it in the back of my mind when I call and schedule the appointments with the cardiologist and pulmonologist I'm supposed to set up this month.
posted by sciatrix


Aw man, this actually made my day. Cheers.
posted by supercrayon at 8:30 PM on March 27, 2015 [18 favorites]


The information about doctors asking women about stress

It is either faith in the placebo effect or handwaving to avoid work by the profession.

This stress theme could very well be addressable with actual technology and the whole new field of biometric data capture.

You can't claim 'abnormal' without measurement data and most people fail at the data capture part.

The US Military-INdustral-Congressional complex has put in a couple of quid into OpenBCI. The units can capture EEG data and with a week or more of data you should be able to show things like pain, stress, er al.

A senior project of "helping to address women's health issues" by contributing code sounds to me like a scholarship opportunity. Toss in some medial privacy HIPPA by making it a local app on an Android tablet or via a dedicated VM and you have a winner.

Now I've had Doctors fail to do work for me. Separate yourself from the other patents. Start off communicating in writing. Write up a formal summary of ALL the interactions each time they happen and drop that off at their office. Then when you have an issue you are in a better position when you write a letter citing the legal nexus of the ACA/State-Fed Constitutional Law/The UN Deceleration of Human Rights and how your issues will make for interesting case law. It was amazing how quickly the paperwork got solved once that letter hit their office and how the clinic admin found time to call me to let me know it was being addressed, then "the matter has been addressed" and a followup "are you happy now?" call. It may help to wear a "not amused" face when dropping off the letter ;-)
posted by rough ashlar at 9:05 PM on March 27, 2015


It is why the obesity epidemic is so hopeless.

It doesn't help that the ACA does not cover weight loss. The lack of data on gut bacteria and cooking methods doesn't help. Making rice less digestable
posted by rough ashlar at 9:17 PM on March 27, 2015 [1 favorite]


17 year old girl goes to Kaiser doctor with severe back pain. Doctor tells her she’s simply too fat and refuses to provide CT, refers girl to nutritionist. Three months later, girl’s leg, half her pelvis, and part of her spine are amputated because back pain was actually due to fast-growing tumor.

(Kaiser exec says doctor acted appropriately.)
posted by flatluigi at 10:29 PM on March 27, 2015 [3 favorites]


Christ, flatluigi.

@supercrayon - Thank you for explaining the procedure. What I was thinking was, if an objective test (like the ECG) could be very quickly and efficiently (and cheaply) performed, by triage staff (if it's in their scope of practice) as part of a mandatory routine whenever that constellation of symptoms is reported, before the snowballing of judgements and bias and notes in the file begins - before the doctor even sees the patient, just at triage - it might make things safer for women at risk.
posted by cotton dress sock at 11:51 PM on March 27, 2015


And regarding that 17 year old girl:

“She told me my back pain was because I had weight in my belly and I needed to go to a nutritionist to lose my belly weight,” Rahm recalled in an interview Thursday.

Because she was normal weight, 5 feet 4 and 125 pounds, Rahm was surprised at the diagnosis. She visited the nutritionist, tried acupuncture and yoga, but the pain only got worse.


125 POUNDS, and the doctor still thought calling her fat was a better option than believing her. Horrifying, and telling. (I am not saying it would be acceptable if she HAD been overweight, but the fact that some doctors default to this nonsense line of "your sickness is your fault because of fat" OR "your sickness is all in your head and you are overreacting" even in cases like this one just speaks volumes.)
posted by a fiendish thingy at 3:35 AM on March 28, 2015 [16 favorites]


My friend told someone her heartburn felt like broken glass. She wasn't a complainer, never thought to call a doctor. Her heart attack killed her. I still miss her.

A few months later, I had killer heartburn. pretty sure it was heartburn, lots of stress in my life. Called my doctor's office rather sheepishly, they said No Big Deal, Come Right In. Put me on a monitor, it wasn't a heart attack, and they assured me that I did the right thing, and I shouldn't be embarrassed. I just needed to share that sometimes the healthcare profession gets it right. Good data helps a lot.
posted by theora55 at 7:37 AM on March 28, 2015 [4 favorites]


if an objective test (like the ECG) could be very quickly and efficiently (and cheaply) performed, by triage staff

Every time I've had an ECG it requires that the chest be bared to attach the wires, which is not something that can be done to women in a triage location - it usually has to wait until you get to a private location. Maybe there's a "field protocol" that could manage by lifting up and down on the shirt at specific times/locations?


Separate quick question: how long after chest pain stops can an ECG tell if it was heart pain or not? If you get the ECG the day after having chest pain all day, could you still tell if it was the heart? I'm asking because chest pain can come and go, and if you don't get to the ER right away, can they still tell it was your heart (instead of gastro pain) if you get the test a day later?
posted by CathyG at 8:06 AM on March 28, 2015


All of this makes it extremely important for women to not just accept shitty doctors. Seriously, if your doctor is ignoring you and patronizing you, and you have the ability to get another doctor, DO IT. I know not everyone can. And I know we need systemic change. But my heart breaks when I hear friends talk about how their doctors treat them (or rather, *don't* treat them). Don't put up with it if you have alternatives!

(If you live in southern Alameda county, I can recommend an excellent doctor at PAMF.)
posted by wintersweet at 9:39 AM on March 28, 2015 [1 favorite]


All of this makes it extremely important for women to not just accept shitty doctors. Seriously, if your doctor is ignoring you and patronizing you, and you have the ability to get another doctor, DO IT.

It is frequently next to impossible to find a non-shitty GP, for the reasons others have previously mentioned. In an ER setting where each patient is seen by whichever doctor is first available, it is literally impossible because there is no choice of doctor. It is under these circumstances where the failure of doctors and triage staff to recognise and treat heart attacks in women is causing unnecessary and preventable deaths for inexcusable reasons. This is not something that patients can influence, especially not when they are in the middle of a life-threatening situation. It is not a patient's responsibility to advocate and negotiate when they are literally dying. It is the doctor's responsibility to do their job and treat their patients without killing them through gendered negligence.
posted by talitha_kumi at 10:35 AM on March 28, 2015 [12 favorites]


I like to remind people that doctors are just meat mechanics. They're not special or magic. They went to school to learn how to maintain the meat machines in which we live. The fact we live in the machine makes it more important than getting the car serviced but the principle is the same.

The fact that they are taught to think they're special or magic doesn't change the fact that they're merely technicians taught (badly, in most cases) how to repair our flesh shell. Don't let them make you feel stupid or inferior.
posted by winna at 11:39 AM on March 28, 2015 [4 favorites]


talitha_kumi, I know and I fully agree (hence my remarks about the system, etc., if you read my entire comment). But I have friends and family who COULD find another doctor, and who SHOULD ask for personal referrals etc., first, and they're not doing it. They shouldn't have to, absolutely. The problem is their doctors' and the system's, yes, absolutely. It's not an option when you're in the ER, yes, obviously. But we still need to speak up for ourselves when we can. People who have the ability to change doctors and find better ones shouldn't just remain where they are because they're embarrassed or don't want to make a fuss or they figure every doctor is the same (patently not true). Not instead of tackling the sexism/sizeism/racism etc., but in addition, to protect ourselves right now (again, if we can).

I hope my meaning is clear here.
posted by wintersweet at 11:49 AM on March 28, 2015 [3 favorites]


It's very true that not every doctor is a misogynist piece of shit. There are good doctors out there and if you have a shitty one it's worth it to yourself to see if you can find that good one. When not in a life-threatening situation of course. The more patients stop putting up with being treated like crap, one would hope, the less doctors would feel like it's acceptable behavior at all. There has already been amazing progress in this effort so far. Look how far we've come!

I gotta say I was having a panic attack one time and went to urgent care, and the very nice female doctor gave me every test under the sun to make sure I wasn't dying. It does happen sometimes.
posted by bleep at 4:29 PM on March 28, 2015 [2 favorites]


I am 100% for advocating for yourself and finding a good doctor, but I think it's not always quite that easy. If you dump your doctor once, you're probably ok, but if you do it more than once, you might be accused of doctor shopping, which a lot of doctors are going to see as a big red flag. (And depending on what your symptoms are, you might be suspected of drug seeking, which is a really big red flag.) Advocating for yourself is great, but it can also backfire, because you can get a reputation for being difficult or hysterical or whatever, and my understanding is that doctors have ways of conveying that in code, so that reputation can follow you even when you move on to a new doctor. You do have to advocate for yourself, and nobody should put up with disrespectful treatment, but like with all of these things where we're supposed to come up with individual solutions to systemic problems, it's hard to thread the needle so that you're advocating for yourself in a way that will be effective and not backfire.

I actually have a fair amount of sympathy for doctors. It's a hard job for all sorts of reasons, some of which are inherent in the job and some of which are caused by the American medical system. I don't think that most doctors are actively malicious. I just think that their biases, many of which are unconscious, can have all sorts of sometimes-lethal implications for their patients, even if they are sincerely trying to do a good job.
posted by ArbitraryAndCapricious at 5:10 PM on March 28, 2015 [4 favorites]


In an ER setting where each patient is seen by whichever doctor is first available, it is literally impossible because there is no choice of doctor.

A few years ago I went to the ER and had my son's broken arm casted -- but it was simply too tight. That night I took him back to the ER, and the young doctor (resident?) who'd been there the night before examined him, and then stalled and hemmed and hawed. (It's wasn't quite as bad as he thought Compartment Syndrome should be, you see: the fingers weren't darn purple yet, and they could still move.)

Eventually a nurse we recognized spotted me though an open door and came in to say hi. When I explained the problem, she looked mad, and summoned the attending doctor. He took one look at the swollen, purple skin, looked disgusted, and muttered, "Get it off." We were out of there very soon after with a new, more comfortable cast.

Yes, the young man had to learn. But just perhaps he should have accepted my observations of my own son's discomfort, being based on a slightly longer acquaintance with the patient.

When we returned to the ER almost a year later for my other son to get a leg casted, this young doctor was there again. He was allowed to hold something while others worked. Our name is quite distinctive, and the young man positively scuttled.
posted by wenestvedt at 10:40 AM on March 30, 2015 [3 favorites]


Just back in town and ran into this. The medical profession continues to be baffled about why they are getting sued and yet, here it is. A failure to listen. I am a woman and have been told I had stress but turns out it was a heart attack....and I did not get out of the hospital before I dropped to the ground. I now start out my conversation with "if you are going to treat me like an old fat white woman" we can just stop now and I will go elsewhere. So I suggest acting like a bitch but a bitch with a written list of complaints and if the doc gets dismissive, be pushy.
posted by OhSusannah at 6:23 PM on April 9, 2015 [1 favorite]


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