How Doctors Take Women's Pain Less Seriously
October 15, 2015 6:17 PM   Subscribe

"If she had been alone, with no one to agitate for her care, there’s no telling how long she might have waited." Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing.
posted by headspace (111 comments total) 48 users marked this as a favorite
 
For a story of this occurring in practice, listen to the latest episode of "Reply All"
posted by SansPoint at 6:29 PM on October 15, 2015 [5 favorites]


Uh. I have totally done the "minimize symptoms so as not to seem melodramatic" thing, which basically means that the price of being taken seriously is that you deny how bad you feel. It's maddening.
posted by ArbitraryAndCapricious at 6:32 PM on October 15, 2015 [20 favorites]


Also an issue with race and children.
posted by idb at 6:39 PM on October 15, 2015 [8 favorites]


Well, this made my blood boil. How can we fix it?
posted by Gymnopedist at 6:39 PM on October 15, 2015 [1 favorite]


In 2009 I went to the ER with what turned out to be appendicitis and was left to sit in the waiting room for four hours before being admitted and given pain meds. I am not even a little bit surprised at this story.
posted by Daily Alice at 6:40 PM on October 15, 2015 [8 favorites]


I live in constant fear of being seen as dramatic or overreacting when it comes to health issues because I am a woman, so this makes me angry and super fucking sad.
posted by Kitteh at 7:07 PM on October 15, 2015 [12 favorites]


I hope that first doctor was fired or sued into oblivion.

I've done the same thing, even caught myself hesitating, with some twisted thinking, that I didn't want to call the doctor's office because I only called when I was sick. Or some twisted version of that, that I was somehow becoming bothersome. What BS. Bad enough if women patients act that way. An ER staffed by professionals, including many women, absolutely shouldn't be that way.
posted by etaoin at 7:12 PM on October 15, 2015 [2 favorites]


Oh man, I totally understand the impulse he's talking about, where the women do this to themselves. The "be quiet, everything is okay, you're just exaggerating, things are fine and normal, don't make such a fuss about everything" voice lives in my head, too.
It's why I got in my car after I fell off a trampoline when I was seventeen, and started driving, even though I knew, I knew something was wrong. By the time I hesitantly mentioned it to my boyfriend, I couldn't straighten my arm past 90 degrees. God bless him, he pointed out the hospital that was only two blocks away.
It turned out that, rather than "making a fuss", I'd been driving with a broken elbow.
Goddammit this article makes me feel sick.
posted by Adridne at 7:28 PM on October 15, 2015 [2 favorites]


It's interesting -- my personal trainer was a volunteer on the ski patrol. She told me that ski patrol volunteers are trained to *de-minimize* women's pain, because women so often minimize their own pain -- saying "I feel some discomfort in my chest" when what they mean is "I'm having a goddamned heart attack over here" or "my ankle kind of hurts" when what they mean is "when you remove my ski boot, my foot is pretty much going to fall off". So as first responders, they're taught to treat women's issues and falls as more serious than the women say they actually are.

I wonder how that ends up translating to ignoring women when they *do* say they're in serious pain in a hospital situation.
posted by jacquilynne at 7:37 PM on October 15, 2015 [70 favorites]


I have experienced this first-hand (though luckily in not such a severe emergency) but in many doctor's appointments, tests, and ER visits.

The MOST frustrating thing is that many, many, horrible, exhausting, painful chronic illnesses primarily affect women!! Yet, somehow doctors look at us and say it's anxiety or sleep more or lose weight or deal with it it's IBS. (Lupus and other autoimmune are 80% women, endometriosis, fibromyalgia, etc.) Not to mention when it comes to internal organs, well we just have more things that can develop cysts and tumors and bumps and stones.

I've been dealing with worsening chronic illness for over two years (undiagnosed but finally closer to a [bad, scary] diagnosis). One part that helped is when I had to get my gallbladder removed after almost a year of severe pain, three months of which I was in so much pain I would wake up in the middle of the night in a sweat and I literally was wishing for death. My Gastro said it was IBS and just gave me more pills, even after being in his office 3 times with worsening symptoms. When that sucker was sent to the lab it was all sorts of screwy.

Another gastro (who I really like, actually) wrote that I was "functional" after literally saying, "I had to quit my job and most days all I can do is lay down." How the hell is that functional?

I'm so glad I have a (female) GP that actually listens to me. While she was on maternity leave I saw another doctor at the practice. He was fine, and ordered the test for the gallbladder, but then said everything was fine, even though it was functioning at 50% and I had all the symptoms. The first day my doctor was back from leave I was in her office, with my own research, telling her my gallbladder needed to come out. She immediately gave me a surgeon's number. Plus my (male) OB has been awesome and said not to hesitate to call if my cycle is more awful after stopping my pills. But it shouldn't be this hard to find doctors that take women's pain seriously.

It's all such crap. It makes me so mad. I have NO doubt that if a man went in with the same symptoms they'd be rushing to figure out what's wrong. It's even harder that dealing with a chronic illness you learn to slap a smile on your face and crack jokes. Then it all relates to emotional labor of course of wanting to placate and not make a fuss. I've had to learn to find some sort of balance of being serious and explaining how these symptoms are ruining my life while not seeming "dramatic" or "fussy" or "hysterical" but also not seeming like it's something I can "deal with." I could rant all day about this. It's so frustrating.
posted by Crystalinne at 7:39 PM on October 15, 2015 [34 favorites]


I'm not bringing this up as any sort of "counter-example" or "what about teh menz" thing, but just because it's a kind of awe-inspiring example of people minimising pain:

My friend was walking on the beach near her house in Australia early one morning a few weeks ago, when a guy crawled out of the ocean, pulled himself up onto the beach, and stared in a dazed way at his deeply gashed, bleeding leg. She was all, "Oh my god, are you okay? What happened?"
He said, "I think I got bitten a little bit by a shark."
She offered to call an ambulance. He said he thought he'd probably be okay, and got into his car and drove off.

(But to me, that story is like every woman's injury or illness ever.)
posted by lollusc at 7:51 PM on October 15, 2015 [8 favorites]


Yeah, I'm never going to the emergency room alone ever again. The one time I did I was turfed out after 12 hours with no diagnosis, one nurse snarling at me and the other one laughing at me. Three different doctors stuck their heads in a couple of hours after I demanded to see them, but none of them stayed long enough to do anything. One nurse - the one who kept calling me "honey" - straight up lied about the number of IV fluid bags she'd given me. Came back with my sister a few days later, and it turned out to be a kidney infection.
posted by The Underpants Monster at 7:53 PM on October 15, 2015 [8 favorites]


Well, back when I was married, we were having an episode where my wife's nausea was so severe (for over 8 hours), that even I, Mr. "I have heard of these doctors in legend, tell me more", finally managed to get her out of the house, into the car, and (with several stops on the way) to the local ER. During the over two hours we waited (several more vomiting incidents), we did witness a boy 11 or 12 get a portable X-ray machine in for a view of a broken arm while no one offered even an anti-emetic to the missus. I thundered and threatened on and on, and, still nothing. Finally, somewhere around ER hour 3.5 (keep in mind this is around 12 hours total here), the missus finally got a handle on it enough to argue me into letting her check herself out.
posted by Samizdata at 7:55 PM on October 15, 2015 [1 favorite]


I was surprised that coming in an ambulance didn't seem to speed up her admittance and examination. I've been to the emergency room a lot recently, and we have learned that when it's serious, we should call an ambulance -- it's more expensive than a taxi, but it means the person will be assessed first by the EMT and admitted immediately after arriving at the ER, instead of waiting outside as when you bring yourself in. We've still had to wait ages for admission to the ward, of course, but not before the initial examination.
posted by jb at 7:56 PM on October 15, 2015 [1 favorite]


I was severely anemic for a pretty long time. I knew about it and had been taking supplements, but I'd had weakness and shaking and intermittent heart palpitations for a while. But I didn't have insurance at the time, so I just dealt. Then, one morning, I almost fainted in the shower. Had to sit on the floor for a while before I could get out. So I went to a nearby doctor and saw a physician's assistant, told him my symptoms and told him I had chronic anemia, and he told me to take cooler showers and drink some tea and work on stress management or something. My head was so muddy and I wanted to leave so badly at that point that I just said OK and left. And dealt. For almost another six months. (I had been remembering this as a much shorter timeframe, but then I recently looked at my medical records, and it was like DANG.)

Finally, one morning, I couldn't even get out of bed, so I called my husband and he looked terrified. He said I was gray and cold to the touch all over. I obviously couldn't drive, so he took me back to that doctor's office and told them I was really sick and to do something, so they finally decided to take a blood test, and my iron levels were so low they were almost at the point that blood transfusions are your only option.

Denouement, in which insult is added to injury: During that initial visit, the PA diagnosed me with 'malaise' and 'anxiety,' so now, when I see a doctor, they see that and read attention seeker/hypochondriac.
posted by ernielundquist at 8:06 PM on October 15, 2015 [26 favorites]


Came back after reading TFA. OMG, ovarian torsion. I had that with my tumor. 11 on the pain scale doesn't begin to cover it. That poor woman.
posted by The Underpants Monster at 8:08 PM on October 15, 2015 [3 favorites]


Man, this is rough. I've gone to the (Australian) ER with my girlfriend in the past when she has had severe abdominal pain and while I don't know if she was treated sooner or later than a man would have been, it certainly took about two hours and nobody seemed to display any particular urgency. They shot her full of morphine and told her to come back later that morning (this was like 2 or 3 in the morning already) and hope that she could get some scans done. It could have been anything.

Well, she didn't want to go back. The pain went away on its own or she got used to it. She said she was never going to emergency again for any reason.
posted by turbid dahlia at 8:10 PM on October 15, 2015


I was surprised that coming in an ambulance didn't seem to speed up her admittance and examination.

Doesn't do shit. I've been in an ambulance once and have travelled with others in an ambulance three or four times in my life. They get to you when they get to you, same as everyone sitting out in the waiting room.
posted by turbid dahlia at 8:12 PM on October 15, 2015 [1 favorite]


Every woman I know, including me, has a story if not exactly like this, along these lines. One friend's burst appendix was nearly missed. Another had to scream murder to get someone to take a second look at the blood clot in her leg. My (female) doctor thought my aches and pains were NBD until I got independent reports from my physio and a sports med that it is just weird for someone my age to have as many tendon problems as I do, after no obvious trauma, and that maybe it's an idea to look at possible systemic causes. Speaking of my awesome lady physio, she had to refuse to leave the ER when the doc there told her she could walk home on what it later turned out were pulverized bones.

My mom, whose fantastic, compassionate, thoughtful, old-school, lady GP recently retired, is entirely discombobulated by what she's experienced since. (She's also an old-school healthcare professional and expects the kids these days to uphold those same standards, which admittedly were probably developed when the pay structure made it easier to do that. She's horrified, anyway, and is hugely disappointed that being a "good patient" doesn't help her out.)

I wonder though if part of the reason men get taken more seriously is that they have a reputation for refusing to seek care other than in extreme circumstances, and under-reporting pain when they do? If so, that might add to the discrepancy, but it doesn't explain it. And it doesn't come close to explaining the crappy attitudes so often in evidence.

Also, nurses, docs need to listen to their nurses more often.
posted by cotton dress sock at 8:20 PM on October 15, 2015 [5 favorites]


All this is making me realize I dodged a damn bullet last month, when I found myself in not one but two ERs. First one, at one point, was going to release me until I slightly shifted and broken ankle went from "kinda broken" to "completely falling apart". But it took the x-ray tech watching me writhe in pain just to twist enough to take three x-rays and then yelling "get her in a goddamn bed" for things to actually proceed. It was better when I got transferred to another hospital. Then, I was seen by someone fairly rapidly, and the wait came from waiting for the OR. At least I had morphine.

But god, I was alone for awhile and desperately trying not to start crying because I really didn't want to jeopardize any chance of my pain being written off because, you know, young woman. That was probably unnecessary, because I had x-rays showing a completely unstable ankle, but it's perverse that I thought it anyway.

I've heard about the rule of thumb among some first responders, when asking about pain on the scale of 1 to 10, "if it's a guy, subtract 2. If it's a woman, add 2" because more often than not, a woman will absolutely minimize her pain . I wonder if that rumor is true and if it is, why isn't it adopted among an actual ER?
posted by ultranos at 8:26 PM on October 15, 2015 [8 favorites]


Has anyone here spent any time reading forums where doctors hang out? Unless they can see your femur protruding from your nose you are a drug seeker until proven otherwise. As a person with an "invisible" chronic pain disorder I have almost given up hoping that a physician will help me. Street drugs are looking more appealing every day.
posted by futz at 8:35 PM on October 15, 2015 [37 favorites]


futz, yeah, this is my guess as well. Of course it's not the full story, but it's at least 80% of the paragraphs.
posted by turbid dahlia at 8:38 PM on October 15, 2015 [3 favorites]


God, this reminds me of a story that's way too personal for MeFi, but I want to tell it because it still makes me mad. Several years back, I had an appointment with a male gynecologist because of abdominal pain. The exam was awful (I bled afterwards) and he said my discomfort was probably because of "not being used to penetration," presumably because all my past partners were female (!). Followed up with somebody else a couple of weeks later when the pain became unbearable; turns out I had an ovarian cyst rupture and probable endometriosis. Fuck you, stupid doctor.
posted by thetortoise at 8:44 PM on October 15, 2015 [22 favorites]


Not to minimise the indisputable fact that women suffer from this more, I think also more broadly the medical establishment struggles a lot with pain.

From my own chronic illness, and growing up with and knowing a lot of doctors now as an adult, I think medical culture is so orientated around health, as opposed to wellbeing, I suppose.

This focus on health, and the no doubt widely variable ways in which pain is experienced and articulated, means that I see a lot of doctors, faced with an unquantifiable unknown (discounting the always iffy report of the patient), who shy away from the difficult issues of pain for fear of encouraging dependency, knowing that pain itself is unlikely to kill or often even harm in the way that medicine typically thinks about harm.

As a patient with chronic pain, this feels so destructive and isolating. You already feel like you are a private citizen of your own country when you're in pain. The disregard shown by medical professionals can feel like a judgemental confirmation of exactly what you fear, that you are being a baby, that it's not that bad, that you are weak and should be better, that nothing is really wrong with you. Gathering the courage to push though this, insist your needs are important, and matter is very hard when you are already compromised.

I have lots of thoughts about pain, guess I've dwelt on it a lot.
posted by smoke at 8:44 PM on October 15, 2015 [30 favorites]


forums where doctors hang out

Oh man, there was a blog post I fell upon once, by a resident who hated med school; it had thousands of terrifying replies from residents and end-of-career doctors.

I can see it, though. I imagine it's hard to see your 20th motorcycle accident victim and not think, "you could also just take the bus".
posted by cotton dress sock at 8:46 PM on October 15, 2015 [2 favorites]


I imagine it's hard to see your 20th motorcycle accident victim and not think, "you could also just take the bus".

I can see that too. That's why I keep an abridged copy of my medical history in my bag and give it to every doc I see. Included are letters from 2 geneticists and 5 doctors explaining my condition and it makes no difference. I even pass drug screens.
posted by futz at 9:17 PM on October 15, 2015 [2 favorites]


One night Mom had abdominal pain so severe she called the ambulance to go to the hospital. In the ER, after an exam, a few tests, and some kind of imaging, they patted Mom on the head and sent her home. It was just indigestion the dude told her. They didn't even give her Pepto. She was so embarrassed. I had to go get her and take her home.

The next morning, the radiologist looked at the pictures they had taken and called her. "Mrs. Obi-Wan's Mom," she said, "we need you to come back to the hospital immediately." When she got there, they rushed her into emergency surgery for a ruptured intestine. She nearly died. She spent a week in the hospital and I still had to live with her for several weeks to do for her while she recuperated at home.

All of which is to say we need a helluva lot more women physicians in this country.
posted by ob1quixote at 9:17 PM on October 15, 2015 [29 favorites]


The next morning, the radiologist looked at the pictures they had taken and called her. "Mrs. Obi-Wan's Mom," she said, "we need you to come back to the hospital immediately."

This is terrible. How did they not have a radiologist there overnight?

And if they did, why didn't the radiologist look at the imagining immediately? Did the hospital not staff overnight radiologists? I know techs aren't legally allowed to interpret imaging. I can see how ER doctors might not have caught it. It's very difficult to read images, which is why radiology is its own own specialty.

Was this a small hospital? No radiologist overnight? Crazy.
posted by discopolo at 9:27 PM on October 15, 2015 [2 favorites]


I'll never forget when I was in labor and having my epidural placed. I was a relatively mellow laborer; just lucky I guess, the pain was hardcore but not unbearable at 7cm and I mostly got the epidural because I wanted to try to rest since I hadn't slept much the night before owing to early labor, which meant I was nearing 36 hours of no sleep. So I was quiet and cheerful, joking around with the nurses and anesthesiologist between contractions, and they started telling me how great it was to deal with someone who was so pleasant. We heard a scream from down the hall and the anesthesiologist goes, "Don't tell me..." and the nurse rolls her eyes and replies, "Yup, she's next in line." "Oh, brother!" laughs the anesthesiologist. "We'll just take our time in here then, whew."

I was like...you took this job in labor and delivery. It is literally your entire job to help laboring women with the notoriously excruciating pain of labor. Whence the attitude, anesthesiologist?

Definitely going to remember that if my next labor is worse. Keep your mouth shut until the anesthesiologist shows up, because the louder you scream the longer it's gonna take. Ultimately, medical professionals are only human, and if there's anything humans loathe it's women who tell people what they need without equivocation.
posted by town of cats at 9:27 PM on October 15, 2015 [38 favorites]


It IS embarrassing and humiliating to be sent home. The alternative is sticking up for yourself which is viewed as disruptive and will be documented and will haunt your medical records forever.
posted by futz at 9:28 PM on October 15, 2015 [10 favorites]


ED is the area with the highest stress and most burnout rate. Most are completely overwhelmed and understaffed: and judging (visually) by the times I've been there, the vast majority of people there aren't true emergencies, and fair number are drunk / high on drugs / have mental illness and end up yelling and abusing staff. (to be fair, this is an inner city ED) So, if you're yelling at the staff, you're probably the 10th person to have yelled / abused them on that shift, with 9/10 of them on drugs / mental cases.

I read once in the local papers that ED consultants in public hospitals were being paid a salary of $500k and they were still leaving the profession because of work related stress, it just wasn't worth it. I have rarely ever met a doctor who actually says they want to work in ED, the rare ones that do tend to be the type that thrive under pressure and constant abuse and seem to not mind working in conditions of absolutely hopelessness and failure - ED is definitely where the medical system "fails" the most, where mental illness patients / drug abuse patients keep cycling through it when they "should" be in a managed care facility. Nearly every doctor comes out of ED disillusioned by the state of healthcare, regardless of which country they're working in.

There's two issues at play here, it seems: differences in response times in care for men / women might have some statistical underlying cause that may be difficult to resolve: for example (speculating) that a larger percentage of women presenting with undefined abdominal pain turn out to be suffering from a chronic condition that ED can't help with, while men who present with undefined abdominal pain statistically turn out to nearly always be something that can be immediately resolved (appendicitis, etc). If it turns out to be ingrained sexism, then protocols need to change.

The other issue is this particular patient's experience: my initial reading is that her experience is a result of human error and negligence, but that's something that has to be fixed by perhaps better controls and processes, and doesn't necessarily indicate that there's something fundamentally wrong with the triage process.

I don't think any ED doctor consciously provides better or worse care to different genders (especially as doctor gender approaches parity nowadays!). All they are focused on is clearing the queue of patients as fast as possible to improve their metrics and getting them to the right doctors for treatment. As I understand it the ED is a pretty brutal place: if you're not clearly dying in the next hour, it's not a concern. If they drug you up too quickly they can't diagnose you or monitor how you're doing, they won't know if you're deteriorating or getting better, that and also the extremely common occurrence of drug seekers coming to ED.
posted by xdvesper at 9:29 PM on October 15, 2015 [8 favorites]


Thanks for 'splaining!
posted by futz at 9:41 PM on October 15, 2015 [40 favorites]


All of which is to say we need a helluva lot more women physicians in this country.

A few of my female doctors/HCPs have let me down. I typically only pick female doctors or nurse practitioners and specialists, and I often feel like they're the ones who minimize my pain and expect me to buck up sometimes.

But overall, I definitely prefer female physicians to male physicians. There are so many health problems that are increasingly being linked to hormones for women, that I just need someone who actually has a shot at empathizing or commiserating first hand.
posted by discopolo at 9:42 PM on October 15, 2015 [4 favorites]


I don't think any ED doctor consciously provides better or worse care to different genders

Nobody is claiming consciously worse treatment. But unconscious biases influence everything we do and doctors are no different. There are many studies out there indicating the differential treatment between men and women when it comes to judging complaints, especially when involving pain.

Total anecdata, but I've been to the ER quite a bit and have also observed that the louder a patient complained, the more eyerolls they were likely to get. This got even worse if you were female, non-white, and/or appeared poor.
posted by schroedinger at 10:06 PM on October 15, 2015 [17 favorites]


I don't want to play down the role of ignorant doctors / nurses, but in my (albeit limited) experience, men generally do a lot more fuss when in pain or discomfort. Up to the point that they become quite nasty and aggressive to the medical staff when not being given immediate assistance. So in the already stressful environment of an ER or even just the normal ward, the most obnoxious patients get treated first to get them out of your hair. It's not an excuse, but maybe an explanation.

As an aside, in the 80s I read an article where the author suggested that if men had to give birth, you'd be given rows of medals for that...
posted by ojemine at 10:17 PM on October 15, 2015 [2 favorites]


On previw: What schroedinger said.

Although being of colour or poor seems to be of no relevance in Berlin hospitals. (Although jazz musician Eric Dolphy died of an easily treatable diabetic condition here in the 60s, but that was in an American Army hospital.)
posted by ojemine at 10:21 PM on October 15, 2015 [1 favorite]


men generally do a lot more fuss when in pain or discomfort. Up to the point that they become quite nasty and aggressive to the medical staff when not being given immediate assistance. So in the already stressful environment of an ER or even just the normal ward, the most obnoxious patients get treated first to get them out of your hair.

The thing you might be missing here is that if a woman made a lot of fuss and was nasty and aggressive to medical staff, they would not be bumped to the front of the queue to get them out of the staff's hair. Because people don't respond the same to women and men, even when they are doing exactly the same thing.
posted by misfish at 10:38 PM on October 15, 2015 [38 favorites]


discopolo: “Was this a small hospital? No radiologist overnight? Crazy.”
It was a unit of one of the largest and most prestigious hospital networks in the Atlanta area. The one my family's long-time personal physician was associated with, albeit at a different location. This all happened almost 20 years ago, but as I recall whoever was on call overnight was inexperienced, and perhaps listened too much to the attending physician who was so dismissive of Mom's pain, so they missed it. When the radiologist who knew what she was doing came in at 7 AM, she spotted the issue immediately and called Mom as she was on her way to work.
posted by ob1quixote at 10:41 PM on October 15, 2015 [1 favorite]


I just remembered another time during chemo, when I was in the ER throwing up that kind of blood that looks like black coffee grounds, and I was doubled over the basin when a young doctor stormed into my cubicle with his chest puffed out, bellowed, "Ma'am? Could you please keep it down in here? There are CHILDREN in this ward!" turned on his heel, and stalked out.
posted by The Underpants Monster at 10:42 PM on October 15, 2015 [17 favorites]


In psychiatry, dismissing female patients is not just a problem, it's a codified diagnostic criteria with a long misogynist history. Now it's not 'hysteria', it's 'histrionic disorder'. It's the allegedly scientific version of 'drama queen', but I'll be damned if there is a 'drama king' who gets this diagnosis. I got this one after insisting that the SNRI Effexor was not only making me whacked out, insomniac and manic but downright homicidal. ( I went to an ER for the violent urges) Which of course, was a histrionic thing to do, right? Catch-22. ( And this is how you go permanently nuts...)

One of the traits of the disorder is "using somatic symptoms to gain attention", so in the eyes of these beholders, their sexist dismissiveness is merely 'scientific objectivity and detachment'.

Turns out, Effexor is one of the top ten drugs associated with violence, according to that histrionic, scientologist, conspiracy theorist rag, Time magazine. No one mentioned the connection, not even once. I had to find it out for myself- and now, I want to alert the clinic of the dangers of prescribing it to bipolar patients like myself, and as I began to write up a complaint, I realized " ahhh... this will make me sound like a big hysterical drama queen and I need this clinic right now, so I guess in order for them to admit a mistake, one of their clients will have to kill someone or something. Especially since psychiatrists & pharm companies cop to mistakes just about never."

*sigh*
posted by GospelofWesleyWillis at 11:01 PM on October 15, 2015 [19 favorites]


the vast majority of people there aren't true emergencies, and fair number are drunk / high on drugs / have mental illness and end up yelling and abusing staff. (to be fair, this is an inner city ED) So, if you're yelling at the staff, you're probably the 10th person to have yelled / abused them on that shift, with 9/10 of them on drugs / mental cases.

Wow..... I mean..... Fucking wow.. Dude seriously consider the words you've typed.. Like read them out loud and imagine you are sitting in front of a patient, their family, or the best of your peers. Like fuck, really?
posted by the lake is above, the water below at 11:13 PM on October 15, 2015 [30 favorites]


I think I've said this before on here, but my mom visited me a while back and was gimping around on a hurting foot. I was concerned but her doctor had said it wasn't anything important, checked her cholesterol and told her to lose weight. She finally got to the point where she couldn't get up the stairs to my apartment so dragged herself to the urgent care by my house, where they sent her to the emergency room because they thought (and were right) she had a fractured bone in her foot and had been limping on it for however long. It was also an indicator of some significant weakening in her bones as a result of some problems with her parathyroid that would've been great to catch earlier.

At least her cholesterol was fine and she knew she needed to lose weight, right?
posted by Ghostride The Whip at 11:13 PM on October 15, 2015 [12 favorites]


Writing from the perspective of a final year medical student: I just want to start by saying that what is described in the story is clearly negligence. There should have been a triage system (and maybe there was and this lady slipped through a crack, or just wasn't unwell enough (generally the markers of unwellness don't really include pain, and painkillers shouldn't really be give before the patient has been seen by a doctor because they can mask the evolution of the symptoms which can be diagnostic). Second, the doctor clearly should have taken a proper history and done a proper examination. No excuses. Clear negligence.

the vast majority of people there aren't true emergencies, and fair number are drunk / high on drugs / have mental illness and end up yelling and abusing staff. (to be fair, this is an inner city ED) So, if you're yelling at the staff, you're probably the 10th person to have yelled / abused them on that shift, with 9/10 of them on drugs / mental cases.

Wow..... I mean..... Fucking wow.. Dude seriously consider the words you've typed.. Like read them out loud and imagine you are sitting in front of a patient, their family, or the best of your peers. Like fuck, really?

I wanted to address this. Reading Metafilter is where I realise how much medical school and working in a hospital can change your perspective compared to the general population. The fact is, a lot of people who come to A&E are drunk/high/abusive or suffering from a mental illness (which needs to be treated, of course, but A&E is generally not the right place for that unless the patient is having a psychotic episode or is acutely suicidal).

The goal of A&E is to keep as many people from dying as possible by identifying and treating their acute physical/mental problems. While this would ideally be done by doctors and nurses with unlimited amounts of patience and compassion, A&E is unfortunately human. When you work a 12 hour shift where you are constantly on your feet and constantly aware that the slower you are with one patient, the more patients keep accumulating in the waiting room, it's almost impossible to give every patient the care we wish we could given unlimited amounts of time and resources.

Solutions? Shorter shifts and more staff in A&E would be a good start! More mental health workers available to help deal with those patients who need their input.

I'm not trying to say that patients should be ok with being treated like shit or negligently in A&E. But please do consider how hard the work is for those of us on the other side, and consider giving us a little slack! We should be better, and trust me, the new generation of doctors (in the UK at least) are trying as hard as we can to be aware and deal with the problems mentioned throughout this thread!
posted by snoogles at 12:02 AM on October 16, 2015 [18 favorites]


So, if you're yelling at the staff, you're probably the 10th person to have yelled / abused them on that shift, with 9/10 of them on drugs / mental cases.

Uh, NO. The person in the article was not yelling at the staff or abusing them. She was just in pain, and the husband went to get help. She probably made some noise, yes, but yelling 'OW, my stomach!' and yelling 'FUCK YOU, Nurse Bitches!' are pretty different utterances.

I saw nothing about him or his wife, or any of the commenters here saying, "Hey you fucking pieces of shit, I want my Percocet NOW". I've worked with that, in a free clinic. And all of us who've been to city ERs have probably seen it. And I do not hear anyone saying anything like that. We're talking about very different kinds of behavior getting waved away. We're also talking about a lack of triage methods being used to near-fatal results sometimes, not just clinicians & staff failing to smile whilst being called a useless waste of flesh and so on.
posted by GospelofWesleyWillis at 12:05 AM on October 16, 2015 [11 favorites]


Wow..... I mean..... Fucking wow.. Dude seriously consider the words you've typed.. Like read them out loud and imagine you are sitting in front of a patient, their family, or the best of your peers. Like fuck, really?

You know how jails end up being dumping grounds for the mentally ill? ERs often end up being dumping grounds for the mentally ill who are physically hurt. As the bottom fell out of the mental health and social services system, the ER turned into the first point-of-call for people who couldn't afford a primary doctor and regular healthcare. They have a medical condition/mental illness that requires medical supervision, they can't afford it, they hit a crisis point, end up in the ER, are patched up just enough to go back on the street, and the cycle starts again.

I don't know if this has improved under Obamacare--hopefully it has. But sick systems take a long time to fix.
posted by schroedinger at 1:08 AM on October 16, 2015 [9 favorites]


Reading Metafilter is where I realise how much medical school and working in a hospital can change your perspective compared to the general population. The fact is, a lot of people who come to A&E are drunk/high/abusive or suffering from a mental illness (which needs to be treated, of course, but A&E is generally not the right place for that unless the patient is having a psychotic episode or is acutely suicidal).

I don't want to speak for the lake is above here, but I do want to explain why xdvesper's words there bothered me too. I know that a lot of the patients in the average ER have ongoing substance or mental health issues, and that this is not what ERs are set up for. But the folks who struggle with those problems are people too, and have often ended up there because it's the end of a line where they don't have access to better resources or those resources aren't reaching them. They do not tend to be a population with a lot of great options. I feel like there are better ways to discuss structural, society-wide solutions to these problems than characterizing these folks as "mental cases," at least in a public forum like this one. I don't know how to fix the system, but I believe the answer will lie in more compassion, not less. I definitely understand that this situation places medical professionals under incredible stress, but people who have addictions to pain meds or psychotic symptoms don't need to be dehumanized any more than they already are.
posted by thetortoise at 1:14 AM on October 16, 2015 [35 favorites]


I just want to start by saying that what is described in the story is clearly negligence.

Yeah, but... I've had tons of time waiting while dealing with horrible abdominal pain - which can be something very very serious. All three times I've been in the ER for abdominal pain (three separate issues) I've waited AT LEAST an hour to get into imaging. And this is (luckily) after seeing a doctor who throws out ideas of what it might be (bowel obstruction, ectopic pregnancy, appendix) and told not to eat until they do tests to make sure I don't burst something and so imaging is clear. So by that point they KNOW it might be something serious but I'm still stuck waiting.

I totally get that ERs are overloaded which is why I try to be a really good patient but shit. If you pass out or something you can't even push the nurse call button and I guess they'll find you eventually... right....?

Also as a women people assume I know NOTHING about my own health.

I'm sensitive to high and low blood sugar more than your average person. I did a lot of work to understand that and balance my diet. I had one doctor in response to me mentioning it say, "Well, if you're hungry just eat." .... uhuh. I never fucking thought of that. You're a genious.

After initial bare bones basic tests (CBC, one thyroid level test) and a call saying everything is normal from the nurse: "Well, does he want to do a followup to see what might be causing these issues?" She literally said, "You can if you want....but..." Yeah. Dumped that doctor.

After my normal gallbladder tests, my ER doctor (who was AWESOME) begrudgingly and empathetically told me there's nothing he can do, and belly pain is really hard to diagnose. Then he told me a story of a woman who came in with similar pain, tested normal, and they had to send her home. Then a few weeks later she came back and they had to do emergency surgery to remove her gallbladder. It was a weird "Have hope it may get worse then we can do something!" speech. I left the ER sobbing and in pain over a month before finally getting surgery.
posted by Crystalinne at 1:19 AM on October 16, 2015 [1 favorite]


Iwanted to address this. Reading Metafilter is where I realise how much medical school and working in a hospital can change your perspective compared to the general population. The fact is, a lot of people who come to A&E are drunk/high/abusive or suffering from a mental illness (which needs to be treated, of course, but A&E is generally not the right place for that unless the patient is having a psychotic episode or is acutely suicidal).

But they do come there whether they should or not. And the way (dismissive/otherizing to me) in which the original commenter referred to patients with substance dependence and mental illness ("mental cases") is exactly the same mentality/worldview that affects those who are at the ER (or anywhere else, really) for the "right" reasons.

Its exasperating, frustrating work, but wouldn't /shouldn't you know that going in and adjust expectations and coping methods accordingly?
posted by the lake is above, the water below at 1:28 AM on October 16, 2015 [11 favorites]


Thanks thetortoise. That's pretty much what I meant. :)
posted by the lake is above, the water below at 1:40 AM on October 16, 2015 [1 favorite]


The nurse who triaged me in A&E told me that she believed that my blood tests were wrong ,despite having all the related symptoms for pancreatitis, because I wasn't in enough visible pain. Despite me telling her that i was actually in quite a lot of pain, she insisted on retaking them to no purpose whatsoever.
posted by threetwentytwo at 1:45 AM on October 16, 2015 [3 favorites]


> I've had to learn to find some sort of balance of being serious and explaining how these symptoms are ruining my life while not seeming "dramatic" or "fussy" or "hysterical" but also not seeming like it's something I can "deal with."

Yes! When I was pregnant I had really awful, constant, debilitating nausea and vomiting, and that was exactly my experience. Fail to make a strong enough point about how much you're suffering, and you can be dismissed as just suffering normal morning sickness, you're fine go away. Make too strong a point about how much you're suffering, and you can be dismissed as a drama queen overreacting to normal morning sickness, you're fine go away. So everything was this exhausting balancing act of trying to walk the impossibly narrow tightrope of phrasing it all just right - which of course changed again and again depending on who I was speaking to.

I appreciate that subjective experience is hard to measure and to demonstrate. The times I had most success in getting taken seriously and treated were times when I put numbers on it - I have lost X pounds, I am vomiting X times a day, I have X level of ketones, I am still sick past X months of pregnancy.* But why is the default assumption "oh, I'm sure it's not THAT bad" when I'm telling you that I am X level of miserable? Why is the burden of proof on me to convince you I'm not lying, overreacting or hysterical? That would be a hard enough ask for someone who is feeling otherwise healthy; it's downright cruel for someone who is not.

* and even that didn't work some of the time. "I've been logging my food and drink, and I'm getting under 800 calories a day now." "Oh, don't worry, the nutrients go to your baby first so your baby will be fine." Well that's great, but the foetus container in front of you would still like to be able to get some nutrients of her own, you know?
posted by Catseye at 2:39 AM on October 16, 2015 [35 favorites]


Its exasperating, frustrating work, but wouldn't /shouldn't you know that going in and adjust expectations and coping methods accordingly?

But they're under-resourced, how much can they do. Under pressure, and when fatigued, people are just going to rely on heuristics/bias/stereotype. I think that's understandable, and not necessarily the worst thing ever if there are checks in place to correct those kinds of errors, e.g. if nurses, medical students and other staff aren't penalized for interrupting a mistake they see happening, and if doctors feel free to admit that they can be wrong sometimes, and if they're reminded to take patients' subjective symptoms just as seriously as lab reports. (But they're under-resourced :/)
posted by cotton dress sock at 3:17 AM on October 16, 2015 [3 favorites]


Its exasperating, frustrating work, but wouldn't /shouldn't you know that going in and adjust expectations and coping methods accordingly?

I think blaming "doctors" is less productive than looking at the system that engenders these actions, and medical culture in which they occur in. "Doctors" cover a huge diversity of personalities, experience, practice and ways of interacting with people. One doctor can be excellent with one patient and not with another. We need to enable environments where the best patient outcomes can occur with regularity. Sadly - and this is what I was getting at in my original comment - I think for a lot of doctors what happens now is, within the confines of the system and funding etc, the best patient outcomes because in their eyes pain doesn't count.

It's not what they view themselves as there for - especially in the confines of an ER where triage, aka life-threatening illness, is the name of the game. Pain would be great to treat, but I think it's often viewed as a nice-to-have, and I think that's understandable in the operating (heh) context.

There's a broader discourse here about the way the medical profession - and indeed our society in general - treats and responds to pain. I don't think it's so simple as 'doctors taking pain seriously', though that's certainly a component. It does pay to remember though, this view of doctors as a form of medical oracle is deeply flawed. They are human beings dealing with vast oceans of imperfect knowledge (their own, and others) buffeted by waves of emotion and limited resources to deal with it.

Thus, a conversation about pain in hospitals quickly becomes a conversation about pain and health in society, in ourselves.
posted by smoke at 3:39 AM on October 16, 2015 [14 favorites]


It's really hard to anticipate just how much working in ED can change you. I did a six month job in a busy ED as a junior doctor, and I expected it to be busy (it was), I expected it to be stressful (it was at times), and I expected it to be a steep learning curve (it was, I learned loads and it was a fantastic experience. Made me as a doctor from a confidence perspective). I also expected to really enjoy the adrenaline and camaraderie, and I really did.

I did not expect at all to end up mistrusting my patients, and seeing them as the enemy. But by the end of six months, I was taking an adversarial "I bet there's nothing wrong with you" stance with almost all of my patients. It was awful. I didn't enjoy feeling like that. I wanted to like my patients. I switched specialties to internal medicine and the attitude vanished literally overnight. I went back to being the caring sympathetic doctor I had been previously. It was purely that environment.

I have no idea how anyone does it for thirty years without burning out. It is tiring to deal with abusive alcoholics, people who don't see why a paediatric cardiac arrest should take priority over their sore throat, people whose "taxes pay your wages" so want the department to pay for them a taxi home with their cut finger, people being racist or otherwise abusive to other far sicker patients etc etc all fucking day long. It is really really tiring. More tiring and with less protection than bar work or waitressing - at least if a customer was shitty in those jobs I could have them kicked out. You can't kick people out of A&E until after you've fixed them. After 13 hours of shitty patients, I'm afraid the normal patients were not getting me at my best. And honestly the normal patients were in the majority, but when I think back it is not them I remember but the timewasters and arseholes.

Castigating the individual doctors is pointless - the system needs to be changed. I don't know how - since this is a problem in both the US and the UK it obviously goes deeper than just individual toxic departments or even health systems. Like I say, I don't know what the solution is.
posted by tinkletown at 5:35 AM on October 16, 2015 [33 favorites]


Hmmmm. I'm sure the problem is WORSE in the ER, but I've certainly encountered it in other areas, and I've heard stories from other women as well, some of them in this thread. (L&D as noted above, and dear lord, that's a horrifying story; primary care; specialists.)

Doctors (some doctors) taking women's pain less seriously is part of a larger pattern of doctors (some doctors) mistrusting or disbelieving women's self-reports about their own bodies.

It's part of a pattern of doctors (of all varieties) attributing women's symptoms to anxiety, depression, or "stress." It's why women in their 20s often can't get diagnosed -- "You're young! You're healthy! You should learn to manage your stress better."

It's also associated with the medical research community (and media portrayals of medical events) focusing on men's pain -- men's heart attacks, men's sleep apnea. Women get these things too, with different symptoms, and get overlooked because they're not showing the symptoms a man would.

For me personally, the solution has been to find better doctors, ones who actually listen to me. I've also started being very clinical and specific when describing my symptoms, so much so that one specialist asked if I was a nurse. I've gotten better about following up, about asking questions, about dumping a specialist if he (or she, but OK, it's usually been he in my experience -- although I've also had some terrific male doctors) dismisses me or ignores me during the consult. But I'm very privileged that these things are possible for me. I live in an area with loads of doctors and specialists, and I have a health plan that doesn't require referrals.

And finding better doctors is not an option in an ER.
posted by pie ninja at 5:51 AM on October 16, 2015 [9 favorites]


My below comments come with two caveats:

1. I'm remembering this from ~11 years ago, so my memory may be fuzzy.
2. Because I'm remembering this from ~11 years ago, the research is most likely somewhat out of date.

However.

During my first postdoc, my institution hosted a symposium on gender differences in pain. A really interesting day of looking at everything from opioid receptor expression in cell lines all the way up the research to societal attitudes to pain. The whole gamut.

Anyway, you could pretty much summarize the way women were screwed over, both biologically and with respect to attitude of health personnel in a couple points:

- There are gender differences in opioid receptor expression in the CNS. The functional outcome of that, in animal models *appears* to be that opiates are less effective in female animals at comparative doses to males. This appears to be reflected in pain measurement studies in humans.

- Female animals and women's pain thresholds are on average lower than men's. For a given noxious stimulus, women and female animals will experience pain at lower stimulus intensity. This is counter to what many people think (see below, re childbirth)

- Attitude of health personnel, as outlined with so many stories above. Doctors not only prescribe opiates less often to women than men (preferring tylenol or ibuprofen, even when quality of pain is reported equally), when they do, the dose is lower (even accounting for body weight). There are a couple of prevailing attitudes -- that women are "built to withstand pain" (bc childbirth) so they don't need strong painkillers, and that women are complainers. Often these seemingly disparate attitudes are found in the same doctor.

So the take home message is, at least with opiates, at least back then, is that the research reflects anecdotal experience well: Women feel pain more/earlier, then the pain is minimized, and even when treated it's treated less aggressively than men's pain. And actually, opiates, at least, are less effective, so in reality needs to be treated more aggressively.

======
Personal anecdote time: I have a running injury at the moment, lots of strained muscles plus bursitis, and it's not resolving and I've seen a number of health care professionals, and holy crap the urge to minimize the pain is *constant*. When I saw a new orthopedist for a second opinion on the MRI he had to tell me multiple times that it was *ok* to say that I was in pain. (after all -- that's what I was there for, right?!?) Society does a number on us, huh?
posted by gaspode at 6:00 AM on October 16, 2015 [15 favorites]


I get that ER work is ridiculously stressful, and that there are mentally ill or drug-seeking patients that need to be weeded out. But even if ER docs only have so many fucks to give, there's still systematic prioritization of men's complaints above women's. And that's all assuming that the downplaying of women's self-reporting only happens in the ER (it doesn't).

I don't have crazy dramatic experiences with this; just the normal microaggressions (although it seems strange to consider things related to my health "micro"). The specialist giving me a consult on the TMJ that kept me from opening my mouth more than a half inch looked at the x-rays from my dentist, asked me exactly zero questions, and told me that I should stress less and take some aspirin. My first obgyn thought that the best solution for my "lying on the shower floor crying and trying not to vomit" cramps was to get more exercise. So yeah, in general I don't go to doctors anymore for illnesses unless it's something that needs antibiotics.
posted by specialagentwebb at 6:06 AM on October 16, 2015 [8 favorites]


When my sister was four she was hit by a car. My mother took her to the ER with a broken leg and was sent home again, my sister not even examined. Finally my mother lay my sister across the receptionist's desk and refused to leave until she got an x-ray. The doctor then questioned my mother about physical abuse.

My grandmother spent the last ten years of her life with terrible nerve pain in her face that her doctors put down to hypochondria. When they prescribed painkillers and she complained that the drugs made her slow and drowsy, they refused to change or even think about changing the medication.

I have asthma and for a period of my life, any cold would morph into a bronchial infection. It got to the point I would walk into my doctor's office and she would write me an antibiotics prescription as soon as she heard me cough. The one time I went to an after-hours clinic and explained my situation, the male doctor told me all I needed was a positive attitude.

I work extra hard now to advocate for my children, and I have seen my daughter's fear and pain dismissed already when she freaked out about getting a vaccination recently. And I am learning to advocate for myself.

And we grew up in a country with reasonably good, government-funded healthcare. I can't even imagine being a woman in a country with a messed-up healthcare system and overloaded ER system like the US.
posted by tracicle at 6:16 AM on October 16, 2015 [3 favorites]


I don't know how long I waited for painkillers when I was in the ER two months ago because my gallbladder went kablooey and pissed my pancreas off.

But I firmly believe that had I been quiet, and not screaming on a gurney, it would have been a whole lot longer. It felt like forever.
posted by bibliogrrl at 6:41 AM on October 16, 2015 [2 favorites]


I have had doctors ignore symptoms and my reports of pain, and chalk it up to depression and anxiety. But without treating the supposed depression and anxiety seriously, because, women, ya know. I've seen my ex- get treated seriously for similar symptoms and his depression and anxiety ignored.

I was overmedicated during labor because they arm-twisted me into it.

Women don't get listened to, women don't get taken seriously. This is true everywhere all the time. Fucking exhausting.
posted by theora55 at 7:13 AM on October 16, 2015 [13 favorites]


For 7 years I had a bad gallbladder. I probably went to the ER twice a year, when the pain got so bad I couldn't manage through it. I will never forgive the male doctor who told me that it was obvious I didn't understand what heartburn felt like. Never once did anyone at the ER check for gallbladder issues, my female doctor found gallstones on a back x-ray. My gallbladder was necrotic when it was removed. I know from personal experience that I have never been taken at my word in regards to pain in an ER, and it's the last place I would go for care.
posted by Nimmie Amee at 7:26 AM on October 16, 2015 [4 favorites]


Also as a women people assume I know NOTHING about my own health.

Ha! So yes! I didn't know whether to laugh or cry the first time a health professional asked me if I could be pregnant, I replied, and SHE ACTUALLY BELIEVED THAT I COULD POSSIBLY KNOW THE ANSWER. I've lost count of the number of pregnancy tests I've been given since my hysterectomy. I've always wondered why they even bother asking if they're not going to believe you. I guess I must look like a safe old lady now or something.

I was concerned but her doctor had said it wasn't anything important, checked her cholesterol and told her to lose weight. She finally got to the point where she couldn't get up the stairs to my apartment so dragged herself to the urgent care by my house, where they sent her to the emergency room because they thought (and were right) she had a fractured bone in her foot and had been limping on it for however long.

I can't remember whether it's 4 or 5 times, but our local ER and affiliated urgent care center have sent me home too often after taking X-rays and telling me there's nothing broken, only to find out after going to the orthopedic surgeon a few days later that there really is. Sometimes it's after the new doctor takes a better X-ray, sometimes it's after the new doctor takes a better look at the original X-ray, and sometimes it's after the new doctor says, "Nothing but a fracture explains all the symptoms; let's get a CT scan like they should have done in the first place."

(That last one was particularly fun - the ER sent me home with two shattered hands and a broken knee that they knew about, and a broken sternum that they completely missed. Their treatment? Ace bandages, OTC Motrin, CRUTCHES to get up the six steps into the house - in a snowstorm - and instructions to find and call an orthopedic surgeon. The orthopedic surgeon's office told me they could try to fit me in sometime the following week. I called my sister at work in unintelligible tears, and I don't know what she did, but somehow she got me in the day after next.)
posted by The Underpants Monster at 8:02 AM on October 16, 2015 [1 favorite]


Until we start treating people with addiction (AKA "drug seekers") as human beings, no one will be treated humanely at the ER.

Pain patients often resent— and rightfully so— being "treated like an addict." But NO ONE should be treated that way, even if they are addicted.

There should be specific procedures for dealing with suspected drug seekers, which aren't about shame, humiliation and attack, but which are about actually helping them. If someone is seeking opioids, they should be thoroughly evaluated for pain and if there is no obvious physical cause but they are clearly physically dependent, they should be, if at all possible, immediately started on maintenance and referred to a program that will continue it.

The idea that you will "help" them by being cruel and throwing them out is backwards: if punishment stopped addiction, the condition couldn't exist, because it is defined by compulsion
*despite* consequences.
posted by Maias at 8:05 AM on October 16, 2015 [55 favorites]


I've been going through this the past two years. I would have agonizing pain all the way down my body, both arms, both legs. My left foot dragged; when typing, I would drop characters on the left side of my keyboard. Sometimes it was so bad, all I could do was lay in bed. I couldn't sit for more than thirty minutes; I couldn't drive for more than thirty minutes.

As long as I did nothing, I wasn't in terrible pain. I gained thirty pounds. The one thing I did know was that when I got asthma-related bronchitis, all my symptoms went away when they put me on prednisone. So I saw my family doctor, who sent me to a sports doctor, who straight up told me that I just needed to improve my posture. When I kept coming back, he rolled his eyes and sent me to a physical therapist for a muscle sprain in my neck. Well, the PT made my muscles feel awesome, but it did nothing for the all-over agony if I did anything strenuous or foolishly tried to sit up for more than an hour or so.

The PT was afraid when she read my symptoms, so she got the doctor to send me to a neurologist. I thoroughly had my head examined, I had my nerves studied-- everything in my brain was working just fine.

After the PT prescription is over, I go back to the sports doctor for my follow up. Explain to his nurse, yeah, my muscles feel great but the underlying problem has not been addressed. The doctor comes in and he's like, so everything's all better huh?? Because he obviously did not speak to his nurse or look at the notes or anything. And I started to cry and I said, it's not better; if anything it's worse, and I've already spent a zillion dollars on PT and neurology and I'm really upset!

And that asshole had the gall to say, "Well don't yell at me! It's not my fault!" Then, so very put upon, he said, "I guess I can send you for an MRI on your neck. I doubt we'll find anything; you just need to improve your posture and lose some weight." Dutifully, I went to spend another million dollars on an MRI, and fuck that guy, I ate Burger King on the way home because I was only overweight because I was in agonizing pain if I did anything except lay around. I was despondent-- I kept wondering, is this shit all in my head? Am I just making this up? And the only thing that kept me going back was the fact that being on prednisone had been miraculous. I was sure there was something mechanical wrong, somewhere.

His office hauls me back in three days later. And the MRI that he said wasn't going to show anything? Showed bone spurs and thecal sac stenosis on four cervical vertebrae, with cord signal abnormality. So all this time that I was just too fat, or too lazy, or just making shit up, or just sitting funny, or whatever, I had spinal cord damage. All of a sudden, I had options! He sent me to a pain clinic; he gave me a referral to a surgeon.

However, despite the fact that I have now earned the right to be in pain, I'm just supposed to take OTC Aleve twice a day even though it's tearing up my GI tract like whoa. I'm afraid to ask for a muscle relaxant or a better pain reliever, though. I don't want them to peg me as a drug seeker.
posted by headspace at 8:11 AM on October 16, 2015 [22 favorites]


So I feel a bit like an asshole here, but as a white male, I'm one of those people who actually gets taken seriously by the ER. I went about a year ago because of a psychologically caused shortness of breath that my doctor told me to go to the ER about. Admittedly, the place was almost completely empty when I showed up, but the doctors took my symptoms seriously, checked my breathing, my heart, told me that I was having a panic attack and helped me calm down. They went to the psychological (which it was) only after checking all my physical symptoms. About the opposite of people here. (My father had died of a heart attack two months previous, probably exacerbated by (we think) sleep apnea. He was one of those stereotypical men who never went to doctors.)

I wish everyone got the same kind of experience that I had in the ER. I don't know if it was the emptiness of the place, the fact that I am white and live in a mixed-race neighborhood or the fact that I'm male (probably a combination of the three) that caused me to be taken completely seriously. But it can be done. I don't know what it would take to have it done, but if the ER can actually be a decent experience for one person, they should be able to do it for all (or at least most).

I wish there was something that I could do to give that experience to the people who really need it.
posted by Hactar at 8:20 AM on October 16, 2015 [2 favorites]


Until we start treating people with addiction (AKA "drug seekers") as human beings, no one will be treated humanely at the ER.
And likewise, if people's symptoms are caused or exacerbated by anxiety, then we need to believe that they have a medical condition that requires treatment, rather than that they're weak, pathetic people who should just suffer in shame. Anxiety is an actual disorder, not some sort of excuse or failing.
posted by ArbitraryAndCapricious at 8:21 AM on October 16, 2015 [24 favorites]


Maias: There should be specific procedures for dealing with suspected drug seekers, which aren't about shame, humiliation and attack, but which are about actually helping them.

In Canada we have some supervised injection sites where people can be treated with respect and get referrals and counseling, or at least be left alone to do their thing. It's telling that our Conservative government is fighting this idea tooth and nail, because they want addicts to be shamed, humiliated and criminalized. Meanwhile, in one of the richest communities in Canada (Calgary), addicts roam the halls of hospitals trying to snatch and grab sick people's painkillers. It's a wiggly world.
posted by sneebler at 8:41 AM on October 16, 2015 [1 favorite]


This makes me think of two different emergency department experiences I had in different countries.

Emergency department experience 1: I was 23, in Australia. I took a Voltaren pill from a friend to treat a nagging knee injury, had a glass of red wine with said friend, then went to friend. I woke up several hours later with my heart pounding, my pulse over 160. I went to the emergency room, where they admitted me quickly due to said heart rate... then ignored me. I remember a junior doctor telling me it was a panic attack before tossing me a pamphlet on anxiety. Meanwhile, my bloodwork came back... which I knew when a nurse came in and placed an IV without telling me what she was giving me or why. Turns out my potassium was very, very, very low. No one came to talk to me about it; no one gave any explanations; no one referred me to anyone for follow up. I still don't know why that incident happened, but suspect it might have been a whacky side effect of a single Voltaren. Still, I infer that once the words 'panic attack' are on the chart of an otherwise healthy young woman, ED doctors stop giving a shit.

Emergency department experience 2: I was 29 in the Netherlands. I start to get stomach pain during a meeting; weirdly, it's worse if I hold my torso at anything other than a 45 degree angle to my hips. I call a taxi; I go to the emergency room. I am admitted immediately. The doctor seems mildly concerned that I refuse to lie flat, and howl with pain when they insist I try. Within minutes a nurse bustles into the room and injects me with morphine. After some blood work and an x-ray they determine that I've had a particularly nasty bout of gastritis. The doctor calmly empathises with me - 'it hurts a lot, but it's nothing to worry about' - prescribes proton pump inhibitors, then very seriously asks me to follow up with my GP.

I'm not sure if it's a cultural difference or not, but I had the feeling that the Dutch ED doctors took my pain very, very seriously, while the Australian ED doctors saw me as nothing more than an annoyance.

I'm sad that we no longer live in the Netherlands now.
posted by nerdfish at 8:45 AM on October 16, 2015 [3 favorites]


The constant minimizing of women's pain is what leads us to avoid the ER until we are literally bleeding from multiple wounds or unconscious. The last time I went to the ER they saw me right away because the entire left side of my head was wet and matted with blood and i couldn't stand or walk on my own. And even then i was like "maybe i'm overreacting?" but i eventually decided that the pool of blood on the floor under my head was probably a good sign that i was thinking less clearly than usual.

It's not just external societal pressure either. My own mom wouldn't take me to the ER when i came home sick with amoebic dysentery from India because she said I was being so dramatic. Meanwhile I hadn't been able to keep any fluids down for so long that i hadn't pissed in 36h and even then i had to threaten to call 911 and embarrass her in front of her neighbors.
posted by poffin boffin at 9:02 AM on October 16, 2015 [17 favorites]


I recently wrote my mom's GP a thank you note, because she a) asked probing questions until she could confidently state, "if your pain is so bad that you're constantly holding your breath and you can't sleep, that's NOT a pain level 2, for future reference", and b) she told the infection disease specialists that were about to send my elderly mother home from the hospital (with MRSA, staph, and other infections) without any follow-up antibiotics that that was "not helping" and didn't let it go until she got prescriptions from them. A woman shouldn't need an MD to advocate for her, but I sure appreciate her GP doing so.

I also appreciate that now that she understands that mom will always underestimate her own pain, she's much more likely to prescribe painkillers than in that past. It shouldn't have taken years of pain to get to that point, but here's to a little more pain management.
posted by ldthomps at 9:24 AM on October 16, 2015 [6 favorites]


if people's symptoms are caused or exacerbated by anxiety, then we need to believe that they have a medical condition that requires treatment

It's also associated with the medical research community (and media portrayals of medical events) focusing on men's pain -- men's heart attacks, men's sleep apnea. Women get these things too, with different symptoms, and get overlooked because they're not showing the symptoms a man would.

I know stress and anxiety can contribute to various illnesses, and that there's a neural component to pain, etc., but I think the idea that soooooo many people's (esp women's) symptoms and illnesses are primarily or significantly psychosomatic will prove to be embarrassing in 50 years' time. So much has been learned even since I graduated high school (e.g. fat is hormonal, not inert tissue that can be sucked out willy-nilly without weird things happening; brains are plastic, and can change, to some degree, throughout life; the gut microbiome, wtf; fibromyalgia may involve physical damage to peripheral nerves; antibiotics may help with some kinds of low back pain [there might be bugs in some of those discs! that e.g. meditation can't touch]). I hope more researchers decide our complicated bodies are worth studying.
posted by cotton dress sock at 9:27 AM on October 16, 2015 [11 favorites]


I'm sad that we no longer live in the Netherlands now.
This probably depends a lot on the doctor and the situation, and your age. My grandmother had cancer (diagnosed, had had chemotherapy etc) and one night she complained that her arm did not feel well. She called her GP, he did not even want examine her (in the Netherlands you are not supposed to go to the ER for things like this, you have to go through your GP, who is on a rotating night/weekend shift with other GP's). When she finally did get medical attention it was too late. And maybe it would have been too late anyway. But I found it so telling that he did not even want to examine my grandmother who was known to have cancer.

I could tell you more stories, but this Dutch article shows that it's sadly a problem here as well. I'm glad you had a good experience though!
posted by blub at 9:39 AM on October 16, 2015


I have epilepsy and have ended up in ERs many times - while PAIN might not get taken seriously, seizures usually grab attention and I've very often been set up in a room with pamphlets on "how to deal with your loss." Yeah.

My most recent ER foray was when I was 28wks pregnant and my hormones and my meds were not playing well together. I started in my OB's office where they called the ambulance after the third seizure. I'm pretty stoic about being sick, but a seizing pregnant lady is a bad scene. The EMTs were great and warned me that "they're gonna make a fuss..."

Except no.

This was bar none the worst ER experience ever. I was alone because my husband needed to stay with our toddler. I was pretty quiet because I wasn't in *pain,* but I was feeling like shit because my brain had LITERALLY GONE HAYWIRE and uncomfortably pregnant. After several hours, I started to sob quietly and another patient's wife came over to see if she could help. "I just want to go home." She went to the desk and told them they needed to see me NOW. I repeated to the nurse that I wanted to leave. She said they needed a doctor to check me out, and grabbed one just to do discharge papers.

Well, he saw seizure and pregnancy and panicked. I guess he missed EPILEPSY in the chart. Took my BP which was high because I was stressed from being in an ER... Told me point blank that I had eclampsia and they would start prepping me to deliver the baby. At 28wks.

Get back into a treatment room, get a new doctor who realizes that no, I do NOT have eclampsia and asks ME what to do about the seizures. I tell him my normal medication routine, he nods and does that, and then I got to wait several more hours to get transported to OB to monitor the fetus (who was fine and not born that day).

After this shit show, my neuro gave me a prescription for my rescue meds - even though they're a controlled substance - since clearly I am better equipped than an ER doctor to know what I need. I am beyond grateful.

Of course ER doctors can't be expected to monitor chronic conditions but Jesus H if a seizing pregnant woman can't get bumped up the list, what in the actual fuck does it take.

(Google eclampsia if you want to find out why my having it for several hours untreated would have been a REALLY FUCKING BAD IDEA.)
posted by sonika at 9:50 AM on October 16, 2015 [15 favorites]


A little bit off topic maybe, but I recently developed a slew of food allergies as an adult and I was kinda leery at first but after over a year of being the most miserable I ever had been (severe stomach pain, hives, sneezing, etc) I started a small list of questionable foods.

Went to see this allergist and right off the bat he's just kind of a dick. Gives me crap about having an epi-pen and inhaler (the consulting doc suggested I have them just in case due to some of symptoms), just generally really rude. We only end up looking into the nut end of things despite my questions about other stuff and to my total lack of surprise things come up pretty bad on both skin and blood tests.

Anyway the dude left such a negative impression on me that I avoided going back for a follow-up for a full year. When I finally went back I had a list of foodstuffs including when I started noticing issues, what those issues were and duration, severity, etc. I was so careful when I showed him this list to couch it in the context that I wasn't sure, these were completely tentative suspicions, some could absolutely be psychosomatic or overcautious, and so on. He wasn't interested and also said he didn't think I needed to have the epi-pen or the inhaler with a really dismissive tone, but I was like, ok fine. We made an appointment to do the whole gamut of skin tests though.

I come back, do the skin test, a couple of things get really bad reactions, we meet to go over it, and all of a sudden when I'm listing things off from that list I'd brought the previous time he's nodding at all of them and saying things like 'that makes sense' and he's all kinds of friendly, telling me I should be using an inhaler whenever I exercise (in kind of a 'I can't believe you haven't been doing this) way, and when he looks at the nut test results again he's like 'oh you definitely should have an epi-pen and inhaler'.

I put off seeing this guy to my detriment and went without having medical supplies I could have actually needed. I have no idea if he was a dick because I was a woman, or if he was just generally a dick. I get that allergies are weird but he was completely dismissive of any of my input. In retrospect maybe the list made me look worse but no matter how I phrased things it seemed like he just wasn't interested in what I had to say.

I'm legitimately excited for when I move away and never have to deal with him again. I'm also willing to bet the next time he looks at my charts he'll change his mind about everything again despite the fact that nothing's changed.
posted by nogoodverybad at 10:49 AM on October 16, 2015 [4 favorites]


Is Medicine’s Gender Bias Killing Young Women?
The presence of stress, the researchers explained, sparked a “meaning shift” in which women’s physical symptoms were reinterpreted as psychological, while “men's symptoms were perceived as organic whether or not stressors were present.”

"In training, we were taught to be on the lookout for hysterical females who come to the emergency room.”

And if it's bad for women, it's also bad for non-whites.
posted by theora55 at 11:01 AM on October 16, 2015 [11 favorites]


I don't want them to peg me as a drug seeker.

I'm not a woman, so not meant to detract from the specific problem of women's pain being dismissed, but I too now have this fear. I was recently diagnosed with ADHD (at 32) and I was prescribed Adderall, a controlled stimulant by my old psych. It was a very low dose to start, but I was given the explicit permission to raise it on my own until I found the right amount up to 20mg/day. For me, that was 20 mg. Well, I was transferred to a new psych by my HMO and once she found out I ran out of my originally Rx "early" she immediately began the suspicious questioning and skeptical stance that I had only heard about from others. Did she even read the Rx?

I suspect she went there because I am very open about my past and current substance use. I am a substance use counselor and try to model in my own life that which I try to encourage in my clients and others, which is to view our use as non-shameful and sometimes even an okay, life-affirming part of our lives (like we see alcohol). She had no relationship with me except my chart and zeroed in on my past use of stimulants. It couldn't even be considered abuse as I suffered none of the DSM criteria for it (no dependence, no functional impairments, etc)! Rather than use any of the softer clinical skills that I would hope a mental health clinician to have, she just jumped to straight to STIMULANT, YOUNG, GAY MALE= meth-addled drug seeker (if I wanted meth it's a hell of a lot cheaper and easier to get than Adderall and the high is significantly better too!). And despite also being a mental health clinician (but not medically trained) working in substance use, none of even that mattered. All that mattered was her snap assessment that seemed based on a flow chart rather than on me as an individual.

Doctors and medical staff in general have a serious problem that they don't seem to acknowledge undermines the whole point of seeking medical attention in the first place. When you're scared to seek treatment because of being forever labeled difficult or drug-seeking that's fucked. The many stories here show that.
posted by the lake is above, the water below at 11:04 AM on October 16, 2015 [4 favorites]


Mod note: Comment removed; talking about what you think isn't accounted for in the study or about other problems that exist in the EMS sphere is fine, but framing that as a sarcastic dismissal of the possibility that there's sexism involved isn't so much.
posted by cortex (staff) at 12:17 PM on October 16, 2015 [2 favorites]


Heh....i have a story for you:
I started bleeding from my lady parts and had SERIOUS stabbing pain late at night so i called the nurse line and described my symptoms. She told me to take 2 Tylenol and call my doctor in the morning. i took 2 Tylenol and an hour later i thought i was going to die, so i drove myself to urgent care.
I got there around 1am and told them my symptoms and they asked me to wait. 3:30 am i was finally called. They took my vitals, and then asked me to wait some more. 5am a doctor comes by...asks a few questions, draws some blood and prescribes fucking Tylenol and said to followup with my doctor in a couple of days. I left flabbergasted. 9am i get a call from the hospital. We need to you come back immediately. I'm like what's the matter? Wouldn't tell me. I drive back, still in agony, tell the front desk i was called back and the bitch horrible lady person at the front desk actually told me i had to wait until she had checked in more critical patients. 45 mins later she checks me in. Literally as soon as my name was entered into the system a nurse comes running outside and drags me inside. Says we need to take you for an ultrasound immediately. Now i'm freaking out but she wouldn't tell me why. We do the ultrasound, and the tech is making weird noises and STILL no-one would tell me what was wrong. A different doctor comes in, confers with the nurse and then says "you have to go in for emergency surgery RIGHT AWAY THIS VERY SECOND because you will die if we wait any longer. So i went from taking 2 Tylenol to having emergency surgery because guess what, i had had a fucking ectopic pregnancy which had ruptured and i was bleeding internally. So basically when i went to urgent care and they drew blood, they didn't wait for the results before they sent me home, and when they got the results later that morning, the morning doctor was like who let this woman leave?!!
Oh, i should add, i am a black woman who went to a hospital in a neighborhood which is predominantly white upper middle class.
posted by ramix at 12:19 PM on October 16, 2015 [45 favorites]


I sat in an ER waiting room once for a little over 5 hours with chest pains that were radiating down my left arm, only to find out after waiting patiently and trying not to cry or freak out or be a nuisance that I wasn't even on the fucking triage list. I had to have someone drive me to a different ER to get checked out, and thankfully it was only costochondritis, but let me just say this: it was beyond galling when a few years later I escorted a boyfriend to the ER when he was having a panic attack and the entire staff there launched themselves into action to make sure he wasn't suffering a heart attack. Dude was hooked up to machines within minutes of our arrival at the ER and tested and re-tested, which was great, but... damn, it'd be nice to have been treated like that when I was having chest pains instead of just being ignored.

Don't even get me started on how ER staff has treated my grandmother when she's landed in the ER with debilitating gut pain and fainting spells. No, doctor, the answer is not to dismissively wave your hand and tell her to eat better, that's the opposite of how to fix an obstructed bowel.
posted by palomar at 12:30 PM on October 16, 2015 [13 favorites]


ramix, favoriting is such a wrong response to your story which is horrible and thank you for sharing it and i'm sorry this happened to you

and thank you to everyone who has been sharing their stories
posted by kokaku at 12:32 PM on October 16, 2015 [17 favorites]


I recently filed a complaint on a care provider for the first time ever in my entire life. I had called my nurse line because I had abdominal pain consistent in type and timing with my normal ovulation pain (which is already pretty severe and unpleasant), but MUCH worse and of a MUCH longer duration -- I took 2 Aleve for it at 10 AM, 2 more at 10 PM and woke up at 1 in the morning literally screaming with pain. The nurse asked me if there was any chance I could be pregnant, and I said "Not much of one, I have an IUD" and she said "Well when did that IUD go in?"

"December of 2010," I said. (This was back in May.)

"Oh, then that's due to come out!" she said.

"Uh, in December, yes. I'll be having it replaced then, I'm on top of it."

"Are you sure an IUD is the best option for birth control for you? There are a lot of other things you can use, you know. Many women don't like the IUD."

"This is my second, and I love it."

"You know what, I'm going to transfer you over to our scheduling department so you can make an appointment to talk to your doctor about what other methods of birth control might work better for you."

I was flabbergasted. I said, pretty sharply, "You know what, I am a lot more interested in having a conversation about the 8 out of 10 pain that woke me up yelling last night than I am in having a conversation about what my birth control choices are going to be in six months. Do you suppose we can talk about that, please?"

She sighed and said, very condescendingly "Well, have you tried drinking some tea? That always helps ME when I have a tummyache. But you may just have to wait this one out, dear."

I said "I can't eat or drink because of the pain. Does it help you any to know that it hurts more when I walk and less when I put pressure on it?"

"Um," she said. "Actually, yes it does. That's very important information. You should probably head into Urgent Care to rule out a surgical emergency, that could be something quite serious."

SO GLAD YOU WERE TRYING TO GET ME OFF THE PHONE BEFORE I DID YOUR JOB FOR YOU, LADY.
posted by KathrynT at 12:32 PM on October 16, 2015 [39 favorites]


This thread is also full of nothing but anecdotes.

That what women are saying here is of no value to you is essentially a reflection of the point of TFA.

Here's another useless story. Not in the ER, but I recently had an excruciating episode of sciatica (which has settled again now thank God but it lasted about 6 weeks) coming from a herniated disc. I went to the doctor - which I rarely do because fuss - and explained the pain was unbearable. He saw in my notes that I've had surgery to relieve the sciatica in the past but still he said it was probably just that I'd "slept funny" and pulled a muscle. He said "bad backs are just a thing that happens, you have to live with it" and advised that I "walk around" in work (even though I told him part of my work is with clients which involves me sitting still for an hour). I asked for a referral back to my surgeon and he said no. Two weeks later when the pain had left me feeling suicidal at times I went back and this time the doctor was a woman. She took one look at my grey, clammy face and saw from my posture that I was in agony, prescribed me medication, and started the (NHS so very long) referral process for me to get another MRI to see if the disc has slipped further. This article does not surprise me, and nor do the responses denying the role of gender. Plus ca change.
posted by billiebee at 12:49 PM on October 16, 2015 [26 favorites]


I love how some people love to shout ANECDATA whenever people are sharing their personal stories. [Ed. note: no, I really do not.]

You know what people used to call anecdata? Police brutality against POC. “There are no studies that show this happening!” people would bleat. “Show me some proof!” And as soon as huge portions of the population were able to afford phones that are also video cameras, suddenly we had all the horrible proof we could ever want. And as soon as people began actually studying the numbers, it turned out that the numbers matched exactly what people had been saying all along.

You know what a lot of men used to call anecdata? Women being sexually harassed while they lived their lives. And then women took secret videos of how they were treated, and men performed experiments where they pretended to be female online and they witnessed the true force of misogyny, and a lot of those men suddenly said “whoa, this might be a systemic problem.” And again, when people started measuring the impact of these behaviors, they turned out to be huge and everywhere.

In fact, basically EVERY systemic problem has had a period when people in positions of power who didn’t want to listen to “anecdata” claimed that a lack of hard data somehow meant that human experience was therefore void.

How many women have to talk about being brutalized by their care providers before the cries of anecdata are silenced? Infinity women, apparently, until they are subjects in an IRB approved study, because some people will never believe anything until DATA.

Of course, this is beside the fact that THE DATA ALREADY EXISTS AND SHOWS THAT THIS IS TRUE. The people complaining about anecdata never seem to actually look for data, for some reason. (The reason is they are not actually interested in any data. Is the reason.) Look up health disparities. Look up all the peer reviewed studies you want. Look up implicit bias in health care providers (i.e., unconscious bias and how it alters their behavior). Look up systematic reviews of all these studies. If you don’t want to believe living, breathing women, or their partners who have witnessed this firsthand while being male, or any human ever talking about a lived experience, then open your medical journals and your academic journals and your PubMed. Hard, cold data, that says the same thing, in population after population.

Anecdata. Give me a break.
posted by a fiendish thingy at 1:20 PM on October 16, 2015 [59 favorites]


Take a look at Brooklyn Hospital Center's Contact Us Page. There's a link for contacting the hospital administrator. There are links to the hospital's social media accounts: Facebook, Twitter, YouTube, Flickr, LinkedIn and Instagram.

Let's say that the next family this happens to starts Periscoping their encounters with hospital staff, or live-tweeting their progress (directing those tweets to the hospital's official account, or the account of its administrator or one or more of its board members). Names are named. Details are given. Photos and videos are posted.

Suddenly, there's nowhere for the dismissive or incompetent to hide. Not only do the powers-that-be know what's happening, they know that they are being observed, and that their observers will expect them to do something.

Would this help? Could a hospital's security staff or its legal team successfully (and legally) kick out a would-be advocate?

I can't imagine watching a loved one go through something like this, let alone taking the time to live-tweet that nonsense. God forbid I'm ever in a position to do so, you'd better believe I'd try if I thought for a hot minute it would help.
posted by Flipping_Hades_Terwilliger at 1:38 PM on October 16, 2015 [2 favorites]


She sighed and said, very condescendingly "Well, have you tried drinking some tea? That always helps ME when I have a tummyache. But you may just have to wait this one out, dear."

I said "I can't eat or drink because of the pain. Does it help you any to know that it hurts more when I walk and less when I put pressure on it?"


Aaaagh! That same night I was sent home after twelve hours, the "honey" nurse gave me a prescription for Vicodin, and said, "The doctor says to make sure to eat plenty of fiber while you're taking this."

I looked at her, incredulous, and said, "Both you and the doctor know that the main reason I'm here is that I haven't been able to eat or drink anything at all for 72 hours without vomiting. You've watched me vomit every time I've tried to take a sip of water all night."

She shrugged, laughed, and said, "Well, then, I guess you should call Dr. *stumbles over the first syllable of my primary doctor's name six or seven times before giving up* about that, then, honey, shouldn't you? Do you want the prescription or not, honey?"
posted by The Underpants Monster at 2:13 PM on October 16, 2015 [3 favorites]


More anecdotes, in July I developed a kidney stone, and (I thought ) twisted ankle. Because I have a prescription for hydrocodone for the severe spinal stenosis and arthritis, every medical professional I saw told me to just take my meds and tough it out. It was September before I convinced an orthopedic surgeon to do an mri, where we discovered a badly healing fracture, a tendon rip, and over 100 micro tears in two tendons.

They put me in a walking cast and told me to take some ibuprofen.

I've been dealing with tendon failure, tremors and chronic pain and exhaustion for years. If the rheumatologist I'm scheduled to see next month (3 month wait for appt...yay American free market healthcare, so much better than socialized medicine...), pats me on the head and tells me to buck up, I swear before gawd, I don't know what I'm going to do. I really don't.

I've gone from lifting 130 pounds, slinging metal around the sculpture studio, rowing 10k a day, to being exhausted by getting out of bed. I've gained so much weight, so much. I look 5 months pregnant, and I'm menopausal. It takes two hands to carry my cast iron skillet from stove to sink, which is only two steps. Every joint hurts,and only prednisone makes me feel better. I can still hide the tremors from people, but it's scary, because I don't know why it's happening.

But I've all but given up getting help from the medical profession, who has apparently decided that if I would just lose weight instead of being a fat lazy cow, everything else would be fine.

I'm in tears just thinking about all the emotional labor I need to do to present my problems to a new medical professional without being branded hysterical or a wannabe junkie.
posted by SecretAgentSockpuppet at 2:55 PM on October 16, 2015 [17 favorites]


My family has a history of sudden lethal reactions to penicillin after taking it previously with no side effects. One uncle died. My dad's heart stopped. As a result, all of the younger generation were told to avoid it. Duh.

My brother has NEVER been interrogated about this. Not once, not ever. I ALWAYS have had doctors look at me like I'm stupid. Wound up in ICU from an infection. Told doctor, who IGNORED me and gave penicillin. I broke out in hives. He then gave me BENADRYL and ANOTHER dose of penicillin. I stopped breathing.

Now when I get the stupid eyeroll and the head-patty "What was your reaction?" -- always from male doctors -- I can say "I FUCKING STOPPED BREATHING WOULD YOU LIKE TO SEE THE CHARTS MOTHERFUCKER" and then I get another doctor.

Sorry for the all caps I obviously still have a few hysterical female issues about this.
posted by SockPuppetOfShame at 2:55 PM on October 16, 2015 [20 favorites]


if people's symptoms are caused or exacerbated by anxiety, then we need to believe that they have a medical condition that requires treatment

The funny thing is, the disorder I'm going to see a specialist about CAUSES anxiety. That's right. Anxiety is a symptom of the disorder. You have no idea the tiny miniscule fiber of a tightrope you walk trying to explain to a doctor that "yes, I know I have anxiety but this type of anxiety is unlike anything I've had before, it feels like something else is causing it." And somehow have them take you seriously. (Thus why the thing I'm being seen for is often underdiagnosed as panic disorder.)

And again, so many disorders CAUSE anxiety or depression as a symptom. Thyroid, hormone levels, adrenal glands, autoimmune, but yet again they tell us it's JUST anxiety.

As far as anecdata versus data - the data are out there. Just look at the statistics of the disorders that primarily affect women. So if there's 1.5 million cases of lupus in the US, and 90% of them are WOMEN and can more often affect women of color, but yet those are the same people that doctors are ignoring and saying they're healthy or to take a xanex. (Sourced from Lupus.org)
posted by Crystalinne at 3:04 PM on October 16, 2015 [2 favorites]


Here's another anecdote for the pile.

My MIL is currently in hospital after being admitted last week with horrifyingly bad pain in her stomach, vomiting and diarrhoea. She's been to the ER at least a couple of times a year for the last three years with the same condition.

Let me tell you a bit about my MIL: she's a tiny Maltese woman, 70s, been in Australia about 35 years. Her English isn't great and she relies a great deal on my FIL to communicate and get around. She's also a strong, stoic woman, the emotional backbone in a family of men. She looks after everyone else before she attends to herself.

In the last few weeks she has been having attacks of vomiting, dizziness and fainting. Her doctor put her on antidepressants and said she's anxious. And we swallowed that because she's had a really hard year: she lost two brothers within 24 hours of each other, her baby grandson was in hospital for an extended period and my husband and i are struggling to conceive. So there's good reasons for her to be stressed.

She's been to the ER a couple of times recently and was finally admitted last week. My husband and BIL have been fighting every day to even keep her in the hospital. The poor woman has been writhing in pain and moaning and screaming (remember the stoic bit?) and they wanted to send her home because they couldn't find anything wrong with her heart. Probably anxiety the doctor said. Yes because anxiety makes you have excruciating unrelenting tummy pain. (Did i mention that they waited 36 hours to give her morphine for the pain?)

She's been on a waiting list for a gastroscopy for four months. My husband and BIL have been doing everything they can to get the hospital to do the gastroscopy whilst she's there but there are still no guarantees.

The thing that kills me is that she's probably been in pain for YEARS. And i can't help but wonder if she's been fainting from the pain. Yet her idiot GP just keeps putting her on pills and we all keep looking for ways she can change her lifestyle to address things. But if they would just INVESTIGATE THE SOURCE OF HER PAIN heaven forbid maybe we can start to actually address the problem.
posted by prettypretty at 4:30 PM on October 16, 2015 [11 favorites]


so I'm counting this thread as conclusive proof that we'd collectively rather have women (and other people who haven't hit the jackpot by being white straight skinny middle-class or above cismen with good hair and no obvious disabilities) suffer and die than allow women (and other non-jackpot-hitters) to potentially have unearned pleasure.

our medical protocols as implemented are not about alleviating suffering. they are about ensuring that suffering is only allieviated if the sufferer is worthy.
posted by You Can't Tip a Buick at 4:39 PM on October 16, 2015 [19 favorites]


Four years ago, I left work to go to the urgent care clinic because of severe abdominal pain. They sent me to the ER. As it happened, my dad had just finished an appointment at a doctor in the urgent care building, so he took me. At the hospital, they gave me dilaudid and after my tests said it wasn't my appendix, they sent me home with some vicodin. The nurse told me to come back tomorrow if it still hurt. I went back, this time with my husband. More dilaudid while the mister argued with the doctor. After another eight hours, they admitted me and scheduled exploratory surgery. Oh, hey burst hemorrhagic ovarian cyst.

The worst part is, after reading this, I want to hug that doctor who scheduled the surgery, even though I think he did so because my husband took charge of my health that night.
posted by Ruki at 5:08 PM on October 16, 2015 [3 favorites]


Yeah, I'm seriously considering asking my husband to take off work to go with me to the rheumatologist, just because maybe the doctor will listen to him...and that is such a deflating, horrible way to feel. i won't probably do it, because it grates so hard on my idealization of my own autonomy, but I have weighed the idea.
posted by SecretAgentSockpuppet at 5:17 PM on October 16, 2015 [5 favorites]


doooo iiit. ask your husband to take off work to militate for you. one of the few good things about having privilege is getting to use it for others under their leadership.
posted by You Can't Tip a Buick at 5:23 PM on October 16, 2015 [5 favorites]


You should ask him. Yes, it is demoralizing, but there's a whole thread here full of the alternative. I'm going to drink a big glass of wine now, because, damn...
posted by Ruki at 5:28 PM on October 16, 2015 [1 favorite]


"men generally do a lot more fuss when in pain or discomfort. Up to the point that they become quite nasty and aggressive to the medical staff when not being given immediate assistance. So in the already stressful environment of an ER or even just the normal ward, the most obnoxious patients get treated first to get them out of your hair."

It's safe for men to throw shit fits to get what they want and get abusive. Not so much with women.

" didn't know whether to laugh or cry the first time a health professional asked me if I could be pregnant, I replied, and SHE ACTUALLY BELIEVED THAT I COULD POSSIBLY KNOW THE ANSWER. I've lost count of the number of pregnancy tests I've been given since my hysterectomy. I've always wondered why they even bother asking if they're not going to believe you. I guess I must look like a safe old lady now or something."

The explanation I got when they forced me to take a pregnancy test before giving me a prescription for more birth control was, "People lie."
posted by jenfullmoon at 5:45 PM on October 16, 2015


My fiancee has a pretty major health issue that has taken FOREVER to be treated properly. I was reading this thread this morning while she was sitting next to me, too sick to be able to go to work, and it made me think of all the times she's been run around by her healthcare providers. The years that problems were minimized, or symptoms written off. I remember, a while ago, saying "I'll be an angry guy and maybe they'll listen to me," but she doesn't want me to help. She wants to be treated with dignity, and neither of us wants it to be an "I'll take this from here, honey" situation. So she soldiers on.

I have a history of mental health issues, and the truly awful thing about all of this is the way these stories reminded me somewhat of how I've been treated at times. But that's the key - at times. The average woman is apparently taken less seriously than a guy with mental health and addiction problems (what a horrible combination to be a woman with mental health issues, and I've seen what happens when that's the case). There is no question that this is killing women.
posted by teponaztli at 6:16 PM on October 16, 2015 [5 favorites]






When my oldest sister was a few years old my mother, driving in Chicago, hit a patch of black ice on Lake Shore Drive and slid into a bridge abutment. My sister was badly injured in the crash -- I'm told she spent nearly half a year in a half-body cast from the waist down. She was immobilized for so long she had to re-learn how to walk when the cast was taken off. And her hip on one side did not heal 100%.

Many years later, as an adult, the mobility problems being caused by her never-healed-quite-right hip had grown to the point where she badly needed surgery to correct them, but due to the deformation of the hip and the fact that she had not yet reached the target age that is expected for hip-replacement patients she had great difficulty finding a surgeon who would agree to help her.

After an exhaustive search she found a highly rated surgeon at the Mayo Clinic in Rochester, MN. I was self-employed at the time and agreed to go with her for the surgery and to care for her afterwards. It wasn't supposed to be a big deal -- we were told to expect only a day or two of post-operative care in the hospital before she could return home and begin outpatient recovery on the new hip.

They performed the operation and pronounced the joint replacement successful but the recovery did not proceed as we had been told to expect. After several days in the clinic where she was unable to move without terrible pain, they told her her insurance wouldn't cover any more time in the hospital and discharged her to a halfway facility nearby. After five days there with no improvement they told her that her insurance wouldn't cover any more of that and that they were sending her home. She couldn't fly so I drove her, in terrible pain despite the painkillers, from Minnesota back to Michigan, and I stayed in her house, caring for her, for another 10 days before the doctor who had promised to perform her after-care once she returned home agreed to see her.

She was still nearly unable to move on her own and in terrible pain at that point, but the local doctor decided she'd already been on too many pain pills and needed to be cut off. What followed was the most stressful and traumatic period in my own life and I can't even bear to think about how much worse it was for her.

That was how I learned about how the medical profession often ignores or minimizes women's pain -- they told us repeatedly that there was no reason that she shouldn't be recovered and that the pain would end on its own. She, and I -- to my everlasting regret, believed them, because after all, these were world-class medical experts from the Mayo Fucking Clinic. Unfortunately they were completely full of shit. In the end it turned out that during the hip replacement, while levering the ball end of the bone into the newly-replaced socket, enough pressure was applied to break her pelvis, but nobody noticed it at the time (somewhat understandable) and none of them thought enough of her continuing pain to do a post-operative x-ray to find out why she was not recovering as they assured us she certainly would (completely inexcusable.) Instead two separate facilities simply ignored her reports and discharged her and sent her home with a broken pelvis.

tl;dr: My sister spent weeks unable to move without excruciating pain -- unable even to go to the bathroom on her own -- because the people in charge of her care at one of the most famous hospitals in the world so minimized her pain that they were incapable of conceiving the idea that they should in fact perform a simple test to see whether it had any explainable basis.
posted by Nerd of the North at 9:08 PM on October 16, 2015 [26 favorites]


ED is definitely where the medical system "fails" the most, where mental illness patients / drug abuse patients keep cycling through it when they "should" be in a managed care facility

I disagree with the tone of this reply, which seems uncharitable to those people presenting with acute mental illness symptoms. In many cases, they literally have no other practical option to get care. However, in the US, it is true that people with acute psychiatric illnessess cycle through EDs for urgent care, occasionally get admitted for acute stabilization, and then for the most part are discharged without being placed in long-term rehab or nursing facility. Why is this so? This is because many of the chronically mentally ill and impaired substance abusers are low-income, and thus reliant on Medicaid insurance as their payer. And since the 1960s, the Medicaid Exclusion expressly forbids the Federal Govt from matching funds to help States pay for post-acute "IMD" (or "Institutes for Mental Disease" facilities for recovery from mental illness or substance abuse. This was part of the "de-institutionalization" program. However, the matching community program funding never materialized. I'm not aware of any other medical speciality where the funding stream for post-emergency care is blocked and so rehab and initiatives to help people not become acutely ill again are ridiculously limited. To take an analogy, it would be as if, for every person with end-stage renal disease, the funding system only covered emergency dialysis but not routine dialysis. In such a world, you would surely see EDs full of extremely acutely ill ESRD patients being quickly restored to a barely functional level before being discharged, and expecting them to re-present at the EDs very soon.

As part of Obamacare, CMS is trying an experiment to see if providing matching Federal funds for mental illness post-acute care will change the dynamic. However, since there's funding to roll this out in any meaningful, large-scale way, and no political ability to expand Medicaid psychiatric funding, the current broken system seems destined to continue to overspend resources in overcrowded EDs and PESs providing last-minute care to the acutely ill who could have been helped much earlier, for much less expense.
posted by meehawl at 9:12 PM on October 16, 2015 [8 favorites]


These stories are so awful! I had a ridiculous experience at an urgent care place lately- I'd had severe cramps for a few hours and finally got my husband to bring me to urgent care after weeping in bed with a heating pad didn't help. By the time I got seen, the pain had let up a lot and I was feeling relatively okay but was worried the pain would come back. I was scared something was really wrong - I told the doctor that it hurt worse than my miscarriage or back surgery or three c-sections... He wrote "ibuprofen" on a prescription pad and gave me a handy tip that "Sex can help with cramps." I rolled my eyes and left. What does he imagine that would be like? I mean has he ever had, say, a stomachache? Or pain? Or, I don't know, sex?
posted by artychoke at 10:31 PM on October 16, 2015 [5 favorites]


sio42: “Sounds like the new "hysterical". Fibro and cfs are certainly real but it sounds like doctors are using them as the new placeholder for "silly lady NOS". ”
Don't forget Borderline Personality Disorder, which at least two of my friends have been told they have because they don't get along with their no-account husbands.
posted by ob1quixote at 10:42 PM on October 16, 2015 [1 favorite]


There used to be a joke that IBS stands for "it's bullshit" because the diagnosis is so often given out when nobody knows what's wrong with your gut and they tell you to be less stressed. Guess what gender is diagnosed with it 2-3x as often! No, don't guess.
posted by thetortoise at 11:56 PM on October 16, 2015 [3 favorites]


Goddamn, what a fucking nightmare. There's probably no way to quantify it, but the substandard care stemming from this kind of sexist quakery must lead to some deaths. They say hospital-acquired infections are a potential danger to anyone going into a hospital, but I imagine these sexist attitudes are just as much a risk to any woman with a serious health crisis. Sexism really is a plague.
posted by homunculus at 12:18 AM on October 17, 2015 [6 favorites]


Fibro and cfs are certainly real but it sounds like doctors are using them as the new placeholder for "silly lady NOS".

Yeah, this. It sucks on two accounts: First, because women who DON'T have fibro or CFS (or IBS) but are labeled with the diagnosis aren't being diagnosed with the actual physical treatable illness that they DO have. And second, because people who actually DO have CFS et al are laboring under a diagnosis that most of the medical community ignores (or worse), with terrible results.
posted by pie ninja at 6:44 AM on October 17, 2015 [2 favorites]


There used to be a joke that IBS stands for "it's bullshit" because the diagnosis is so often given out when nobody knows what's wrong with your gut and they tell you to be less stressed.

Yeah, this is what I was diagnosed with as a teenager and now, 15 years later, after I took it up on my own to look into allergies, I'm pretty sure the IBS thing was bullshit because I've been feeling a lot better since I've started switching to foods my body doesn't think are trying to kill me.
posted by nogoodverybad at 7:55 AM on October 17, 2015


You know, I'm not sure that Drs actually read the patient charts, other than a cursory glance. Nothing else could explain the morality lecture about 10 mg hydrocodone daily pain killers that I got from my Drs practice partner when I had to see him instead of my real doctor. I'm prescribed almost 4x what I actually take, because I'm afraid that if I actually took the drugs it takes to make me fully pain free and functional, they would brand me a junkie and cut me off, so now I just take a painkiller at night so I can try to get 6 hours of sleep.

And even with that, other medical professionals just see hydrocodone on my chart and just write me off, without looking at the radiology reports that show how destroyed my bones and ligament have become. It's why, I am convinced, it took me 7 weeks to convince someone to do an Mri on my torn tendons.
posted by SecretAgentSockpuppet at 9:17 AM on October 17, 2015 [1 favorite]


Don't forget Borderline Personality Disorder, which at least two of my friends have been told they have because they don't get along with their no-account husbands.

Oh, it's worse than that. Something like 75% of people with BPD diagnoses have a history of childhood sexual abuse or assault. According to my psychiatrist, evidence is mounting to suggest that these people don't have BPD at all -- they have PTSD, where the traumatic trigger is physical and emotional intimacy. Hell, when Freud was treating patients with what was then known as hysteria, he was very alarmed by the high percentage of his female patients who reported childhood sexual abuse. But rather than believe that their fine, upstanding fathers were capable of such a thing, he formed his theory of the Electra complex, in which these women secretly WANTED to have sex with their fathers but were denied and frustrated.
posted by KathrynT at 9:35 AM on October 17, 2015 [19 favorites]


A friend of mine had a medical emergency, what turned out to be internal bleeding after surgery a few days before, and... it was awful. I don't even want to get into too much detail.
We had the one two punch that he was man, but a gay man, and I'm a far too calm woman. Which apparently made me useless as an advocate.

So, when you have someone who has on their records that they had abdominal surgery a few days earlier, bleeding, and are fainting if they are raised above a 45 degree angle on a BED, then you think you'd see a doctor, right?
No, because they wanted scans first, but they couldn't do the scans because he couldn't STAND UP without fainting, so they did nothing for 6 hours while I monitored his heartrate and found blankets because he was getting cold, and told myself if either dropped any lower I was going to start screaming and screaming until someone helped him, and luckily it didn't. Drop further.
By the time we saw a Doctor, they immediately freaked out and started scheduling emergency surgery to remove part of his intestine, and, yes, yelling about why he hadn't been seen earlier. Surgery turned out not to need to do that because it had been so long that he'd started clotting. He'd stopped bleeding. He just needed blood, a LOT of blood. And a stay in hospital.

There was one nurse in particular, who we couldn't get past. What did she think the fainting indicated? That he was a wuss because he was gay? She completely ignored the quantities of blood we were talking about.

Think is, I'm still kind of screaming on the inside about it.
He could have died. Or been missing large chunks of intestines.

Of course, it means if I'm ever in that situation again, I may well be one of the people making a scene in the ER, because I have lost a lot of trust, and I know we just needed ONE person to see and recognise his condition, and last time, that didn't happen.
posted by Elysum at 3:11 AM on October 19, 2015 [7 favorites]


I had pain so horrendous in my ovary ---I couldn't walk, I couldn't sit, I couldn't lay, I couldn't even go to the bathroom it was excruciating. I thought I had a torsion. Nope, it was a regular cyst. So I can't even imagine her pain.

But being in the ER with a child who had breathing issues and the ER doc and staff were an utter joke...I can see how this whole situation happens. ER is used to seeing visible, near death injuries for them to respond. If you can "walk" in and are talking, you're last on the list.
posted by stormpooper at 12:04 PM on October 19, 2015


Oh, oh, and then, most recently, there was the doctor who misdiagnosed my shingles as acne. Hahahahaha, sob. I didn't even get to describe my other symptoms before I was handed a prescription for extra strength noxema and shuffled out the door. Thanks be for second opinions. I wish I had done a chargeback for the copay.
posted by Ruki at 10:20 PM on October 19, 2015


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