February 8, 2012 • 30 mins
Do doctors listen to female patients? Women often complain of doctors not taking symptoms seriously, and patient-doctor mistrust is nothing new. Tune in to learn more about this relationship, including how stress influences a female patient's diagnosis.
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Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve camera.
It's ready. Are you welcome to stuff Mom never told you?
From House Step works dot Com. Hello, and welcome to
the podcast. I'm Caroline and I'm Kristin. There seems to
(00:21):
be a lot of questions floating around the Internet about
women and their doctors, and I'm just getting the impression
generally that women feel that doctors don't listen to them.
I came across two big questions on said Internet regarding
women and doctors. One is whether or not male doctors
(00:42):
come on to female patients and where the ethical lines are.
I did not investigate that one. That's the whole other podcast, yes,
and that we probably will never record. And also whether
or not doctors listen to female patients. Right, there's a
lot of interesting data out there about um just gender interactions,
(01:05):
both the gender of the patient and how that affects
the doctor patient relationship and and as you can imagine,
the gender of the physician, and I, for one, have
always thought out female doctors. I feel more comfortable with
a female gynecologist and a female internist, my chiropractor, and
my acupuncturist. I'm just going to tell you everything about
myself right now. Do you want to know my blood type?
(01:27):
I don't know it. Oh God, we should figure that out.
They're male. So the people, the people who are like
cracking my spine and sticking needles and mirror are guys.
But you know, I just feel like if I'm going
to be doing talking about really personal things and getting
medicine prescribed, I just I feel more comfortable with a
lady doctor. And this question of the doctor female patient
(01:51):
relationship has been snowballing in our minds as we've been
doing episodes on under diagnosed chronic conditions among women, such
as volvidenia, and it also stood out in our podcast
we did a while ago on gender differences in anxiety
because Taylor Clark over its Slate pointed to the American
(02:14):
Psychological Association's Stress in America survey in two thousand and eight,
which found that if a woman goes into a doctor's
office UH and complains of symptoms, they are more likely
to be dismissed as just the products of female stress,
just the product of being a woman, perhaps the change
(02:36):
of life, yes, the seasons turning uh, whereas male symptoms
the same symptoms presented by a male patient often taken
more seriously, and this is specifically in regard to cardiology,
and we'll get into that a little bit more. So,
we decided to look into whether or not that was true,
(02:58):
whether or not women are just complaining more loudly? Are
we just pickier about our doctors? Are we all hypochondriacs? What?
What is happening? Yeah? There was a May blog post
by Nancy kleimus On on the Miss magazine blog and
she posed the question that that we're going to get
into about why don't doctors listen to women? Or do
(03:21):
doctors listen to women? And she said, how do we
dispel the age old myths that women are emotional, overreactive
and generally unable to describe their own medical conditions? What
is up with doctors making up their minds about us
when we've uttered three words about what we're suffering? And
I believe Clemus also is a medical doctor, So this
(03:41):
is a doctor posing this question about other doctors now
across the board. Probably because of the limited amount of
time that doctors have to see patients in the exam room,
there is some mistrust that goes on between patients and physicians.
There was us a two thousand eight column in the
(04:01):
New York Times by Tara Parker Pope who was citing
a Johns Hopkins study finding that about one in four patients,
it's pretty high. One in four patients feel at their
physicians sometimes exposes them to unnecessary risk, and she quotes
a New York doctor saying that nobody's talking to patients.
Everyone is so rushed. I don't think doctors are bad.
(04:23):
People were just working in a broken system. And on
a side note, this is coming from a report in
the Wall Street Journal from to two thousand five, the
time of doctor spends with individual patients has actually increased
from a whopping eighteen minutes, which was high I thought,
to twenty one minutes um. As far as the environment
(04:49):
that these doctors are working in, Tara Parker Pope in
her post says that dealing with declining reimbursements and rising costs,
doctors have only a few minutes to spend with the patient,
and sometimes when I cut to the doctor, I feel
like it is literally just a few minutes. I'm really
surprised by that twenty one minute figure. Well, the that's
averaged out and the writers suggest that it might be
(05:12):
that high number might be due to an aging baby
boomer population sort of skew the skew the curve could
be could be um. Some things that influenced the trust
issues between doctors and patients are news reports about medical
mistakes and drug industry influence. So the more you hear
about malpractice suits and you know, people leaving medical instruments
(05:34):
and someone's spleen after a surgery, maybe you're more likely
to worry. Yeah, and because a lot of adults are
very attuned to what could possibly be wrong. I don't
know about you, Caroline, but I have inadvertently diagnosed myself
with a terrible cancer symptom checker have cancer. It's it's
(05:56):
pretty dangerous. This was according to a few Internet pro
ject survey uh sient of women and percent of men
will research what could be ailing them before the even
step foot in the doctor's office. Right, And that's actually
sort of a uh maybe not a dangerous mistake to make.
But if you've done all this research because you're worried
(06:17):
about your help, that mean it makes sense. But if
you take all of that into your doctor and say, okay, look,
here's what this website says, this is what I have. Well,
even though your doctor is a very smart individual, he
or she might sort of follow you down that path
and think, Okay, you're right. And this actually I say this.
I say this because it happened to me. I actually
had it. It was a minor and a brief dermatological issue,
(06:39):
and I looked it up online and I was like, okay, good, well,
hey I'm not dying, and be this sounds like what
it is. So well, you know, I went to the dermatologist.
Wasn't my normal doctor. I went to a new one
because I couldn't get in anyway. So I go in
with all this information and they're looking at me and
I'm thinking, okay, I'm not gonna say anything. I'm not
gonna say anything. I'm gonna let them decide what it is.
(07:01):
And finally, you know, they're poking at me and stuff,
and I'm like, you know what, I think it's this
and they look and they're like, yeah, here's some hydrocortisome cream.
Go home. Well then it wouldn't go away. I mean,
you know, it was nothing bad, but it kept like
it just kind of hung around. And so then I
went into my my normal dermatology. She's like, oh god,
how long have you been using this hydrocortisown cream And
(07:22):
I said, well, really not as much as they told
me too. She said good, because that's not what you have.
And if you had used hydrocortisome cream every day between
then and now, your skin might be falling off. Oh
my goodness. So yeah, it is dangerous to go in
with your mind made up already. Well. In addition to
women possibly over educating themselves about what could be going
(07:42):
on compared two, men were also more likely to like,
you did, take action and make that appointment and go in.
This is coming from the Centers for Disease Control and Prevention.
This is excluding pregnancy related visits. Women are thirty three
percent more likely van men to visit a doctor. Now
(08:03):
that starts to close with age, as we all get
old and we're all equally sickly. Um, but doctors see
our faces more often, right, and according to a meta
analysis of data from nineteen sixty seven to two thousand one.
This appeared in the Journal of American Medical Association. It
(08:23):
found that visits with female doctors last two minutes longer
on average as far as gender goes, So as far
as women, women are in the doctor's office more, but
if you're seeing a woman doctor, you're also going to
be seeing her more, a little bit more, a little
bit more, twenty seconds more. I wonder if two minutes
makes that much of a difference, though, if you have
(08:44):
a question, yes, that's a brief question. And you mentioned
that the pattern is slightly different for UM O, B
G Y n's and this is true. It's interesting because
all these studies are saying that, you know, female patients
go to the doctor more, they spend more time at
the doctor or um female physicians are more likely to
spend more time with you. But all of that is
(09:04):
not the case for male O, B G I N.
They actually demonstrate a higher level of emotionally focused talk
with their patients. But maybe that has to do with
them tailoring communication styles to their patient population, because studies
have also demonstrated that female patients, unsurprisingly UM tend to
(09:29):
communicate more, want to do more of the the whole
person analysis how they're feeling um mentally, physically, emotionally, uh,
instead of just you know, be sticking more to what
is going on, what is my denvergure and my blood
pressure exactly like male robots. Yes, as you know, men
(09:50):
talk like robots. Um. The Journal of Patient Education and
Counseling in two thousands six published a study that found
that while men tend to be satis by regardless of
the doctor's gender and communication style, US ladies are more
particular and we tend to be happiest with female doctors
when those doctors expressed great concern, empathy, and reassurance. And
(10:12):
I mean, that makes sense to me. I want to
know that my doctor is listening to me and understands.
I don't I don't need her to be like, oh boo,
don't worry, but you know, I want to know she's
listening and understands. But actually, the whole the whole thing
flips on its ear. And if those doctors were male,
female patients were dissatisfied with overt displays of caring. Ah,
(10:33):
we can't be pleased, they just can't. But it makes
sense so that women might be more particular about the
kind of health care they are receiving. Because we are
spending more time in doctor's offices, we're probably seeing more doctors.
And again we go in statistically, we go in armed
(10:54):
with more knowledge. So maybe we set the bar a
little bit higher. And this is not to say by
any means that male doctors are somehow not doing their
job properly. They're simply a communication difference. Because there was
a journal I don't know, Carolina, did you reference as
the Journal of Women's Health study from two thousand nine
that found that male physicians had a higher component to score,
(11:17):
which was understanding the whole person, which is really what
it sounds like, more what female patients are interested in. Right.
It seems like we want to get the whole picture,
the whole health picture laid out, and from the same study,
female physicians had a greater component one score, in other words,
(11:37):
exploring both the disease and illness experience. But I'm wondering
if maybe this big dissatisfaction has much less to do
with the gender of the physician that we're talking to,
because again, um, I don't want to say that that
female or male physicians are one is superior to the other.
(11:57):
But maybe it's how when men present their symptoms and
whether or not the word stress comes. Because a Cornell
study presented at the two thousand eight Cardiovascular Research Foundation
found that mentioning stress affects a doctor's perception of a
(12:18):
woman's symptoms. These researchers examined how doctor's reaction reacted to
patient descriptions of cardiovascular problems for male patients versus female patients,
and they concluded that quote the inclusion of a stressor
precluded doctors from making a coronary heart disease diagnosis in
(12:38):
women but not in men. So there's something about women
saying stress that like sets off alarm bells in physicians
brains says oh you know what, Uh, it's probably just
your stress levels. Here is something that will take care
of that. Yeah, here's an anti anxiety or an antidepressant, right, right,
(13:01):
Maybe that's why. According to the CDC, the major classes
of drugs doled out to women are painkillers and adepressants
and estrogenda. Oh hey interesting, um yeah, as far as
as the mental health and anxiety goes, I mean, yeah,
we did reference that stuff in our anxiety podcast and
it was interesting to see how doctors perceive women so differently.
(13:24):
But according to the World Health Organization, doctors are more
likely to diagnose depression in women compared with men, which
we've talked about before, even when they have similar scores.
On standardized measures of depression or present with identical symptoms.
And this is a quote. Uh, you know you think
about predictors for for being diagnosed with a disease, you
don't think of your gender. I mean, I I don't know.
(13:46):
It's a female. Gender is a significant predictor of being
prescribed mood altering psychotropic drugs. So just being a lady,
you're more likely to get mood altering drugs. Women also
tend to seek more generalized medical assistance for mental health issues,
as again coming from the World Health Organization, compared to men,
(14:08):
who are a less likely to seek mental health but
when they do, they'll go more to specialists, right. And
and there's just there's something about gender stereotypes, not only
for women, not only doctors thinking oh she's just hysterical, um,
but for men as well. And uh, gender stereotypes regarding
proneness to emotional problems and women and alcohol problems and
(14:31):
men appear to reinforce social stigma and constrain help seeking
along stereotypical lines. That's also from the World Health Organization.
So these are barriers I think too, to getting quality care.
If you're if maybe if you assume something about your
own situation or if your doctor just assumes something because
of your gender, and the fact of the matter is, uh,
(14:52):
you know, we're talking a lot about whether or not
women are satisfied with their patient care, but guys, you
you also are suffering from a healthcare gap as well.
Over the life term. Male healthcare costs far more than
women's because you're not investing as much in preventative care
and going to the doctor um as often as we are.
(15:17):
So it's kind of like, you know, maybe at some
point we need to meet in the middle where doctor's
quit dismissing women's complaints is just the byproduct of everyday stress,
and men stopped going in when it's a situation, so
that doctors take your you know, symptoms far more seriously, Right, Yeah,
I go for more more checkups along the line instead
(15:41):
of waiting until it's just at the tipping point. And
as far as identifying problems, especially mental health issues along
gender lines, UM, there was an interesting interview with Dr
Jerome Groupman by NPR. He read a book called How
Doctor Stink after he himself had a bad experience about
trying to get something die agnosed, and he went to
several different doctors, and um, finally I think it was
(16:03):
the fifth doctor. Someone finally listened to all of his
symptoms and he got the right diagnosis. But so he
wrote this book called How Doctors Think after his experience,
and he's talking about how doctors maybe have errors in thinking.
It's not that they're bad people, it's that, uh, we
use shortcuts. He says, most doctors within the first eighteen
seconds of seeing a patient will interrupt him telling his
(16:25):
story and also generate an idea in his mind of
what's wrong. So they're making this snap judgment. And he
calls it an anchoring mistake because once you utter a
couple of words about what you're experiencing, what hurts, or
what feels bad, Um, some doctors have already made a
decision about what you have based on your gender, age, race, whatever,
and they kind of stick with it and maybe, uh
(16:48):
use everything else you say to confirm what they already believe.
So as far as having an idea of what someone
is already suffering from or not suffering from, UM an
interesting study from the Cardiac and Vascular Institute at New
York University Langhorne Medical Center. This was published UH in September. UM.
(17:08):
Anywhere from forty thod to a hundred thousand women every
year with arteries that show up is clear on an
angiogram suffer from a heart attack. And thirty eight percent
of the time they have the kind of plaque that
doesn't show up on an angiogram. And so a lot
of these doctors are sending women home because they just
do this one test and they say, oh, you're fine,
it's probably indigestion. You know, here's here's a prolatack or whatever.
(17:32):
Go home, lie down, get some rest. But then when
the woman comes back and she's going, no, okay, for real,
I'm I'm having a heart attack. Um, that's when they
realize that something very serious is wrong and and women
are symptoms and and this says, I feel common knowledge.
I know that women present very different symptoms when they're
having a heart attack and men do. UM. And that
(17:53):
is something that really needs to be taken into account.
If a woman is suffering from the same thing a
man is, she just might not present the same symptom
in the same way. And so I think, UM, if
maybe if we get more time with our doctors, if
we go to them with enough time in advance of
any problems we have, then maybe we could um be
(18:14):
taken more seriously and get these things diagnosed as far
as and I mean, instead of waiting until it's almost
too late. Well, and if the standard tests for things
like heart disease and heart attack our tailored to what
more commonly manifests and meant, it would make sense that
within that eighteen second window that you mentioned from how
(18:34):
the book how Doctors Think? It makes sense that you know,
doctors would conclude that yea or nay, this is or
is not going on UM. So it sounds like there's
room for more nuanced in the exam room, but also
before that, taking more even in med school, training doctors
to look more closely for UM, for for the gender differences.
(18:57):
I have never been to med school. People who have
been let me know if that is happy. I'm sure
it's happening a lot more than it used to, because
we've talked about in the podcast before. How with for
a lot of prescription medications, for instance, it's only been
in recent years, in the past, like twenty years probably
that they have started using women in more test groups,
(19:20):
whereas everything was tailored to men because men are more
stable because they don't have menstrual cycles. And by stable,
and I'm not talking about like brain and mood stable,
I mean physiologically levels of hormones in their body fable.
But to cap things off, let us let us at
least verify that it is not just in our heads.
(19:44):
Even though women are going to the doctor more often
than men, a December two thousand eleven study published in
the European Journal of Public Health via the Public Health
Agency of Barcelona found that women did indeed report health
problems more often, but it's because we are actually suffering
(20:06):
from a higher rate of chronic disease, and the lead
researcher says these results suggest that the poor self rated
health of women is a reflection of the higher burden
of disease they suffer, and it should be the findings
should be offered up as support that women are not
just a bunch of raving hypochondriacts. And of speaking of hypochondria.
(20:28):
According to the National Institutes of Health, hypochondria presents itself
equally among men and women, especially with websites like WebM d.
Recall to do is click on that little body and
tell it what hurts. It's always cancer. There's always you
could scrape your knee and web m D symptom checker
(20:48):
would give you knee cancer. It's it's always going to
be cancer or foot fungus. Like it's something where you're like,
how do you how do I have prostate cancer? Web D?
I'm I'm a woman, Come on, um. But okay, so
we we've we've come back around to the whole self
diagnosis thing, and I think we should talk about some
(21:09):
of the mistakes that we do make when we go
to the doctor's office. I already told my long story
about my hydrocortisome cream. We don't need to revisit it. Um.
But Dr Christie Northrop was quoted in a two thousand
eight CNN column by medical correspondent Elizabeth Cohen and actor.
Northrop said that women make a huge mistake by feeling
(21:31):
paralyzed and voiceless in a doctor's office. Although I'm not
sure how you can call and something like that a
mistake if you feel paralyzed, do you feel paralyzed? But anyway,
she says, you shouldn't feel paralyzed, and so so she
breaks down the five the five mistakes that we make,
and one is we don't question our doctors. She compares
(21:52):
it to a a child versus parent interaction that we're
just like, okay, whatever you say, you're smart. So we're
just passive sitting on the exam table waiting for the
terrible prognosis of knee cancer. Exactly, you're gonna get letters
from people with knee cancer. Um. She suggests taking someone
with you who will ask questions, who who maybe isn't
(22:14):
afraid to ask questions to the doctor, or just ask
the doctor to slow down and say, look, I don't
I didn't go to med school. Can you please help
me understand this? So that's that's what idea. And she
also says that instead of just seeing the two facts,
were offering interpretations which could lead the doctor down the
wrong path. In other words, what she's saying is you
go and prepared, know that you're going to have a
(22:35):
limited amount of time, and know what you want to
talk about. If there are you know, three things specifically
that are happening, be ready to cut to the chase,
right and yeah, cutting to the chase, which is what
I should have done earlier with my story. Um. She
says that you know, don't interpret your systems or your
symptoms in the doctor's office. Don't just state the facts,
(22:59):
state what you're offering from. Don't say like, oh, well,
so then I was reading that maybe it could be
foot fungus. Um. Just just let them let them exam,
you know, examine you. And I'm not gonna lie. I
am totally guilty of going into the doctor for something
and not wanting to reveal the fact that I had
done the research for fear of seeming like a crazy
(23:22):
internet hypochondriac. But so many of us are, and I
think they know that. I mean, I think if you're
a doctor here, an internist, probably I would say a
huge chunk to be very specific, come in every day
just being like, well I read this on the internet.
It sounds like we just need more honesty in the
in the exam room, and maybe several follow up appointments.
(23:43):
I'm going to prescribe our listeners more honesty and gumption
next time they go to the doctor. Put that on
a pillow. Um. And one one major issue that she
points out is that we don't as women, we don't
recognize gender bias. Apparently, she says that our issues are
more likely to be interpreted as emotional issues or complaining
like we've touched on and uh. Dr Nissa Goldberg, author
(24:08):
of the wonderfully titled women Are Not Small Men, um,
thank you, Dr Goldberg. She says, you don't want to
go to a doctor who says, now, honey, it's not
all that bad, which is true. I mean you want
to If you're taking the time to go to the doctor,
you're probably taking off work or school or whatever. You
want to be taken seriously, so listen to us. And
we're not small men, right, Like you said, we have
(24:31):
menstrual cycles. So we've been addressing a lot from the
patient end of things. What I'm also interested in two things.
A for people working in the medical field out there,
how do you I mean doctors and nurse practitioners and
everybody else cannot be blind to this communication barrier between
(24:54):
patients and the physician. So I'm wondering whether or not
this is something that is talked about, whether or not
it's something that is kind of dismissed. If you if
you have those certain patients who it's like, well they
stop talking about my mother and get ready for a
bunch of complaining um or you know, how how you
(25:15):
how you manage that Um and also men out there
doesn't Are are women just complaining more? Or is there
a similar disconnect between what you need when you go
into the doctor and the kind of care that you
are or are not getting. Is this something that we're
all experiencing? Because I feel like the um the issues
(25:37):
that we're talking about have as much to do with
with patient interaction as it does with how doctors are responding.
And I want to hear from from women. I know
we've heard from a couple already when we did our
Valvedenio podcast about what symptoms have you had? What what
health issues have you had? The doctors have dismissed and
that you found out later it was actually something serious.
(25:58):
So we just asked, are so much from everyone? But
but really I'm very curious to hear from folks. Mom
stuff at Discovery dot com is the addressed. Okay, I
have a letter from Christina Um. She says, has anyone
ever told you this? Before? The movie Whip? It encompasses
(26:20):
at least six elements from stuff Mom Never Told You episodes.
Let me explain. First, the Roller Derby show obviously what
the movie was about slightly mentioned. Second, the women of
the Oscar show. This movie was not up for an
oscar as far as I know, but in mentioning general
female directors, Drew Barrymore directed and start in it. Third
is Miss America relevant That show? Ellen Page's character Bliss
(26:43):
was being pressured by her mother to be a part
of a beauty pageant show. Fourth feminism, as mentioned in
most shows, Bliss lived happily ever after without Oliver, the
cheating boyfriend decided not to buy his crap about a
girl in a picture wearing a striper shirt she discovered
on his band web page. Also, be your Own Hero
was catchy empowering quote. Fifth bullying show. Maven Juliette Lewis's
(27:05):
character was bullying Bliss, but earned her respect at the end.
Sixth the Girl Scouts show herl Scouts was the team
name that Bliss played on. Isn't this strange or is
this someone's favorite movie? The movie was cool, but I
love your show and wanted to point this out. So
that's something I've never thought about. And I wrote back
to tell her that I have never seen Whippet, but
(27:25):
now obviously it's really cute. It's really cute, and I
don't want to spoil anything for anyone who hasn't seen
it kristin your mooths. But the part where you mentioned
Christina the whole like living without Oliver the boyfriend. I
love that theme. That's my favorite. I have no idea
what you're talking about, So I'm going to talk about
grammar just from Mary Ellen. She has a p sheet
(27:48):
in linguistics and is writing in response to Grammar Girl,
and she took some issue to some of the things
she writes. When answering the question about whether men or
women pay more attention to grammar, Grammar Girl mentions that
older women tend to be bigger sticklers for grammar because
all of the teachers way back when we're women. While
this might be true, it's only part of the story.
(28:09):
At least in Western culture, language has been a vehicle
of upward mobility for women. Think my fair lady. If
women speak properly, they can have white collar jobs such
as teachers and secretaries and move out of the lower class. Men,
on the other hand, benefit from speaking the vernacular and
are mocked if they speak too proper, which brings to
(28:29):
mind this the whole kind of elitism argument that crops
up often in political seasons. As we are in. Finally,
I want to comment on if you Will. I disagree
with grammar girl. I don't think that it undercuts what
you are saying. What if you Will does is ask
your audience permission to use a word or phrase that
you're acknowledging as inadequate but best fits because you can't
(28:51):
think of a better word. I think it's a useful
phrase and don't see any reason that you shouldn't use it,
you know what. Mary Ellen is one of many who
has written in too in court of if you Will.
But I don't know. I don't I don't know if
I can do it. I feel like I've trained myself
to weed it out so thoroughly as you wish, that
(29:11):
as you wish will be the only thing that will
suffice if you will. So, if you have any questions
to send our way. Mom Stuff at discovery dot com
is the email address, Facebook dot com, slash stuff mo
I've Never Told You is the surprise Facebook place to go,
and then at mom Stuff Podcast is how you can
reach us on Twitter, and of course if you want
(29:32):
to find us during the week, we are over at
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(29:58):
you by the reinvented tooth thousand and twelve Camry. It's ready,
are you
Brought to you by the reinvented two thousand twelve camera.
It's ready. Are you welcome to stuff Mom never told you?
From House Step works dot Com. Hello, and welcome to
the podcast. I'm Caroline and I'm Kristin. There seems to
(00:21):
be a lot of questions floating around the Internet about
women and their doctors, and I'm just getting the impression
generally that women feel that doctors don't listen to them.
I came across two big questions on said Internet regarding
women and doctors. One is whether or not male doctors
(00:42):
come on to female patients and where the ethical lines are.
I did not investigate that one. That's the whole other podcast, yes,
and that we probably will never record. And also whether
or not doctors listen to female patients. Right, there's a
lot of interesting data out there about um just gender interactions,
(01:05):
both the gender of the patient and how that affects
the doctor patient relationship and and as you can imagine,
the gender of the physician, and I, for one, have
always thought out female doctors. I feel more comfortable with
a female gynecologist and a female internist, my chiropractor, and
my acupuncturist. I'm just going to tell you everything about
myself right now. Do you want to know my blood type?
(01:27):
I don't know it. Oh God, we should figure that out.
They're male. So the people, the people who are like
cracking my spine and sticking needles and mirror are guys.
But you know, I just feel like if I'm going
to be doing talking about really personal things and getting
medicine prescribed, I just I feel more comfortable with a
lady doctor. And this question of the doctor female patient
(01:51):
relationship has been snowballing in our minds as we've been
doing episodes on under diagnosed chronic conditions among women, such
as volvidenia, and it also stood out in our podcast
we did a while ago on gender differences in anxiety
because Taylor Clark over its Slate pointed to the American
(02:14):
Psychological Association's Stress in America survey in two thousand and eight,
which found that if a woman goes into a doctor's
office UH and complains of symptoms, they are more likely
to be dismissed as just the products of female stress,
just the product of being a woman, perhaps the change
(02:36):
of life, yes, the seasons turning uh, whereas male symptoms
the same symptoms presented by a male patient often taken
more seriously, and this is specifically in regard to cardiology,
and we'll get into that a little bit more. So,
we decided to look into whether or not that was true,
(02:58):
whether or not women are just complaining more loudly? Are
we just pickier about our doctors? Are we all hypochondriacs? What?
What is happening? Yeah? There was a May blog post
by Nancy kleimus On on the Miss magazine blog and
she posed the question that that we're going to get
into about why don't doctors listen to women? Or do
(03:21):
doctors listen to women? And she said, how do we
dispel the age old myths that women are emotional, overreactive
and generally unable to describe their own medical conditions? What
is up with doctors making up their minds about us
when we've uttered three words about what we're suffering? And
I believe Clemus also is a medical doctor, So this
(03:41):
is a doctor posing this question about other doctors now
across the board. Probably because of the limited amount of
time that doctors have to see patients in the exam room,
there is some mistrust that goes on between patients and physicians.
There was us a two thousand eight column in the
(04:01):
New York Times by Tara Parker Pope who was citing
a Johns Hopkins study finding that about one in four patients,
it's pretty high. One in four patients feel at their
physicians sometimes exposes them to unnecessary risk, and she quotes
a New York doctor saying that nobody's talking to patients.
Everyone is so rushed. I don't think doctors are bad.
(04:23):
People were just working in a broken system. And on
a side note, this is coming from a report in
the Wall Street Journal from to two thousand five, the
time of doctor spends with individual patients has actually increased
from a whopping eighteen minutes, which was high I thought,
to twenty one minutes um. As far as the environment
(04:49):
that these doctors are working in, Tara Parker Pope in
her post says that dealing with declining reimbursements and rising costs,
doctors have only a few minutes to spend with the patient,
and sometimes when I cut to the doctor, I feel
like it is literally just a few minutes. I'm really
surprised by that twenty one minute figure. Well, the that's
averaged out and the writers suggest that it might be
(05:12):
that high number might be due to an aging baby
boomer population sort of skew the skew the curve could
be could be um. Some things that influenced the trust
issues between doctors and patients are news reports about medical
mistakes and drug industry influence. So the more you hear
about malpractice suits and you know, people leaving medical instruments
(05:34):
and someone's spleen after a surgery, maybe you're more likely
to worry. Yeah, and because a lot of adults are
very attuned to what could possibly be wrong. I don't
know about you, Caroline, but I have inadvertently diagnosed myself
with a terrible cancer symptom checker have cancer. It's it's
(05:56):
pretty dangerous. This was according to a few Internet pro
ject survey uh sient of women and percent of men
will research what could be ailing them before the even
step foot in the doctor's office. Right, And that's actually
sort of a uh maybe not a dangerous mistake to make.
But if you've done all this research because you're worried
(06:17):
about your help, that mean it makes sense. But if
you take all of that into your doctor and say, okay, look,
here's what this website says, this is what I have. Well,
even though your doctor is a very smart individual, he
or she might sort of follow you down that path
and think, Okay, you're right. And this actually I say this.
I say this because it happened to me. I actually
had it. It was a minor and a brief dermatological issue,
(06:39):
and I looked it up online and I was like, okay, good, well,
hey I'm not dying, and be this sounds like what
it is. So well, you know, I went to the dermatologist.
Wasn't my normal doctor. I went to a new one
because I couldn't get in anyway. So I go in
with all this information and they're looking at me and
I'm thinking, okay, I'm not gonna say anything. I'm not
gonna say anything. I'm gonna let them decide what it is.
(07:01):
And finally, you know, they're poking at me and stuff,
and I'm like, you know what, I think it's this
and they look and they're like, yeah, here's some hydrocortisome cream.
Go home. Well then it wouldn't go away. I mean,
you know, it was nothing bad, but it kept like
it just kind of hung around. And so then I
went into my my normal dermatology. She's like, oh god,
how long have you been using this hydrocortisown cream And
(07:22):
I said, well, really not as much as they told
me too. She said good, because that's not what you have.
And if you had used hydrocortisome cream every day between
then and now, your skin might be falling off. Oh
my goodness. So yeah, it is dangerous to go in
with your mind made up already. Well. In addition to
women possibly over educating themselves about what could be going
(07:42):
on compared two, men were also more likely to like,
you did, take action and make that appointment and go in.
This is coming from the Centers for Disease Control and Prevention.
This is excluding pregnancy related visits. Women are thirty three
percent more likely van men to visit a doctor. Now
(08:03):
that starts to close with age, as we all get
old and we're all equally sickly. Um, but doctors see
our faces more often, right, and according to a meta
analysis of data from nineteen sixty seven to two thousand one.
This appeared in the Journal of American Medical Association. It
(08:23):
found that visits with female doctors last two minutes longer
on average as far as gender goes, So as far
as women, women are in the doctor's office more, but
if you're seeing a woman doctor, you're also going to
be seeing her more, a little bit more, a little
bit more, twenty seconds more. I wonder if two minutes
makes that much of a difference, though, if you have
(08:44):
a question, yes, that's a brief question. And you mentioned
that the pattern is slightly different for UM O, B
G Y n's and this is true. It's interesting because
all these studies are saying that, you know, female patients
go to the doctor more, they spend more time at
the doctor or um female physicians are more likely to
spend more time with you. But all of that is
(09:04):
not the case for male O, B G I N.
They actually demonstrate a higher level of emotionally focused talk
with their patients. But maybe that has to do with
them tailoring communication styles to their patient population, because studies
have also demonstrated that female patients, unsurprisingly UM tend to
(09:29):
communicate more, want to do more of the the whole
person analysis how they're feeling um mentally, physically, emotionally, uh,
instead of just you know, be sticking more to what
is going on, what is my denvergure and my blood
pressure exactly like male robots. Yes, as you know, men
(09:50):
talk like robots. Um. The Journal of Patient Education and
Counseling in two thousands six published a study that found
that while men tend to be satis by regardless of
the doctor's gender and communication style, US ladies are more
particular and we tend to be happiest with female doctors
when those doctors expressed great concern, empathy, and reassurance. And
(10:12):
I mean, that makes sense to me. I want to
know that my doctor is listening to me and understands.
I don't I don't need her to be like, oh boo,
don't worry, but you know, I want to know she's
listening and understands. But actually, the whole the whole thing
flips on its ear. And if those doctors were male,
female patients were dissatisfied with overt displays of caring. Ah,
(10:33):
we can't be pleased, they just can't. But it makes
sense so that women might be more particular about the
kind of health care they are receiving. Because we are
spending more time in doctor's offices, we're probably seeing more doctors.
And again we go in statistically, we go in armed
(10:54):
with more knowledge. So maybe we set the bar a
little bit higher. And this is not to say by
any means that male doctors are somehow not doing their
job properly. They're simply a communication difference. Because there was
a journal I don't know, Carolina, did you reference as
the Journal of Women's Health study from two thousand nine
that found that male physicians had a higher component to score,
(11:17):
which was understanding the whole person, which is really what
it sounds like, more what female patients are interested in. Right.
It seems like we want to get the whole picture,
the whole health picture laid out, and from the same study,
female physicians had a greater component one score, in other words,
(11:37):
exploring both the disease and illness experience. But I'm wondering
if maybe this big dissatisfaction has much less to do
with the gender of the physician that we're talking to,
because again, um, I don't want to say that that
female or male physicians are one is superior to the other.
(11:57):
But maybe it's how when men present their symptoms and
whether or not the word stress comes. Because a Cornell
study presented at the two thousand eight Cardiovascular Research Foundation
found that mentioning stress affects a doctor's perception of a
(12:18):
woman's symptoms. These researchers examined how doctor's reaction reacted to
patient descriptions of cardiovascular problems for male patients versus female patients,
and they concluded that quote the inclusion of a stressor
precluded doctors from making a coronary heart disease diagnosis in
(12:38):
women but not in men. So there's something about women
saying stress that like sets off alarm bells in physicians
brains says oh you know what, Uh, it's probably just
your stress levels. Here is something that will take care
of that. Yeah, here's an anti anxiety or an antidepressant, right, right,
(13:01):
Maybe that's why. According to the CDC, the major classes
of drugs doled out to women are painkillers and adepressants
and estrogenda. Oh hey interesting, um yeah, as far as
as the mental health and anxiety goes, I mean, yeah,
we did reference that stuff in our anxiety podcast and
it was interesting to see how doctors perceive women so differently.
(13:24):
But according to the World Health Organization, doctors are more
likely to diagnose depression in women compared with men, which
we've talked about before, even when they have similar scores.
On standardized measures of depression or present with identical symptoms.
And this is a quote. Uh, you know you think
about predictors for for being diagnosed with a disease, you
don't think of your gender. I mean, I I don't know.
(13:46):
It's a female. Gender is a significant predictor of being
prescribed mood altering psychotropic drugs. So just being a lady,
you're more likely to get mood altering drugs. Women also
tend to seek more generalized medical assistance for mental health issues,
as again coming from the World Health Organization, compared to men,
(14:08):
who are a less likely to seek mental health but
when they do, they'll go more to specialists, right. And
and there's just there's something about gender stereotypes, not only
for women, not only doctors thinking oh she's just hysterical, um,
but for men as well. And uh, gender stereotypes regarding
proneness to emotional problems and women and alcohol problems and
(14:31):
men appear to reinforce social stigma and constrain help seeking
along stereotypical lines. That's also from the World Health Organization.
So these are barriers I think too, to getting quality care.
If you're if maybe if you assume something about your
own situation or if your doctor just assumes something because
of your gender, and the fact of the matter is, uh,
(14:52):
you know, we're talking a lot about whether or not
women are satisfied with their patient care, but guys, you
you also are suffering from a healthcare gap as well.
Over the life term. Male healthcare costs far more than
women's because you're not investing as much in preventative care
and going to the doctor um as often as we are.
(15:17):
So it's kind of like, you know, maybe at some
point we need to meet in the middle where doctor's
quit dismissing women's complaints is just the byproduct of everyday stress,
and men stopped going in when it's a situation, so
that doctors take your you know, symptoms far more seriously, Right, Yeah,
I go for more more checkups along the line instead
(15:41):
of waiting until it's just at the tipping point. And
as far as identifying problems, especially mental health issues along
gender lines, UM, there was an interesting interview with Dr
Jerome Groupman by NPR. He read a book called How
Doctor Stink after he himself had a bad experience about
trying to get something die agnosed, and he went to
several different doctors, and um, finally I think it was
(16:03):
the fifth doctor. Someone finally listened to all of his
symptoms and he got the right diagnosis. But so he
wrote this book called How Doctors Think after his experience,
and he's talking about how doctors maybe have errors in thinking.
It's not that they're bad people, it's that, uh, we
use shortcuts. He says, most doctors within the first eighteen
seconds of seeing a patient will interrupt him telling his
(16:25):
story and also generate an idea in his mind of
what's wrong. So they're making this snap judgment. And he
calls it an anchoring mistake because once you utter a
couple of words about what you're experiencing, what hurts, or
what feels bad, Um, some doctors have already made a
decision about what you have based on your gender, age, race, whatever,
and they kind of stick with it and maybe, uh
(16:48):
use everything else you say to confirm what they already believe.
So as far as having an idea of what someone
is already suffering from or not suffering from, UM an
interesting study from the Cardiac and Vascular Institute at New
York University Langhorne Medical Center. This was published UH in September. UM.
(17:08):
Anywhere from forty thod to a hundred thousand women every
year with arteries that show up is clear on an
angiogram suffer from a heart attack. And thirty eight percent
of the time they have the kind of plaque that
doesn't show up on an angiogram. And so a lot
of these doctors are sending women home because they just
do this one test and they say, oh, you're fine,
it's probably indigestion. You know, here's here's a prolatack or whatever.
(17:32):
Go home, lie down, get some rest. But then when
the woman comes back and she's going, no, okay, for real,
I'm I'm having a heart attack. Um, that's when they
realize that something very serious is wrong and and women
are symptoms and and this says, I feel common knowledge.
I know that women present very different symptoms when they're
having a heart attack and men do. UM. And that
(17:53):
is something that really needs to be taken into account.
If a woman is suffering from the same thing a
man is, she just might not present the same symptom
in the same way. And so I think, UM, if
maybe if we get more time with our doctors, if
we go to them with enough time in advance of
any problems we have, then maybe we could um be
(18:14):
taken more seriously and get these things diagnosed as far
as and I mean, instead of waiting until it's almost
too late. Well, and if the standard tests for things
like heart disease and heart attack our tailored to what
more commonly manifests and meant, it would make sense that
within that eighteen second window that you mentioned from how
(18:34):
the book how Doctors Think? It makes sense that you know,
doctors would conclude that yea or nay, this is or
is not going on UM. So it sounds like there's
room for more nuanced in the exam room, but also
before that, taking more even in med school, training doctors
to look more closely for UM, for for the gender differences.
(18:57):
I have never been to med school. People who have
been let me know if that is happy. I'm sure
it's happening a lot more than it used to, because
we've talked about in the podcast before. How with for
a lot of prescription medications, for instance, it's only been
in recent years, in the past, like twenty years probably
that they have started using women in more test groups,
(19:20):
whereas everything was tailored to men because men are more
stable because they don't have menstrual cycles. And by stable,
and I'm not talking about like brain and mood stable,
I mean physiologically levels of hormones in their body fable.
But to cap things off, let us let us at
least verify that it is not just in our heads.
(19:44):
Even though women are going to the doctor more often
than men, a December two thousand eleven study published in
the European Journal of Public Health via the Public Health
Agency of Barcelona found that women did indeed report health
problems more often, but it's because we are actually suffering
(20:06):
from a higher rate of chronic disease, and the lead
researcher says these results suggest that the poor self rated
health of women is a reflection of the higher burden
of disease they suffer, and it should be the findings
should be offered up as support that women are not
just a bunch of raving hypochondriacts. And of speaking of hypochondria.
(20:28):
According to the National Institutes of Health, hypochondria presents itself
equally among men and women, especially with websites like WebM d.
Recall to do is click on that little body and
tell it what hurts. It's always cancer. There's always you
could scrape your knee and web m D symptom checker
(20:48):
would give you knee cancer. It's it's always going to
be cancer or foot fungus. Like it's something where you're like,
how do you how do I have prostate cancer? Web D?
I'm I'm a woman, Come on, um. But okay, so
we we've we've come back around to the whole self
diagnosis thing, and I think we should talk about some
(21:09):
of the mistakes that we do make when we go
to the doctor's office. I already told my long story
about my hydrocortisome cream. We don't need to revisit it. Um.
But Dr Christie Northrop was quoted in a two thousand
eight CNN column by medical correspondent Elizabeth Cohen and actor.
Northrop said that women make a huge mistake by feeling
(21:31):
paralyzed and voiceless in a doctor's office. Although I'm not
sure how you can call and something like that a
mistake if you feel paralyzed, do you feel paralyzed? But anyway,
she says, you shouldn't feel paralyzed, and so so she
breaks down the five the five mistakes that we make,
and one is we don't question our doctors. She compares
(21:52):
it to a a child versus parent interaction that we're
just like, okay, whatever you say, you're smart. So we're
just passive sitting on the exam table waiting for the
terrible prognosis of knee cancer. Exactly, you're gonna get letters
from people with knee cancer. Um. She suggests taking someone
with you who will ask questions, who who maybe isn't
(22:14):
afraid to ask questions to the doctor, or just ask
the doctor to slow down and say, look, I don't
I didn't go to med school. Can you please help
me understand this? So that's that's what idea. And she
also says that instead of just seeing the two facts,
were offering interpretations which could lead the doctor down the
wrong path. In other words, what she's saying is you
go and prepared, know that you're going to have a
(22:35):
limited amount of time, and know what you want to
talk about. If there are you know, three things specifically
that are happening, be ready to cut to the chase,
right and yeah, cutting to the chase, which is what
I should have done earlier with my story. Um. She
says that you know, don't interpret your systems or your
symptoms in the doctor's office. Don't just state the facts,
(22:59):
state what you're offering from. Don't say like, oh, well,
so then I was reading that maybe it could be
foot fungus. Um. Just just let them let them exam,
you know, examine you. And I'm not gonna lie. I
am totally guilty of going into the doctor for something
and not wanting to reveal the fact that I had
done the research for fear of seeming like a crazy
(23:22):
internet hypochondriac. But so many of us are, and I
think they know that. I mean, I think if you're
a doctor here, an internist, probably I would say a
huge chunk to be very specific, come in every day
just being like, well I read this on the internet.
It sounds like we just need more honesty in the
in the exam room, and maybe several follow up appointments.
(23:43):
I'm going to prescribe our listeners more honesty and gumption
next time they go to the doctor. Put that on
a pillow. Um. And one one major issue that she
points out is that we don't as women, we don't
recognize gender bias. Apparently, she says that our issues are
more likely to be interpreted as emotional issues or complaining
like we've touched on and uh. Dr Nissa Goldberg, author
(24:08):
of the wonderfully titled women Are Not Small Men, um,
thank you, Dr Goldberg. She says, you don't want to
go to a doctor who says, now, honey, it's not
all that bad, which is true. I mean you want
to If you're taking the time to go to the doctor,
you're probably taking off work or school or whatever. You
want to be taken seriously, so listen to us. And
we're not small men, right, Like you said, we have
(24:31):
menstrual cycles. So we've been addressing a lot from the
patient end of things. What I'm also interested in two things.
A for people working in the medical field out there,
how do you I mean doctors and nurse practitioners and
everybody else cannot be blind to this communication barrier between
(24:54):
patients and the physician. So I'm wondering whether or not
this is something that is talked about, whether or not
it's something that is kind of dismissed. If you if
you have those certain patients who it's like, well they
stop talking about my mother and get ready for a
bunch of complaining um or you know, how how you
(25:15):
how you manage that Um and also men out there
doesn't Are are women just complaining more? Or is there
a similar disconnect between what you need when you go
into the doctor and the kind of care that you
are or are not getting. Is this something that we're
all experiencing? Because I feel like the um the issues
(25:37):
that we're talking about have as much to do with
with patient interaction as it does with how doctors are responding.
And I want to hear from from women. I know
we've heard from a couple already when we did our
Valvedenio podcast about what symptoms have you had? What what
health issues have you had? The doctors have dismissed and
that you found out later it was actually something serious.
(25:58):
So we just asked, are so much from everyone? But
but really I'm very curious to hear from folks. Mom
stuff at Discovery dot com is the addressed. Okay, I
have a letter from Christina Um. She says, has anyone
ever told you this? Before? The movie Whip? It encompasses
(26:20):
at least six elements from stuff Mom Never Told You episodes.
Let me explain. First, the Roller Derby show obviously what
the movie was about slightly mentioned. Second, the women of
the Oscar show. This movie was not up for an
oscar as far as I know, but in mentioning general
female directors, Drew Barrymore directed and start in it. Third
is Miss America relevant That show? Ellen Page's character Bliss
(26:43):
was being pressured by her mother to be a part
of a beauty pageant show. Fourth feminism, as mentioned in
most shows, Bliss lived happily ever after without Oliver, the
cheating boyfriend decided not to buy his crap about a
girl in a picture wearing a striper shirt she discovered
on his band web page. Also, be your Own Hero
was catchy empowering quote. Fifth bullying show. Maven Juliette Lewis's
(27:05):
character was bullying Bliss, but earned her respect at the end.
Sixth the Girl Scouts show herl Scouts was the team
name that Bliss played on. Isn't this strange or is
this someone's favorite movie? The movie was cool, but I
love your show and wanted to point this out. So
that's something I've never thought about. And I wrote back
to tell her that I have never seen Whippet, but
(27:25):
now obviously it's really cute. It's really cute, and I
don't want to spoil anything for anyone who hasn't seen
it kristin your mooths. But the part where you mentioned
Christina the whole like living without Oliver the boyfriend. I
love that theme. That's my favorite. I have no idea
what you're talking about, So I'm going to talk about
grammar just from Mary Ellen. She has a p sheet
(27:48):
in linguistics and is writing in response to Grammar Girl,
and she took some issue to some of the things
she writes. When answering the question about whether men or
women pay more attention to grammar, Grammar Girl mentions that
older women tend to be bigger sticklers for grammar because
all of the teachers way back when we're women. While
this might be true, it's only part of the story.
(28:09):
At least in Western culture, language has been a vehicle
of upward mobility for women. Think my fair lady. If
women speak properly, they can have white collar jobs such
as teachers and secretaries and move out of the lower class. Men,
on the other hand, benefit from speaking the vernacular and
are mocked if they speak too proper, which brings to
(28:29):
mind this the whole kind of elitism argument that crops
up often in political seasons. As we are in. Finally,
I want to comment on if you Will. I disagree
with grammar girl. I don't think that it undercuts what
you are saying. What if you Will does is ask
your audience permission to use a word or phrase that
you're acknowledging as inadequate but best fits because you can't
(28:51):
think of a better word. I think it's a useful
phrase and don't see any reason that you shouldn't use it,
you know what. Mary Ellen is one of many who
has written in too in court of if you Will.
But I don't know. I don't I don't know if
I can do it. I feel like I've trained myself
to weed it out so thoroughly as you wish, that
(29:11):
as you wish will be the only thing that will
suffice if you will. So, if you have any questions
to send our way. Mom Stuff at discovery dot com
is the email address, Facebook dot com, slash stuff mo
I've Never Told You is the surprise Facebook place to go,
and then at mom Stuff Podcast is how you can
reach us on Twitter, and of course if you want
(29:32):
to find us during the week, we are over at
how Stuff Works dot com. Be sure to check out
our new video podcast stuff from the future. Join how
Stuff Work staff as we explore the most promising and
perplexing possibilities of tomorrow. The house Stuff Works iPhone up
has a ride. Download it today on iTunes, brought to
(29:58):
you by the reinvented tooth thousand and twelve Camry. It's ready,
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