Getting doctors to take us seriously

I woke up this morning to news that a friend is in hospital with a burst appendix. This should not have happened.

She developed the characteristic pain associated with appendicitis last week and saw an after hours doctor. She was referred to a hospital for assessment where she was examined by another doctor who decided she didn’t need further treatment. She was not offered either ultrasound or a CT scans. She was sent home.

Her doctor accepted the word of the hospital doctor and continued to work with my friend to determine what was going on. There were tests. There was pain medication and ultimately a burst appendix. All this in spite of my friend repeatedly reporting acute abdominal pain.

I can’t help wondering if women reporting pain are treated differently to men reporting pain. This is not my only recent experience of this apparent bias.

My daughter has an unfortunate history of not being taken seriously by doctors, particularly with regard to pain. As her mother, I know that she is inclined to actually be rather stoic when it comes to pain. She does not exaggerate and she’s likely to wait a while before she resorts to pain medication. I know that if she says she is in pain she means it.

And yet, time and again she has had doctors dismiss her with a shrug of their shoulders and a suggestion that she should ‘just keep an eye on it’. This week she will have surgery on her finger. It has been causing problems for a couple of years now. It is always tender and if she bumps it against anything she experiences strong, stabbing pain on the underside of the nail bed. She has repeatedly told various doctors about the problem.

Finally my daughter encountered a freshly minted doctor, filling in at the practice she regularly attends. The locum was interested enough to send her for an MRI. What it revealed was a tumour. While currently likely to be benign, this type of tumour does have the potential to become cancerous. It needs to be removed.

My daughter is understandably angry. She’s not only had years of pain in the hand, she’s had it while working through a university degree and having to type on a daily basis. She’s had it in spite of several reports to doctors who seem to have just assumed she was over stating her pain, or displaying some kind of hypochondria.

Not only that, but this is just the most recent in a series of similar events where it has taken her two, three or four visits to different doctors before she finally finds someone prepared to take her seriously. In every single case there was a serious underlying medical condition that required treatment.

How does this happen? Are doctors’ surgeries so filled with over-reporting, attention-seeking women that the rest of us get tarred with the same brush?

My daughter wonders if she would have received better treatment if she had been a man, particularly a large, football-playing man. I think she would have. I think a doctor would have assumed that any man attending the surgery and reporting acute pain in his finger had something worthy of further investigation.

If you are a doctor and you are reading this then I would like to offer this piece of advice. Please do not assume. Your opinions about female patients might have some basis in fact and I allow for that. It could be that women actually are more inclined to exaggerate their symptoms or to seek medical attention when some over the counter pain relief and a bit of rest are all that is needed. Personally, I doubt this. It is inconsistent with my own experience but my personal experience is limited and perhaps you know better.

Still, here’s the thing, even if some women (or even most women) are inclined to this type of behaviour, many of us are not. Many of us are the type of people that wait to see a doctor and possibly wait a bit too long. When we arrive at your surgery seeking your help we’ve already given time and Panadol a go. We have already been ‘keeping an eye on it’ and that is why we are now seeking your help.

You might also like to keep in mind that we have a naturally higher pain threshold than men. There’s good science on this. So when we report pain it is likely to be more serious, not less.

I think it’s just possible that there is a long history of characterising women unfairly. We used to be treated for ‘hysteria’, a mysterious condition thought to be caused by our womb roaming our body and creating mood swings. In recent years the assumption that our menstrual cycle will result in strange and irrational behaviour every month has become so widely accepted that it now gets used as a criminal defence. The truth is that most of us manage to live our lives without turning into raging lunatics once a month.

Menopause is characterised by some as an onset of permanent mood swings that are as suddenly changeable as New Zealand weather patterns. Which is odd, given that I now keep company with a circle of post menopausal friends who clearly manage entire days, weeks and months of sensible behaviour.

Enough.

Women are not over emotional. We are not, by nature, moody, unreasonable, attention-seeking drama queens. Most of us are just like men in this regard; capable of experiencing the full spectrum of human emotions and expressing them in appropriate ways. The exceptions are just that. Getting doctors to understand this is not just about better bedside manner. It is about saving lives.

My daughter’s cyst could have become a tumour. My friends appendix has burst and she is now dealing with the risk of long term health consequences because of it. Head to any cancer forum and you will read story after story of women that were told a lump was nothing to worry about only to discover it was a tumour. We’re not making this stuff up!

As patients I think we also need to be aware that this bias exists. I wish it was as easy as saying to a doctor, ‘Do you think you might take me more seriously if I was a man with these symptoms?’ I am known to be what my husband politely refers to a a ‘forthright’ but even I would find this kind of comment too confrontational. There are gentler ways to achieve the same outcome.

Perhaps it would be a good idea if we enter a doctor’s surgery with a clear idea of what we want and refuse to leave until we get it. Being able to ask for a scan or some other form of diagnostic test can be difficult. We want to trust our medical professionals. We feel rude challenging their diagnosis.

I have found that it can be useful to frame this kind of request as a need for reassurance. This doesn’t challenge your doctor’s expertise. It can also be useful to ask your doctor to consider alternatives. Yes, a second opinion is an option but it is also both time consuming and expensive, and there is no guarantee that you’ll be treated any better by another doctor.

So here, in the interests of better health care, are my suggestions for questions to ask your doctor when you feel like you’re getting the ‘silly woman’ treatment:

I have been worried about this and I would really feel a lot better if I could have an x-ray (ultrasound, bone scan, blood test etc).

I know you don’t recommend having any kind of testing for this but I’d like one anyway.

May I please have a referral for an ultrasound? And if your doctor replies that they do not think you need one: I appreciate that but I would like one anyway.

What should I do if I still have the same symptoms in a couple of days? (Next week? Next month?)

What else might be causing this? 

None of these questions are rude or discourteous in any way. You’re just asking for what you want. Of course asking for what you want can feel like hard work in an environment where you know you might be dismissed as over reacting, simply because of your gender.

Which is precisely why I think we should all get a lot better at doing it.

 

 

Why I don’t care about Cate Blanchett’s cosmetic surgery

 

It seems that it’s now impossible for me to go blog surfing without finding a rant about the pressure we’re also supposed to suffer as a consequence of fashion models and famous people looking fabulous. As a 55 year old woman I’m apparently also supposed to be angry about the lack of media representation for women of ‘a certain age’ and the pressure exerted upon me to stay looking younger. Pardon me while I scoff.

Most recently, a friend turning 50 was infuriated by the suggestion that Cate Blanchett may have had cosmetic surgery and botox injections. She was angry that women in the media and entertainment industries weren’t content to age naturally. She saw the actror’s refusal to confirm or deny as ‘an act of betrayal’. Really? I see it as none of my business.

I was also fortunate enough to see and Australian screening of ‘Miss Representation’, a wonderful movie about the distorted ways women are depicted in television, magazines and movies. It’s an inspirational film about how we need to fight back against unrealistic expectations of beauty and how we might overcome the bias against women in the media. The movie made some astute observations about the way female politicians are denigrated and the pressures young people feel. None of it was news to me. This subject has been covered before and while I’d recommend the movie, I still take issue with some of the content. It assumes my self-image will be affected by the media portrayal of women. I just don’t think this is always true.

I’ve never felt intimidated by those that rely upon their appearance to make a living. I’ve always assumed that the life of a high fashion model is a rigorous routine of exercise, dieting, avoiding any form of injury or blemish and constant anxiety over the limited time they’re likely to have a career. I know they suffer disproportionately from anorexia and bulimia.

Think you’ve got a body image problem? Imagine working in an industry where you’ll be ‘styled’ beyond a point where your Mum would recognise you and then ‘enhanced’ using photoshop. Extend your empathy to understanding what it must feel like for these women to constantly have their appearance auditioned and rejected.

The career of a fashion model is notoriously insecure and their working life is short. They might be lucky enough to have a fashionable ‘look’ for a season, only to find that they don’t have the same appeal the following year; the industry has moved on to another ‘look’. They can also expect to be hated by other women and dismissed as a mindless bimbo. Do I envy them? Not one bit.

Have I ever looked at a fashion model and wanted to look that way? Honestly? Never! I’ve always known that they were a tiny percentage of the population, a kind of genetic freak, and that old saying about walking a mile in someone’s shoes, even their ridiculously expensive and crippling designer shoes, holds true. Before I consider envying anyone I always try to imagine what it would be like to have the whole of their life, not just the bit that appeals to me.

How about the glamorous life of an actor? Financial insecurity is also a looming cloud and while a select few do manage to earn huge sums of money, most do not. This is an industry where fame certainly appears to require some talent (although not always) but where clever marketing, public popularity and box office bankability will also impact upon your success. If you’re a television or stage actor the same pressures apply.

If you’re a woman in this industry then your appearance is a significant concern. Venture out to the local shops without makeup, gain a few pounds over Christmas or forget to get that regrowth re-dyed and you can expect to find it reported. I don’t want that life. While you’re involved in a production you can expect to have restrictions placed on your weight range and your ability to make decisions about your own body. Did you know that actors are often legally prevented from restyling their hair!

As an actor you can expect the possibility of a longer working life, if you’re lucky enough to work, provided you continue to attract fans. Popularity is everything and the public are a fickle lot. Arguments about making movies with older women ignore the simple economic imperative that drives this industry. We’ll see more movies with older women when we watch that type of movie in droves. The excitement over the Marigold Hotel franchise was amusing to me. Older actors can actually draw a huge audience, even with their crows feet showing! Why did this surprise anyone? The baby boomers are still a huge audience and we are all at retirement age, or close to it.

If you’re an actor a big part of your job will be the tedium of memorising someone else’s words and the dubious art of pretending to be someone that you’re not. Because you are considered a ‘public figure’ people will be able to take your photo or film you whenever you step out your front door and they’ll be able to express their personal opinions about you in the media, no matter how offensive. If they lie about you there’s legal recourse, but it’s going to be expensive and you might lose fans in the process.

I don’t envy actors. And not envying them means I don’t particularly care what they do to maintain their appearance. I’m very glad that I’ve never worked in an industry where I had to be that obsessive about my face and body.

You can understand why I don’t think that the way these women look has anything to do with my body image or self esteem. I don’t want their lives. I have another issue with the claim that we’re all supposed to suffer under the pressure imposed by the way women are portrayed in the media; Our participation is optional. We are not required to watch TV or movies or to buy magazines. We don’t need to wear makeup every day, adhere to current fashions or spend a fortune on skin care. It’s all a choice. I’d certainly defend the right of any woman to make that choice but please don’t then complain about how you feel intimidated by all the beautiful people. You don’t need to watch any of it.

Cate Blanchett’s choices, and the speculation around them, are just gossip and really none of our business. If it pleases you to have cosmetic enhancement then go right ahead. If you’re feeling the pressure because someone famous has had it done then your money might be better spend talking to someone about why that person’s choices are having so much impact upon how you live your life.

 

My free Kindle promotion is now live.

If you’ve been waiting until my book was available on Kindle for free, now is your chance!

Please leave a review once you’ve read it. Thanks so much.

It will be free for the next three days to celebrate the anniversary of the mammogram that found my triple negative breast cancer four years ago. Four years! Giving the book away to anyone that needed it seemed like an appropriate way to acknowledge all of the love and support I have had, both during treatment and since it ended.

The early feedback on the book is great and I’ve already had a psychologist tell me that she plans on recommending it to her patients (even the ones that haven’t had cancer!). My goal now is the get this information into the hands of as many people as I can. If you can help by sharing this post, putting the link on Facebook or in any other way that would be fantastic!

My deep gratitude in advance.

Meg

Free From Fear: Living well after cancer

GREAT DEAL on my book, now also in paperback!

GREAT NEWS! To celebrate four years since my initial diagnosis I’ve asked Amazon to make the electronic version of my book available for FREE on the 19th, 20th and 21st of June 2017. If you didn’t want to pay for it, couldn’t afford it or know someone that would like it for free, please put this date in your diary and make sure you have Kindle on your device so you can download it and read it.

If you don’t already have it, you can get the Kindle reader software from Amazon for free and load it onto your laptop, smart phone or tablet.

In response to all the requests I’ve received, I’ve also now made the book available in paperback! Thanks for the challenge everyone. It turns out there’s a fair bit of technology to negotiate but I’m pretty happy with the result. I must admit I’m a book lover myself. There’s just something about holding it in your hands and turning the pages. I like to use little sticky notes to mark the bits that strike a chord and to flick back and forth from section to section. An ebook just isn’t the same.

As part of the celebration for my four years of living, I’ve also reduced the cost of the paperback to just $10 US for the whole of June 2017.

At these prices I’m not making any profit. As you know, that was never my goal. I want to get the book out to those that need it.

To those that asked if it’s going to be available in book stores, sadly, no. Independent publishing means they only print copies as they are ordered, which keeps the costs down. It would need to be picked up by a major publisher to be produced in the kinds of numbers that would get it out into bookshops, so it’s Amazon or nothing.

If you’re concerned about the safety of electronic transactions online I highly recommend Paypal. I used to be the head of fraud for the NSW Police so when I say this is your safest option you know I don’t say it lightly!

Please help me by spreading the word so that as many people as possible can be free of the fear of recurrence, and if you do get a copy and read it, please leave an honest review on the Amazon site. As we all know, the opinions of fellow survivors mean a lot to all of us.
Thanks in advance for all your support.
Love and gentle hugs
Meg