Women and medicine: unconscious bias

In 2011 I had a kidney op. It went wrong. They did not believe me it had wrong at first. Was I really in pain? Hmm. Had I ever been through labour? No? Ah well.

The repair operations (yes plural) took place over a period 8 months, because yes, it had gone rather wrong.

In 2016 I was told I'd need the same op on the other kidney. Could we put a management plan in place to avoid a repeat? No, as what happened first time round was just a one-off. How did they know? They just did.

Had the op. Started to experience familiar pains. Returned to hospital. There's nothing wrong with you, here is a paracetamol now fuck off Couple of hours pass. Now throwing up with pain. Return to hospital, admitted via A&E to emergeny surgery unit.

On duty consultant: "You remind me of my sister, you know. She is also (!!) an anxious young lady. She is always making up things that are wrong with her. As a doctor and her big brother it is my job to laugh her out of her fears."

Emergency surgery next day. Five days in hospital and further ops over next 6 mos.

Because guess what? Anxiety doesn't make you throw up in pain. No, that would be the massive fucking obstruction in my PUJ area. And guess what else? I have since had 3 DC with no pain relief and turns out labour is a piece of piss compared.

I had a GP fail to take me seriously when I kept going for help with very bad internal pains. He kept insisting I'd pulled a muscle and it turned out I had a blocked bile duct and could have died. I ended up with very bad jaundice and an emergency operation.

To make matters worse, when I made a formal complaint, part of his defence was that I wasn't a reliable person because I'd been the victim of a sex assault a few years previously (for which someone was convicted in a court). How that particular misfortune made me unsuitable to be believed about suffering pain I don't understand.

I think he had both unconscious bias and screamingly, outrageously conscious bias and was also a wanker of the first order. It's an interesting subject.

Doctors in training are brought into a culture that falsely believes women exaggerate and men try to put on a brave face - add a racial and class based lens on that and it gets much worse.

I've also found that this really chimes with my own experience - my DH is a complete hypochondriac, and I've been astonished at how many unnecessary tests and scans he's been sent for by GPs 'because men don't come to the doctor unless there's something really wrong'. I also suspect it helps that he's white and posh (as am I - and being articulate and 'their sort of people' has definitely got me better treatment from doctors, too, particularly surrounding my mental health) - his ridiculous delusions that he's ill (I love him really!) get automatically taken seriously.

The patriarchal attitude in medicine is definitely taught. Take a browse through a medical textbook - you get chapter and verse on the symptoms of a heart attack, and then a little footnote that this may be different for women. Doctors in training are brought into a culture that falsely believes women exaggerate and men try to put on a brave face - add a racial and class based lens on that and it gets much worse.

I also suspect this is exacerbated by the NHS being on its knees financially. Not just from a cost perspective but also because of the narrative that surrounds it now. We're supposed to be so grateful that we're getting free treatment that we shouldn't complain about bad treatment or bother the doctors too much and anyone that tries to push for treatment is a difficult woman (as opposed to a determined man).

I also believe it's a 'we know better than you' attitude to many women who dare complain about what is going wrong with their bodies.

It's a case of not listening to women.

It took me 14 years to get a diagnosis for one of my conditions. It destroyed my childhood.

I would second watching 'Unrest' or 'Voices from the shadows' which is on vimeo

So who is this down to, is it the doctors or their training? Do female GPs not outnumber men as GPs now?
I find it hard to understand why they would ignore women but listen to men more.

Because women also absorb the lessons of a patriarchal society?

So who is this down to, is it the doctors or their training? Do female GPs not outnumber men as GPs now?
I find it hard to understand why they would ignore women but listen to men more.

I think this belief that things are 'normal' is really important to talk about.

Most women I know with a similar diagnosis to mine will talk about having 'known there was something not quite right for them' but also believing or being told that it was 'normal' due to their age, life circumstances etc.

I do also wonder how much of the 'don't make a fuss, this is what women have to put up with' becomes internalised. It was definitely something I remember vividly being told as a girl.

Thank you for the flowers Ekphrasis and R0wantrees - it was a long time ago now but made me very aware how easily dismissed any gynaecological symptoms are.

I put up with a lot of stuff post-birth too because I thought it was ‘normal’ and this is another area where women are patronised. One of my main worries in childbirth was not having my pain taken seriously - I wasn’t a screamer, just went into myself and very quiet. To an onlooker I probably looked calm and in control!

boldlygoingsomewhere I'm so very sorry to hear about your Mum.

I was diagnosed with gyny cancer a number of years ago and so am painfully aware of how many women and their families experience this.

This is a very common issue in the diagnosis of gynaecological cancers.

As well as there being a very low level of awareness of common symptoms, many women will have been to their GPs a number of times.

for example:
Target Ovarian Cancer:
"The UK has amongst the lowest survival rates in Europe for ovarian cancer, with a five year survival rate of just 46 per cent. If diagnosed at the earliest stages, up to 90 per cent of women would survive five years or more. Sadly, nearly two thirds of women in England are diagnosed with ovarian cancer once it has already spread. The role of GPs in diagnosing ovarian cancer early is crucial, but diagnosis is not always easy.

Evidence now shows that most women are symptomatic, regardless of the stage at which they are diagnosed"
www.targetovariancancer.org.uk/health-professionals/information-gps

I agree that experiences like miscarriage and period pain vary from woman to woman (and from time to time - I've had three miscarriages, all between 6 and 8 weeks, and two were like my normal period pain but a bit worse, one was really very painful and felt quite different), but I don't think that explains why the possibility of these things being very painful are dismissed. My sciatica is unpleasant but I can live and work through it fine, but lots of people can't, but I still don't see it being described as 'discomfort'. I do think there's something gendered about the way that any pain that could be considered reproductive or gynaecological is played down.

I suppose that is like how some women do not find periods painful, how I long to be back in that group

MargaretCavendish such a good point about "discomfort" - the sweep they gave me (without consent I might add!!!!!) was said to give me "a bit of discomfort" - bloody heck those contractions after that sweep were worse than when I was in actual active labour.

Mum has arthritis but took a few years to get diagnosed as she was deemed too young
My cousin has gone through early menopause at 22 but was dismissed for first few years and put down to just her period playing up due to her age
My sister has a strange knee condition (cannot remember for life of me what its called) but was dismissed as being a dramatic teenager for over a year
I'm currently undergoing medical investigations for pelvic pain etc and so far I feel as though I am being dismissed as "it cant be that painful, you managed to get here today" and "are you sure you aren't pushing for diagnosis because you struggling to conceive quickly"

This is really interesting. I find that female pain is very much dismissed. I can't speak to childbirth, which is I guess the ultimate example of this, but both having an IUD fitted and miscarriages were experiences where I was told to expect 'discomfort' but the doctors were then unsurprised when that turned out to mean 'considerable pain'. I don't think we'd do a procedure as painful as every woman I know has found having a coil fitted on men with no pain relief at all. I've never found this happens with pain that isn't specifically women's pain - no one refers to 'back discomfort'.

It’s so depressing reading this but very common occurrence.
My mum was dismissed time and time again and told her symptoms were just the menopause. No further investigation was done until she collapsed at home one day - turned out she had cancer and she died 6 weeks later.

My EDS diagnosis took 16 years (I was 28 and first had issues in high school). Spooky!

I also had depression and anxiety for a similar amount of time before I asked for an Asd assessment - and got a diagnosis

Thanks for thenlink elendon will check it out.

For anyone interested watch Unrest on Netflix it's based around ME but covers a lot of ground with immune sytem disorders, how they are more prevalent in women and the funding for research is shit. How different women in different countries are treated - spoiler alert BADLY. It's well worth a watch even if you don't have an immune sytem disorder. It wasn't all gloomy though if you can believe it.