Thoughts On “How to Get Your Doctor to Take You Seriously”
I really enjoyed this post. I think it’s part of an incredibly important, ongoing conversation about gender disparity in medicine.
I’m also a little embarrassed that it has to exist. I am a physician and agree- when it comes to women’s symptoms, the medical community tends to minimize or attribute them to mental illness. I originally started to just write a response to the post, but found myself going on and on…
So, I organized it a bit…. Some of these are just thoughts, some are other ways I have been corrected into taking patients more seriously.
A few thoughts on Getting Your Doctor to Take You Seriously….
This is your advocate in the room, the witness to your interaction. You’re sick, they’re not — they’re going to help you think of questions you might not think to ask. I can tell you firsthand, that when I walk into a room with patients who have families or friends in the room, there is a clear shift in power differentials. It’s no longer patient and doctor, it’s patient’s team and doctor.
To be clear, the idea is not to intimidate or overpower, it’s to level power and someone in the room with you helps with this. You are the patient; the center of this wheel. Your needs should be the agreed upon priority. If your physician finds this intimidating, there’s an issue with your physician. Get a new one. The goal is to have fair communication.
It’s fair to say that physicians are humans too. I (we, I would think) would like open, clear communication where we are given information we can trust to act upon. We have seen tens of thousands of patients and have been manipulated more times than you can imagine. We’re pretty good at sniffing this out. Accordingly, “Appealing to [a physician’s] authority” does not level communication, it manipulates it. If your goal is optimizing your health outcomes and being taken seriously, it will not benefit you in any way to be perceived as manipulative.
You want to be viewed as a team member. You’re walking into a situation where there is, by definition, a power differential. A person in the room with you helps level this. The idea is that you (as the patient) have an advocate. With an advocate, there is another reason for increased transparency in your care plan. There’s accountability introduced on the part of the physician — and there’s also accountability on the part of the patient. If you say that you’re going to take your antibiotics until they’re gone, follow a diet, quit smoking, etc., you also have a witness to that (and so do we!).
I am amazed at how infrequently patients ask specific questions, like “What do you think the diagnosis is?”, “Why do you think that?”, “What is this test for?”, “What is the long term plan?” or “What will we do if my tests come back negative?”.
It is certainly the doctor’s job to communicate this information but patients should have some insight in to what to ask in the first place to increase communication. This is the same concept you apply to any other aspect of your life — if you can speak a little mechanic, you’ll have a better experience when bringing your car in. If you speak a little contractor, you’ll have a much better home renovation experience. Medicine is no different. When it comes to medicine, the game is specific questions and evidence behind the answers.
If you come in dropping medical terms you learned from Google, it won’t work in your favor.
Specific questions like “Why?”, “What’s the evidence for that?”, “What’s the long term plan for this?”, “What else could this be aside from the diagnoses you just mentioned and how will we exclude those?”
At the same time, document the answers. If you’re keeping a journal, put this information in there so that you can revisit it with your physician, a new physician or a second opinion.
“Dr. Smith says they think I have pneumonia. They’re going to order an X-ray and prescribe antibiotics. They want to see me again within the next week. Their advice is to go to the emergency department if X, Y or Z happens. They said I should start to feel better in about four or five days and definitely within seven or eight days. If I’m not better when I come back in a week, Dr. Smith will do blood work and maybe a CT scan.”
The working diagnosis, treatment, plan, warning signs, follow up and next steps are all there, in one paragraph.
I don’t think we need to look at unusual presentations of rare diseases to see the bias (most 19 year olds with abdominal pain don’t have pancreatic cancer and most people with pancreatic cancer aren’t 19). We can look at more common killers in the US like heart attacks and find the same biases. Or, we can look at major influencers of life quality (like chronic pain) and find the biases.
Just my opinion; but when I see illustrations of inherent biases in medicine with a focus on relatively rare conditions or unusual cases, it automatically inserts the thought that these diagnoses would have been missed in any patient. If a 19 year old male with abdominal pain shows up in my ED tomorrow, I wouldn’t be thinking “Pancreatic cancer!”.
It does a disservice to the majority of women with more common illnesses that are also receiving disparate care. Let’s focus on getting cardiovascular disease appropriately tested and treated in women (and in every other group that isn’t a white male who is also done a disservice).
As an aside, in my experience, this bias isn’t limited to male physicians. In fact, I have seen plenty of female physicians be much harder on female patients than their male counterparts.
Some diseases more prevalent in women are notoriously difficult to diagnose, with non-specific symptoms that are difficult to articulate in general — like multiple sclerosis, lupus, rheumatologic illness in general, fibromyalgia. Real conditions with real diagnostics and treatment options that manifest in a number of ways.
Some of these conditions take time to diagnose. Some of them don’t have any clear blood work or imaging findings that confirm a clinically suspected diagnoses. Some require invasive testing that isn’t always immediately indicated. Some have test results that can be positive for a number of reasons to the extent that a positive test doesn’t really give you any more information. Some have no agreed upon treatment.
In my opinion, this means that the best situation is having a functional, communicative relationship with a physician. This means follow up, keeping track of symptoms, discussions and revisiting as much as it means testing.
Physicians are tasked with balancing the odds of having conditions with appropriate testing. Diagnoses sometimes take time to make and observing the pattern of symptoms is the key to appropriate treatment. You wouldn’t want a physician who draws your blood and radiates you for every symptom you have. A physician who can communicate their thoughts, concerns, the logic for the interventions they’re making. And sometimes, no intervention is the right answer.
Thanks for reading this far — I think the topic is important and I think understanding the various perspectives can help make for better communication.
Thoughts On “How to Get Your Doctor to Take You Seriously”
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