"The pain is definitely in here, though," I said, as I pointed to my mid-abdomen after my doctor recommended a transvaginal (internal) ultrasound to diagnose my random bouts of abdominal pain.
"We should start with your ovaries," he said.
"I am a midwife, so I do have a working knowledge of this—and I just had my yearly pelvic exam a few months ago; I can tell you it's not my ovaries."
"Let's start with your ovaries and we'll go from there."
I have been a midwife for 11 years, and I have become (happily so) the go-to person in my circles for the medical-related "hey, can I ask you a question?"s, especially when it comes to women's health.
And I cannot tell you how often I hear stories about women being gaslit by medical providers.
A woman who knew something was wrong, was dismissed for 2 years and then found out she had cervical cancer.
A woman who could not shake a bad feeling about her pregnancy, was not given the ultrasound she knew she needed, and found out several weeks later that she had, in fact, had a miscarriage.
A woman who sat in the recovery room after her Cesarean section for hours without pain medication, because she was "pushing her call bell too often" which made it seem, apparently, like she was drug-seeking.
The medical community does not listen to women—especially BIPOC. And the evidence is beyond anecdotal.
One study found that women wait longer to be seen in emergency rooms than men: 65 minutes versus 49 minutes respectively. Others have found that doctors prescribed less pain medication to women than men who underwent the same medical procedure or reported the same level of pain. Another found that women waited longer than men to be diagnosed with brain cancer. And still others report that women who complain of pain are more likely to be given anti-anxiety medication than men with the same complaints, indicating that prescribers believe the pain to be "in their heads" rather than real.
This is just scratching the surface—because for BIPOC women and LGBTQ+ people it's even worse.
For example, a study found that medical professionals believed that Black people do not experience pain as intensely as white people, and therefore recommend inaccurate treatment plans for their Black patients.
We saw an example of mistreatment when Serena Williams shared that after her birth, her medical team initially dismissed her concerns—and she was then diagnosed with a pulmonary embolism. She survived, but Black women are 3 to 4 times more likely to experience maternal morbidity and mortality; and the root is clear: Systemic racism, compounded with systemic distrust of women is killing women.
Why doesn't the medical community listen to women?
Our society is built on sexism and racism—and the medical community is not immune. These societal constructs have seeped into medical textbooks and medical jargon in profoundly impactful (albeit seemingly subtle) ways.
For example, it's evident in the language we use for women's health. It is not a coincidence that hyster is the baseword used when talking about medical procedures involving the uterus. Hystera is the Greek word for womb, and hysteria was the medical name used to describe "unhealthy emotion or excitement." It was often determined that a woman's 'hysteria' (i.e. the having of emotions and thoughts) was the result of having a womb—and the treatment for such was removal of the uterus, or a hysterectomy. While this "treatment protocol" has been abandoned, the word is very much alive and well, and illustrates the pervasiveness of gender bias in medicine.
(The history of the word hystera is fascinating—if you're interested, this is a great article to read.)
And medical providers are humans, complete with biases and preconceived notions. Ignoring and dismissing women may not be on purpose, but it is an ingrained behavior deeply rooted in who we are as a nation.
One might argue that 'women don't stand up for themselves enough' in the medical setting—but that puts the onus on the women being dismissed, rather than the ones doing the dismissing. Yes, our culture teaches women not to be "pushy" or "demanding;" it teaches that other people's comfort is more important than their own. So it is likely that women don't feel as comfortable standing their ground as men might—but blaming women for this and the subsequent health ramifications is neither fair nor a way to fix the problem.
What will fix the problem?
Spoiler alert: It's more than teaching women how to advocate for themselves at doctor's appointments. Because again, that implies that women are the problem.
We don't need to teach women how to talk. We need to teach medical providers how to listen.
We need to trust that women are the experts of their bodies and can make decisions accordingly.
We need to put more stock in "gut feelings"—the times our patients tell us something is wrong, even if they can't pinpoint exactly what it is. This is supported by science. Researchers are devoting more time to studying intuition or gut feelings, and it turns out that intuition plays a significant role in problem-solving for human brains. "I just have a bad feeling" might be enough justification to schedule a test.
Yes, testing is expensive and potentially risky. But rather than withholding diagnostic options from patients like all-knowing gatekeepers, we need to bring patients into the conversation. "It sounds like you are really worried about XYZ. There is a test we can do for that. Here's how much it costs, what is involved, the risks and potential benefits. Would you like to proceed?" That is 100% more validating than "I'm sure it's nothing." She is not sure that 'it's nothing'—and she is what matters here.
That women are not trusted to manage their bodies is, quite frankly, embarrassing—and deadly. 'Do no harm' includes not ignoring people. Do better.