Pittsburgh Post-Gazette - Women's Health
How to advocate for yourself at the doctor’s office
Alarge body of research shows that women are dismissed more frequently than men in medical settings — and that such experiences can have consequences. “In general, there is a difference between the way men and women are perceived even outside of health care,” said Prerna Mewawalla, a hematology doctor and chair of Allegheny Health Network’s women physicians employee resource group. “Men are seen as more credible automatically, unfortunately, and this credibility transfers over into the medical setting.”
Studies support this. One, published in 2022 in the Journal of the American Heart Association, found that women — especially those of color — waited longer in emergency rooms and were less likely to be admitted when complaining of chest pain. Another study of more than 20,000 participants, published in JAHA in 2018, found that women with heart conditions were more likely to report poorer patient experience and health-related perceptions than men.
Aside from the acute danger of missing a life-threatening symptom, dismissiveness in the health care setting can lead to mistrust and anxiety. When that occurs, there are ways for patients to prepare, to ease stressors and increase the chances of developing a healthy relationship with their doctors.
At the center of many suggestions from experts is the importance of patients engaging in their own health care process; tracking symptoms, asking questions, doing research.
“Be assertive and clear,” said Mewawalla, the diversity officer for AHN’s Cancer Institute. “Describe your symptoms in detail instead of [saying], ‘I’m not feeling well.’ ” This can help a provider zero in on a potential root cause.
“And don’t be afraid to ask questions,” she added.
Patients also can bring a support person along to advocate for them and help maintain a focus on the key issues. Also on that front: Write down questions and bring them with you.
Christine Ko, a dermatologist and author of the book “How to Improve DoctorPatient Connection,” used to roll her eyes at lists, thinking them time-intensive and, at times, disjointed. Now, she said, she appreciates them.
Just keep that list a reasonable length. Having double-digit concerns can overwhelm doctors, who already are stressed and busy, Ko said. Home in on three to five concerns you most want addressed, and try to ensure the doctor does so by the end of the visit.
When it comes to doing their own research, patients should consider the source — and not just click on whatever their preferred search engine offers up.
“Google is not the right place to look,” said Mewawalla. It is best to stick to trusted sources such as Cleveland Clinic, Mayo Clinic and journal articles if the language is accessible.
And if a chosen provider isn’t a good fit — for whatever reason — patients should be proactive and find one who is.
Provider selection can be especially stark for trans and gender-diverse people, a population that “faces discrimination and mistreatment from providers at higher rates than their cisgender (nontransgender) counterparts,” Charlie Borowicz, trans and gender diverse program manager at AHN, said in an email.
“[N]ot all providers are trained to provide care to trans and gender diverse people. They may decline to see these patients, citing discomfort and/or a lack of expertise,” Borowicz added. Because of that, Borowicz suggests seeking out providers who are “trans competent.” Both AHN and UPMC offer resources to help in finding those providers, as do local organizations such as SisTersPGH and PGH Equality Center.
Even if a patient has found compatible care, the relationship is an ongoing one. A way to strengthen it — and this goes for patients and providers — is to bring human connection back to the office, if it’s lacking.
“We are really busy,” said Ko, a professor of dermatology and pathology at Yale University School of Medicine. “Something kind of needs to wake us up. Smiling, greeting the doctor by their name and leaning toward them — having that initial brief connection only takes two seconds, but it pulls me out of myself and my stress.”
The onus shouldn’t all be on patients though, said Ko. Providers can take time to examine their existing biases — “Cognitive bias helps us simplify the world,” Ko noted — and try to slow down in the office.
“I have had patients come in, frustrated, with symptoms they’ve had for a year and a half,” said Mewawalla. “Sometimes, it’s just so important to listen, hear them out and let them finish what they’re saying … and to believe patient experiences. A lot of times, patients know their bodies better than anyone else.”
Ko used to feel more rushed in the clinic, and she’d get distracted by her own agenda for a patient, until extensive medical care for her son put her on the receiving end.
“I think I really thought that being a good doctor was about having good technical skills and knowledge,” said Ko. “While that’s important, you could be a doctor that knows about all the diseases in the world, but if you’re a terrible communicator, you’re still going to make mistakes.”