That headline up there is a bit more provocative than this post will actually be, but I didn’t want to make the subject line several sentences long.
Short version: In my more-than-30 years of experience, many older male doctors seem to attribute those illnesses that aren’t immediately visible and obvious as non-existent if the patient is female. To a lesser extent I’ve seen this in other combinations of ages and genders as a general medical attitude as well, but it seems more pronounced with that particular combo.
Long and very rambling version with several stories from my own and others’ experience: In my senior year of high school, I had splitting headaches that lasted for weeks on end. I got sinus x-rays and a cat scan, and my doc eventually came to the conclusion that it was “muscle contraction headaches.” (As soon as my mother and I left his office we looked at each other and said, “so, he just said stress headaches, didn’t he?”) We felt this was pretty ridiculous, but he was the doctor and knew better, right? (Heh.)
He put me on heavy-duty tricyclic antidepressants, at a dosage that later we found out was far too high for my size. I went from a normal senior in high school who hadn’t been depressed or having problems and who’d been getting A’s, to a zombie getting D’s. Eventually in desperation we turned to a chiropractor, who took x-rays of all his patients, and he noted what looked like teeth up where I shouldn’t have teeth. He sent me to a dentist—who tried to schedule an appointment with a TMJ specialist (until my mother, who at the time almost NEVER swore and tended to be very mild-mannered, actually swore at them and told them to make the appointment to take x-rays). Anyway, I turned out to have two wisdom teeth impacted against my sinuses. Took them out and my headaches went away.
Two interesting side-notes to all this: One, my step-mother, who worked at the local hospital in radiology, later had my sinus x-rays pulled and asked a radiologist to look at them. He commented that my sinuses were fine, but I really needed to get those wisdom teeth out! (I.e., my doc should have noticed them.) Two, even after the removal of the teeth and end of the headaches my doc refused to admit he was wrong. He wrote in “migraine headaches” on my college health forms.
At the time I tended to think this was an isolated experience with one lousy doctor. After all, he did get banned from the local hospital some time later due to frequent mis-diagnoses. However, this pattern has repeated itself many times, and while I’ve had several wonderful female practitioners who haven’t treated me this way, I’ve only had one male (out of several) who didn’t treat me this way.
It doesn’t help that I’ve inherited from my mother a tendency to have odd problems with symptoms that don’t necessarily fit precisely within expected paradigms, or that don’t test easily. I have weird reactions to medications and the like that doctors just can’t always make sense out of. Of course, so do many people I know.
A friend of mine was having inexplicable and incredibly uncomfortable stomach pain. Her doctor was busy, so she went to a different doctor in his clinic. That doctor was an older man, and he gave her a lecture about how she should deal with pain better, and at his age everything hurt, and she should be on anti-depressants (which she already was, and she was doing fine on them, thanks very much). She was so angry after that experience that she made a scene in the waiting room (I would have too at that point), and her doctor came out and quickly made time for her. As it turned out, she had a very simple issue with a stomach valve not opening properly that could be easily solved with the right medication.
In the case of a relative, after 10-15 years of her feeling cruddy and low-energy, they finally figured out that she has sleep apnea; once on a CPAP machine she felt worlds better.
Anyway. Because I’ve been exposed to this so much, I find I tend to constantly question myself when I feel that something’s wrong. I also tend to worry that my doctor’s going to think I’m a hypochondriac if I tell them about my symptoms, so I’m sometimes reluctant to tell them things—which doesn’t help them make a good diagnosis, so it’s not a good attitude for doctors to instill in their patients.
Take my current digestive-maybe-gallbladder issues. It’s pretty obvious to me that this isn’t normal. I’m nauseous after eating anything fatty. However, nausea and indigestion have been much bigger problems for me than the more normal abdominal pain that most people get with this; that’s been mild (although present). The first ultrasound was negative, and I’m assuming the pancreas-related blood tests last week were as well since I haven’t heard from my doc yet.
So, once again I found myself turning to my husband and saying, “do you think I could be imagining this?” And, since I know he’s capable of taking a pretty unbiased-yet-aware look at how I’m doing, it’s very reassuring to have him say, “no way. There’s definitely something wrong.” And yet, as I wait for yesterday’s scan results and wonder if they’ll show anything, I still find myself asking that question again.
I went in for the scan yesterday after the required four hours of no food or drink (it’ll be clear in a minute why this story is relevant). I went back to the exam room and the technician spent some time trying to find an adequate vein for the IV port. I ended up with tourniquets on both front arms while she smacked the backs of my hands (quite hard) trying to get the veins to sit up and pay attention. Eventually she picked one and inserted the port. It hurt like hell and, oh joy, I had a vaso-vagal reaction and nearly passed out. Then she administered the radioactive tracer and I spent an hour lying motionless on a hard surface under a big scanner, watching little white dots accumulate on a dark screen and trying not to move as my tailbone and lower back became more and more painful. Next came a saline IV and another half hour of motionless scanning.
Finally I was out of there, just in time for dinner. I was starving (for some reason my metabolism is such that I can’t eat much at once and need to eat often, and I hadn’t had anything to eat or drink since a late breakfast). I was craving steak for some reason, and my husband graciously offered that after a long and/or annoying medical procedure one should get to eat wherever one wanted, so we went to Outback. I knew it was a bad idea; fatty foods have been making me sick. I have no excuse for those appetizers. I was dumb; I was stubborn; a part of me still wondered if I was imagining it; I was overly hungry. (But I have to admit, that crab dip is awesome!)
Thus it was that around midnight I woke up feeling incredibly nauseous. I got up and played video games for a couple of hours until it abated. My husband woke up when I went back to bed, and I explained why I was up. He said, “well, at least you know you aren’t imagining things now.”
He knows me so well.
To be fair to the docs, I grew up with an older male who had similar attitudes—anything he didn’t like or didn’t understand just didn’t exist, must be a product of one’s imagination, etc. This probably makes it much harder for me to have confidence in my own observations and get past my worries that they won’t take me seriously. But I do wonder how much of the attitude I’ve noticed hearkens back to when women were diagnosed with things like “hysteria” and “nervous breakdowns.” How many doctors out there still have attitudes tinged by those days?
Well, it’s definitely worth it to me to spend the time it takes hunting down one who listens to their patients and takes their concerns seriously, no matter the age or gender (of either the doctor or the patient).