If you are ill, and identify as female, advocating for yourself within a healthcare setting, can be an uphill battle.
A bloody nightmare, if I’m being brutally honest.
As in all areas of our culture, sexism is still very much alive and kicking, but in Medicine, it really can mean the difference between life and death.
If you are a cis gendered, white, heterosexual male, chances are that you have absolutely no idea what I’m talking about. So let’s do a super-quick experiment.
Do this as quickly and instinctively as possible.
You are waiting to board a plane (Golly, remember air travel?….)
You see the cabin crew walking towards you, maybe 4 or 5 people, all in airline uniform.
2 of them look to be ‘more important’, the ‘leaders’ of the gang, each wearing a peaked cap and carrying a briefcase.
1 is male.
1 is female.
Which is the Captain?
(OH GOD! For this post, I just searched for male and female pilot images….guess what… the male images were all of official looking men and the female ones….?
The first 6 images were all ‘sexy’, all bare legs and smiling provocatively..
Jilly buries her head in her hands)
Apply this to a hospital setting.
You are waiting to see a consultant and have been told that the consultant, and their assistant, are on their way.
They arrive at your bed, both wearing scrubs.
1 is male.
1 is female.
Who do you automatically assume is the ‘boss’?
I imagine, I hope, that the younger you are, the less likely you are to assume it’s the man.
Dear God, I hope that this is true…
Point made yes? Institutional and systemic sexism are still very prevalent within our society, although hopefully, things are changing.
Just as my parents’ generation will usually assume the ‘boss’ is the man, personally, I will ‘catch myself’ if I am making a similar assumption, and make a conscious decision to not.
And, I do see evidence that the generations coming up (my partner’s teens) couldn’t give 2 hoots whether it’s the man or the woman, as long as they can fly the bloody plane!
However, for a myriad of reasons, attitudes within the medical profession still seem to be underpinned by the self-same biases.
Medical sexism is still very much alive.
“..the Greek philosopher Aristotle characterised a female as a mutilated male, and this belief has persisted in western medical culture” writes Gabrielle Jackson in the Guardian https://www.theguardian.com/lifeandstyle/2019/nov/13/the-female-problem-male-bias-in-medical-trials
Jackson goes on to write, that research conducted by Dr Kate Young at Monash University, Australia, showed that for example;
“endometriosis patients are often viewed as “reproductive bodies with hysterical tendencies”.
And in another predominantly female condition one male GP said to Young,
“I’ve never met a fibromyalgia patient who wasn’t batshit crazy”.
Medicine has long been a male-only stomping ground:
It was only 148 years ago that a book was published by a Dr E. H. Clarke (Edward) called, ‘Sex in Education’ in 1873, where he warned that
‘higher education in women produces monstrous brains and puny bodies,
abnormally active cerebration and abnormally weak digestion,
flowing thought and constipated bowels’.
In the 19th century,
the only way that a woman could qualify and practise medicine,
was to jump through a variety of loopholes:
The first woman officially registered by the General Medical Council (UK based) was Dr Elizabeth Blackwell in 1858, who had studied at an American medical school and was therefore permitted to register through a clause which allowed women with foreign medical degrees to practise as medical doctors in the UK.8
Upon realizing that a woman (Elizabeth Garrett Anderson) had been awarded a medical qualification for her studies in midwifery in 1865, the Society of Apothecaries (later the British Medical Association) banned future female entrants.3
In Edinburgh, there were similar restrictions, for example Sophia Jex Blake was allowed to attend medical lectures but faced strong opposition and harassment from male students.
Despite sitting the same examinations, she was awarded a Certificate of Proficiency rather than the medical degree awarded to her male counterparts.3
Frustrated, she left Edinburgh and continued her studies in Berne, where she was finally awarded a medical degree, and in Dublin, allowing her to register with the GMC.
8 Witz A. Professions and Patriarchy. London: Routledge, 1992.
3 Bourdillon H. Women as Healers; A History of Women and Medicine. Cambridge: Cambridge University Press, 1988.
The full paper can be viewed here https://academic.oup.com/bmb/article/114/1/5/246075
In addition to the historical attitudes, or is it maybe due to the past, conditions that commonly affect a much greater number of females than males, are woefully misunderstood and often waived (far) away and (well) under the carpet with a ‘tch tch’ noise,
as the doctor writes a prescription for anti-depressants.
Think migraine, depression, menopause, endometriosis.
“You’re suffering from stress”, “These will make everything better”.
I’ve heard from many women who are so angry and frustrated at not being heard/being taken seriously, that they become upset in the consulting room,
only leading to the doctor to smile patronisingly at them, as the patient seems to prove them right; she’s crying, she must be depressed.
WE ARE FRUSTRATED NOT CLINICALLY DEPRESSED!
If you have a look at my Blasto blogs, I had a very challenging time with severe gastrointestinal issues for many months. Towards the end of my journey with the NHS, I had an appointment with ‘specialist in diarrhoeal diseases”. A private GI consultant. As all my tests came back ‘negative’, the course of treatment that he decided on was to gave me a ‘script for amitriptyline.
A drug commonly used to treat severe pain, depression and sleeplessness.
Me, “And how is this going to help me please?”
Him, “Well, it will help you to sleep” he said, adding “and you do look a bit down”.
SO WOULD YOU BE IF YOU’LD HAD THE SHITS FOR 9 MONTHS AND,
call me old-fashioned but, I’d rather not sleep through as my bowels empty.
If it’s all the same with you.
Pure dead ragin’ I was!
(You can read more about the ‘Diarrheal Disaster Years, in my Blasto Blogs)
Bearing all of the above in mind, here is my Top Tip for when you are feeling unheard in the consulting room.
Would I be treated any differently if I were a male patient?
Can I imagine the medical professional suggesting the same treatment or lifestyle changes to my husband, brother, uncle, dad?
(OK, if you’re asking about the menopause,
then this might no’ work so well,
but you get my drift yes?!)
If the answer is, possibly not, or you’re just not sure – dig down deep in to your boots and ask them!
Just come right out with it
“if I were a man, would you be suggesting the same treatment please?”
I know, I know, it is REALLY hard to do. SO very hard to think on your feet, in the moment,
AND to have the courage to ‘question authority’, but it is your body!
You only have one! And you probably know your body better than they do – you’re living in it!
However, if the very idea of the above, has your stomach doing flip-flops, it’s ok. Don’t beat yourself up!
You may not even think about it until after the appointment!
If so, give yourself a few days to mull it over, then think about a new plan of action eg. asking to see a different doctor, maybe a new surgery, doing more research to take back to your next appointment.
! Points To Note !
- Cultural sexism and bias have been around for a v-e-e-e-r-y long time
- The medical profession has been run by men for a v-e-e-e-r-y long time
- Females, both human and animal, are not generally used in clinical trials
- Which means that there are often no female-specific protocols for treatment anyways!
- So don’t always blame the doc.
- Research, and advances in medical knowledge, are continually changing and developing
In my next post, I shall look more specifically at gender bias within clinical trials and how that affects available treatments and protocols.
How we can use the internet to our advantage and to safely research our condition, which, if done correctly can actually help our healthcare providers.
So stay tuned!
My digestive health condition, circa 2014-2016, a parasitic ‘infection’, blastocystis hominus, was/is not recognised by the medical profession as a ‘condition’ that requires treatment.
My new heart condition (diagnosed March 2021) is rare and, was unknown within the medical profession until about 5 years ago.
Most paramedics and non-heart doctors have never heard of it…. until I show up!
Both have required me to advocate for myself to a great extent.
My aim is to share the knowledge learned over the last few years on how best to advocate for yourself within a healthcare setting.