Sexism/ableism in medicine

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Sexism/ableism in medicine

Postby ischemgeek » Wed Dec 19, 2012 1:12 pm

On Greta Christina's blog in one of her posts, a user and I started a conversation in the comments about sexism/ableism in medicine. I didn't feel it appropriate to continue the conversation there since it would have been insensitive to Greta, but the conversation was interesting, so I'm starting a thread here to continue it. Here's the posts that started it, for context:

ischemgeek wrote:
I have a chronic illness, and, hm. I don’t feel like a fraud, but I feel like other people will feel like I’m a fraud if I don’t present ‘right’. And I’m usually right about that – there’s a balancing act between caring enough about my health to keep myself healthy and not seeming to care too much about my health lest people consider my high-strung. That I’m a young woman definitely does not help here: my chronic illness is moderately severe asthma, and there are more than a few doctors out there who genuinely believe that shortness of breath in a young woman is an anxiety attack until proven otherwise – and good luck disproving an anxiety attack to a doctor who refuses to review your medical record or run any spirometry. I’ve gone to the ER with severe flares, with my oxygen saturation so low I was turning blue, and had a sexist doctor sit me unsupervised and alone in a quiet, dark room so I could ‘calm down,’ despite the fact that the paramedics had measured my O2 at 82%. Normal, btw, is >97%. That was a life-threatening attack, and it’s sheer luck I didn’t worsen, pass out, and die right there in the ER. Why did he assume anxiety? Because shock and awe, not being able to breathe is scary, so I was crying.

So I have to work at maintaining my health whilst not seeming like I’m working at maintaining my health. And I have to care about how I’m breathing while pretending to not care about how I’m breathing. Which is pretty much impossible in a really severe flare. But I have to wait until I’m in a severe flare before I go in, lest the ER staff ask me why I’m wasting their time. In so many words. Because we can’t trust the asthma patient who’s been living with this for twenty-five years that she’s going into a severe flare, nooooo. *eyeroll*

And then when I do get sick but not bad enough to go to the hospital (which thankfully hasn’t happened in over two years), there’s a balancing act of when I go to work and when I stay home. I general, because I get sick more often than most people, I have to stay at work when sicker than most because if I don’t show I’m sick, I’ll start getting snide remarks like, “are you sure you’re sick?”

And so on… I’ve called it chronic illness performance art in the past because if I don’t jump through hoops like a circus animal, people will think I’m faking and/or having an anxiety attack despite no history of anxiety. Because young, healthy-looking twentysomething women aren’t physically sick unless they’re coughing up a lung in front of you.

See also: pretty much everyone with a chronic illness I’ve met hates the sentence, “but you don’t look sick!” Oh, I’m sorry. I’ll be sure to avoid sunlight and make myself sicker by shorting sleep so I look appropriately sick to you, person who does not have my lungs but seems to feel qualified to make decisions about my health or lack thereof.

So, yeah. I definitely relate. And that’s without going into my rant about other people who are not in my body trying to decide what I am or am not physically capable of (if I’m not flaring, I’m as capable as those without chronic illness at my work – but until recently, I had a coworker who’d forbid me from doing physical crap in his presence because it might flare my asthma. Benevolent ableism in the same sense as benevolent sexism. To you chronically well people out there: Let the chronically ill person decide what xie is capable of that day. Because if you presume to judge for hir, I guarantee you’ll get it wrong).


huntsdoddard wrote:Please tell me you don’t live in the UK, since i don’t want to believe what the wingers tell me about NHS. Any doctor who doesn’t immediately recognize asthma should be fired on the spot.


ischemgeek wrote:
No, I don’t live in the UK, but I’ve heard stories from there, and in the States too. The problem isn’t my medical system (I live in Canada), but rather sexism and the god complex actively encouraged in med schools. Fact is that docs can’t know everything about medicine, but they’re taught to act as if they do (and I understand why – in an emergency, being paralyzed by doubt would be a bad thing). Problem: They’re not trained to know when they need to defer to the patient who’s been living this for twenty-five years. So if you’re anything less than cookie-cutter stereotype of your disease (and I’m definitely not a stereotypical moderately severe asthmatic because my baseline lung function is really high and I’m not a wheezer at all), they’ll probably mistreat you.

Couple that with sexism about teh flighty wimminz, and it’s a recipe for experiences like mine. I’ve had similar experiences in other countries (the US and Germany), and other women with asthma from elsewhere in the world who I know also have similar experiences in their home countries. I’m pretty sure it’s not Canada-specific, I’m pretty sure it’s sexist-culture-specific.

Also, Greta, I didn’t say this before because I hadn’t had my coffee and my rant button was pushed but I’ll say it now: I’m glad you’re starting to feel better, and just take things at your own pace during your recovery. A close friend of mine was killed in a car crash two years ago next May, and I’ll still cry about her sometimes. It takes time to recover, and it’s okay to still be hurting about it. Some things never heal fully, and the death of someone close to you is one of them, I think.

huntsdoddard wrote:
but rather sexism and the god complex actively encouraged in med schools

Too many rocks stars, not enough humble physicians. It seems to be that way in a lot of professions these days, doesn’t it?

ischemgeek wrote:Erm, I'm not really comfortable continuing this conversation in Greta's comment thread - it seems like a derail, and it strikes me that it would be really insensitive of us to talk about sexism in medicine when she started a thread asking for advice and emotional support. If you want, you could come over to the A+ forums and we could talk about it in this thread I've started. I won't reply to this comment thread here anymore about this topic.
Last edited by Catherine on Wed Dec 19, 2012 3:16 pm, edited 1 time in total.
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Re: Sexism/ableism in medicine

Postby Hunt Stoddard » Wed Dec 19, 2012 2:12 pm

You're right (about posting at Greta's blog).

Sexism yes, definitely in many circumstances, though don't discount human error and the tendency every human has to immediately abandon all training and jump to whatever illogical conclusion "common sense" might dictate. If the ER sees 100 young women and 99 have anxiety, they're going to put you in that category automatically. Why? Partly it's incompetence and partly it's laziness, but the sad part is that when they don't catch you watching, just about every profession reverts to mindless and highly flawed probabilistic reasoning.

Allow me to illustrate with a little story. Unlike you, my "big deal" health problem actually IS anxiety, and I have had several very severe episode of it in the last ten years. So one day I'm pulling a fiberglass rake a little too hard and a splinter breaks away and goes straight through my index finger. I drive myself to the urgent care clinic attached to the hospital at which I've been seen for anxiety and meet with the triage nurse who, looking at my record, is immediately hostile (the diagnosis of anxiety is often met with either hostility or impatience in those who don't understand it, particularly when the subject is male--yes, more sexism). "What is it?" she demands. Savoring the moment, I show her my finger, which elicits and immediate and dramatic shift in her attitude. Suddenly it's a "real" problem (face-palm).

So, while I'm not contradicting your story (yes, there's a shitload of sexism in medicine), bad behavior--and bad treatment!-- of the type you describe isn't always caused by it. Sometimes it's just dumb human beings being dumb human beings.
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Re: Sexism/ableism in medicine

Postby SubMor » Wed Dec 19, 2012 4:53 pm

Hi Hunt Stoddard, and welcome to the A+ forums! We've got a custom here where mods deliver customary link baskets to new members, so without further ado, I'm pleased to offer you yours:
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I hope you stick around.
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Re: Sexism/ableism in medicine

Postby smhll » Wed Dec 19, 2012 5:19 pm

If the ER sees 100 young women and 99 have anxiety, they're going to put you in that category automatically. Why? Partly it's incompetence and partly it's laziness, but the sad part is that when they don't catch you watching, just about every profession reverts to mindless and highly flawed probabilistic reasoning.

Medical staff working off of real probability numbers makes sense, at the outset. However, the made up numbers in your example are problematic.

Now, my expectations about probability are shaped by my experiences and my experiences (like anyone else's) are too small a sample to reflect the whole population. My son and husband have asthma, and I've been in the ER when pollen levels are high and lots of people with asthma are receiving breathing treatments. Thus, without looking at data and just guessing, I would guess that the number of people on average in an ER being treated for asthma is higher than the number being treated for anxiety, not ninety times lower. (However, trading made-up statistics is not going to progress this argument.)
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Re: Sexism/ableism in medicine

Postby Avenel » Wed Dec 19, 2012 6:50 pm

Well, this paper says that there are 1.7 women patients with anxiety disorders for every male patient.

And, this paper says that adolescent boys are more likely than girls to have asthma, but asthma is more prevalent in adult women than adult men, 'though no numbers are given in the abstract.

This page states that 1 in 5 ER visits is anxiety related.

This page states that 1 in 4 ER visits is due to asthma.

It doesn't seem reasonable, then, to presume that anxiety is more likely than asthma, given that adult women suffer from both at a higher rate than men, and asthma accounts for more ER visits than anxiety.
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Re: Sexism/ableism in medicine

Postby Eowyn Entwife » Wed Dec 19, 2012 9:10 pm

ischemgeek wrote:
huntsdoddard wrote:
...the god complex actively encouraged in med schools

We had a strange encounter of apparently this kind today, with an added twist of if it's in the computer it must be true.

Background:
Two weeks and two days ago I had to growl at Doctor A (a youngish white man) to get Metronidazol (a strong antibiotic, which usually kills amoebas and their ilk) for second daughter. S.d. had been ill with a plethora of stomach symptoms for over four weeks at that point. Blastocystis had been identified in her stool sample as "+++", which is the highest concentration that that kind of a lab test can give as its result. S.d. had no other clinical findings at all, despite having been bloodlet for every possible standard and quite a few non-standard blood labs and repeatedly poked and probed. Doctor A was -- against current peer reviewed medical evidence -- of the opinion that "Blastocystis is unlikely to be the cause of the symptoms". He had also entered that opinion in our daughter's file as a part of his report. (I've written more specifically about Blastocystis and parasite-related racism and hygiene/climate hubris in this thread, if you're interested)

The 9 day Metronidazol course was horrid for s.d. She did throw up more seldom and her queasiness lessened, but her dizziness got so much worse that she barely could walk unaided, especially in the morning. However: when the course was over, the first morning without the meds she rose from her bed as her normal, ordinary self - not a trace of dizziness, queasiness, lack of appetite or any of the other symptoms she had had. Not a word of complaint during morning chores, nor in the car on her way to school. And she has been like that since. It feels as if a pale, tired, unhappy stranger had been living with us for six weeks and then, quite suddenly, we got our daughter back. I cannot describe with words how fantastic that is.

Happened today:
When s.d. had her post-antibiotics checkup this morning, we reported the effects of the medication and the abrupt change to the better immediately after the course to Doctor B (a white youngish woman from the same ethnic/language group as us and Doctor A). She also did a standard clinical examination (minus neurostatus, as s.d's head aches have been gone for over two weeks now) and after that declared s.d. healthy. She also heard that s.d. very clearly stated her impatience to get to school (they are training for the xmas feast poem recitation).

Despite hearing our report of the apparent effect of the medication and despite of her own observations during the examination, she then, after looking at the computer screen, declared that "Blastocystis was unlikely to have been the cause of s.d's symptoms." I am glad that I had the wherewithal to formulate my answer no worse than: "Excuse my French, but that is utter bull." She immediately declared herself "not an expert" in a startled tone and I then managed to round up with a somewhat friendlier tone and asked her to please read at the Blastocystis Research Foundation site, because they have been studying this organism and literature about it for a long time and really know their stuff. We departed on tolerably good terms, considering.


But what the actual fucking fuck?! Doctor B believes the words of a colleague (because they are in the computer system - ?) more than what the patient and her parent report, even though our report was fully supported by what the clinical examination -- which Doctor B did herself -- showed.

Excuse me while I once more go collect my jaw from the basement.


Edit: typos
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Re: Sexism/ableism in medicine

Postby Hunt Stoddard » Wed Dec 19, 2012 11:24 pm

Medical staff working off of real probability numbers makes sense, at the outset. However, the made up numbers in your example are problematic.


Oh I know. Those numbers were rhetorical, sorry for the confusion.

"at the outset" is the key phrase. In terms of Bayesian inference, "at the outset" equates to prior probabilities. That's fine so long as the decision making process involves gathering specific evidence. Sadly, as time constraints and stress go up, the priors often become the decision making criteria, and that's when the trouble starts. When there isn't even that excuse, using priors alone as decision criteria is inexcusable (though not, I have a feeling, all that rare), particularly in medicine.
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Re: Sexism/ableism in medicine

Postby Sylvia Sybil » Wed Dec 19, 2012 11:58 pm

I get shit about sexism/ableism/sizeism almost every time I see a medical practitioner. A couple of examples off the top of my head.

1) I went to my general doctor with two complaints: I'd gained 60 pounds in 6 months, and my bowels were irregular. He referred me to an endocrinologist. The endo immediately and without further inquiry declared the weight gain to be the result of diet and exercise. I told him I was absolutely positive neither of those habits had changed in the last six months, and his response was a flat, "That's impossible." No room in his head for anything else. I asked about my digestion and he handed me a flyer explaining the food groups. He was not covered by my health insurance so my mom paid for this visit out of pocket.

The next week I mentioned my frustration to my therapist and he told me the anti-depressants I'd been prescribed starting six months earlier had a side effect of severe weight gain. He got my psychiatrist to switch my meds - my digestion instantly cleared up and the weight gain ceased. How difficult would it have been for the endo to look at my medical chart and see that I was on medication with a side effect of weight gain? But when a fat woman says she's had an unusually severe amount of weight gain, it must be the result of diet and exercise and everything she says is just denial and laziness. She couldn't possibly know her own body and her own life habits. :sarcasm:

2) I went to get a pap smear (tmi details at my Tumblr). The nurse practitioner asked me lots of questions about my fitness habits and didn't believe me when I gave all the "right" answers. Her conclusion (to the question I didn't even ask her, I was there for my vagina not my waistline :evil: ) was that I needed a friend to keep me "accountable" - as if I was lying about my habits! Heavens forfend that some women are just fat, and especially protect us from women who don't fucking apologize for being fat.

3) The first doctor I saw about my self-diagnosis of autism a) "corrected" me when I said Asperger's was a form of autism, b) said it was unlikely I was autistic because it's more prevalent in men than women (it's diagnosed more frequently but the disparity has been plummeting) and finally, c) told me I couldn't be autistic because I "make good eye contact". No, I fake good eye contact, a necessary life skill for living in a society designed by allistic people.
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Re: Sexism/ableism in medicine

Postby ceepolk » Thu Dec 20, 2012 12:26 am

eye. roll.

and yeah, i'm switching a medication currently for exactly the same reasons - luckily it wasn't met with anywhere near as much resistance. my doctor asked me if i felt i was getting enough exercise, and I said, "well we can take the rest of this meeting for a jog around the reservoir if you like," and he laughed and said, "maybe we *should* do that one meeting, but for now let's switch your meds."

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Re: Sexism/ableism in medicine

Postby Sylvia Sybil » Thu Dec 20, 2012 2:31 am

ceepolk wrote:a not-sexist doctor who listens, his price is above rubies, for he is not a jackass.


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Re: Sexism/ableism in medicine

Postby ApostateltsopA » Thu Dec 20, 2012 3:21 am

I have only once encountered this, but it was obnoxious. I went in for a. Physical, to a clinic I had not yet visited and which did nothave my previous records. The nurse who measured my height did so from the side of my head, not the crown. Consequently I was measured two inches shorter than my actual height.

When I told the nurse about the error he denied it and told me how tall I was. He was at least a foot shorter than I am and could not possibly see the measuring stick thing. After he refused to reperform the height check I got to be lectured by the doctor about my obesity, despite the lack of obesity. When I told her about the error she simply stated that government regulations forced her to give me the lecture and passed me some papers whose finding of diet and excorcise being excellent treatments. For my problem.

I don't visit that clinic anymore.
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Re: Sexism/ableism in medicine

Postby Mocha » Thu Dec 20, 2012 7:20 am

I've had my fair share of what I'll call "doctors with a god complex so big that I'm surprised their heads haven't exploded from ego alone" and I've had my fair share of sexist doctors, and sometimes those two overlap.

I had a pediatrician who liked to make rather crude jokes most of the time, which was always excused as "it's just boy humor". No. It is NOT appropriate to make boob jokes as a doctor to your fucking patients.

My former endocrinologist never wanted to explain the math or science behind why we were making the changes that we were to my medication regimes, even though I could understand and follow along when he was explaining the math and science to my older brother for his tweaks. He just didn't want to "bother my pretty little head" with "frivolous details."

Every time I went in to the student health center in college, they always wanted to re-diagnose my type of diabetes because they are idiots who think that type one magically turns in to type two the second you become an adult. I obviously didn't know what I was talking about because I never went to medical school.

I had a GP who kept telling me I was fat and needed to lose weight when I had a BMI of 22.9 (not that the BMI is a good measurement) because I was a women and I needed to shed those pounds to be pretty.

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And that's what I can think of off the top of my head.

I fortunately have doctors now who are working with me and not at me. They aren't perfect (like one sometimes still assumes I'm an idiot and has a god complex going, but I keep reminding him that I'm not when I lay the most recent scientific studies and suggest treatment tweaks), they've been treating me like a person, somewhat. More so than most of my other previous medical encounters.
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Re: Sexism/ableism in medicine

Postby fiainros » Mon Dec 31, 2012 7:56 am

Sometimes, ischemgeek, I think you and I are almost the same person.

I don't like doctors. Why not? Because 9 times out of 10 they treat me like crap, and are either "god doctors" or sexist or both. I can relate so many stories like the ones above. So many.

Here's a different one: My freshman year of university I went into anaphylaxis due to an allergic reaction to something I knew I couldn't take, but was hoping it would be okay that one time. So, I knew exactly what was happening as my eyes and nose and throat all were swelling shut. At that point, my time from start of anaphylaxis to suffocation was about half an hour. Managed to get taken to the student health urgent care, managed to spit out exactly what was happening to the doctor, who asked "What's your usual treatment for this?" I told him. He ordered it. I was better within an hour. Was a refreshing experience. Was a rare experience in my 36 years.
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