Why I Insist on Demanding More from the Medical Community
And my opinion is not less valid because I’m a woman or because I don’t have a degree in medicine.
It is very hard for me to talk about my health. It’s hard to talk about it with friends, with family members, in my writing, or even with doctors. It feels very vulnerable and scary because everyone seems to have an opinion about it. Further, I very rarely feel seen or heard.
It was scary for me to write about my experiences with doctors and my issues around the ageism and sexism that is all too common at the doctor’s office. And sure enough, it brought out some strong opinions, one in particular that not only entirely misconstrued what I said, but again reinforced my feeling of not being seen or heard.
At the risk of being misunderstood yet again, and in spite of the vulnerability I feel around this subject, I’m going to take another stab at this.
The reality of aging
I understand that with age comes certain health issues and increased risks for certain diseases. I understand the importance of risk assessment and increased testing and scans.
My objection is the way the medical community handles this. I do not think it is healthy to speak about aging and declining health in a catastrophic way. For instance, I can’t count how many times a doctor has said to me that ____ (insert disease here) was “inevitable.” That’s utterly absurd (no doctor, I don’t care how advanced their degree, can predict my future) and dangerous.
It is well-documented that stress, anxiety, and emotional upheaval have wide-reaching effects on our health — from our mental functioning, to cardiovascular health, to inflammation. Further, studies on the mind-body connection are proving that our mindset is deeply connected to our physical health. Dr. Laura Kubzansky, professor of social and behavioral sciences at Harvard T.H. Chan School of Public Health says, “Your outlook — having a sense of optimism and purpose — seems to be predictive of health outcomes.”
Studies have even shown a correlation between health and our outlook on aging. The Ohio Longitudinal Study of Aging and Retirement “found that older individuals with more positive self-perceptions of aging…lived 7.5 years longer than those with less positive self-perceptions of aging.”
So how is it helpful to aggressively insist to patients that disease is inevitable? Why can’t we talk about health with a less alarmist, more pragmatic perspective that doesn’t increase a patient’s stress or cause them to develop a negative outlook on aging? That, to me, is not promoting health.
The importance of accurate statements
In addition to focusing on pragmatic information about risk-assessment, I think it’s so important that doctors not misuse statistical data. Two years ago, during a visit with the #2 breast cancer specialist in my state, she said, “Two out of three women will get breast cancer in their lifetime. That means that at some point, either you or I are going to have it. That’s just the reality of the situation. So we have to be practical about that.”
I was steaming when she said that. That’s not how statistics work. Those are abstract numbers. You can’t put three women in a room and know for a fact that two of those particular women will get breast cancer.
I know that she knew I was afraid of all the scans she was suggesting and that her statement was meant to reassure me that with early detection, I would probably be fine. But I still think that making inaccurate statements and misusing statistical data does a grave disservice to patients, especially when they are emotionally vulnerable.
I would have found much more comfort to have heard her say, “This is a very common disease and we can treat it with early detection.” And then, perhaps she could have chosen to rattle off a different set of statistics: the survival rates of women whose cancer was detected early (numbers which are comfortingly high).
Why wouldn’t a doctor choose to motivate me with empowering data that would spur me into action rather than scaring me in a way that made me want to avoid further medical intervention?
Where was the intervention when I truly needed it?
Another point of contention I have is that when I was in genuine medical crises — including all-consuming eating disorders that had my weight dangerously yo-yoing for over a decade and struggling with suicidal depression — doctors expressed little to no concern. Many, at the height of my bingeing patterns, would scold me for being obese (according to BMI charts — which have been long-criticized for their inaccuracy), and simply told me to lose weight, ignoring the fact that I was deeply entangled in disordered eating and clearly needed intervention.
When I was struggling with depression — especially the few times I was experiencing suicidal tendencies — I was only given a prescription for antidepressants. No recommendations of potential therapists I could see. No guidelines on how to use the medication (except not to stop using it cold turkey). No suggestions for how to deal with the side effects that had, in the past, been so hard for me to manage.
Today, in the best health I’ve ever experienced as an adult, I absolutely want discussions about my risk factors and pragmatic suggestions for disease screening and prevention. But I do not need to be treated as if I already have a disease.
The fact that this attention was not given to me during genuine health crises is astounding to me.
Sexism & ageism is real
I was surprised that few addressed my biggest complaint about the medical industry: that sexism and ageism are real. I cited research and shared my own experiences as a female (and someone over 40) and still, it would seem that the whole point of the article — ageism and sexism in the medical community — went largely unnoticed.
Of course, some part of me (my inner cynic, I suppose) assumes that this is because I’m a woman. Of course people won’t acknowledge sexism when a woman is calling it out. That is the way it tends to work, just like people ignore, for instance, a Black person calling out racism.
Speaking of racism, it’s a fact that the medical community still exhibits deep racial biases. There’s countless documentation of the less-than-optimal care African-Americans and Hispanics have received, in comparison to white patients.
There are also widely documented issues around doctors’ weight bias — especially when it comes to women. Many serious health issues are ignored because some doctors can only see the numbers on the scale.
These are issues that need to be called out and addressed within the medical community. Why is it so hard for some people to admit that?
I know my body
One of the points I tried to impart in my article — and in every instance in when I talk about my health — is that I know my body better than anyone. I know my body better than my friends and family. I know my body better than a doctor who has spent five minutes looking at the checked boxes on my chart and another five minutes asking me questions. I know my body better than a stranger on the internet who thinks they have the right to tell me that I should shut up and listen to my doctors.
Just because a doctor has an advanced degree doesn’t make them an expert on my body.
To me, good medicine happens when a doctor brings their expertise to meet the expertise the patient has about his/her/their own body. Between these two collections of knowledge, the course of health can be charted.
I don’t believe that we should cede all authority to our doctors. I don’t believe that we should ignore our own experience of our health and our bodies so someone who knows medicine — but doesn’t know us — can tell us what’s what.
I respect what a doctor brings to the table. And I fully acknowledge that they know more about the functions of the body than I do. But none of them have 43 years of experience in this body. None of them have an M.D. in Yael. Yes, I want their information (without all the catastrophizing) and if they’re good doctors, they should want my information, too.
Folks can disagree with me or call my words “pseudoscience” all they want, but the fact is, the medical community needs to do some serious internal audits as much as any other industry does and as much as we, as individuals do. Improvements around inclusivity and equality need to be made. Biases need to be addressed and corrected. I don’t care what anyone says — that’s the truth and I will not back down from that.
You can discount me as much as you like — because I’m a woman or because I don’t have a medical degree… It doesn’t matter why you think I’m wrong. If it’s data you want, there’s plenty to confirm my statements on this topic. Need numbers? Then go take a look at them before telling me how I should behave at the doctor’s office.
© Yael Wolfe 2020