In the mid-1980s, when I was in my late twenties, I jumped over a tennis net to congratulate my opponent, which is what tennis players did back then. My sneaker got caught, and I went sprawling. Hip aching, right leg strangely wooden, I made an appointment with an orthopedist. The doctor asked me to walk around in my johnnie, presumably so he could observe my gait.

“You want my diagnosis?” he said. “Nice legs.”

Over the next few years, my symptoms worsened. By now, I was married, and my husband’s insurance allowed me to see one of the most respected young rheumatologists in Boston. I wanted to have a baby, I told him, but I didn’t see how I could care for an infant, hampered by the numbness and pain I was experiencing.

The doctor said he could diagnose my problem without examining me. “You are a depressed, middle-aged woman who is using this as an excuse not to have a child.”

Ashamed to use my imaginary numbness and pain to put off parenthood, I went ahead and got pregnant. My son, who weighed nearly 10 pounds at birth, didn’t walk until he was 16 months, which meant I needed to carry him everywhere. Working full-time and shouldering nearly all the childcare and housework, I tried to ignore my pain and advancing paralysis. This went on for 16 years, until my father, in the late stages of cancer, slipped and fell; when I bent to pick him up, electric shocks went zinging across my arms and down my spine. Finally convinced my symptoms were real, I made an appointment to see the head of neurosurgery at the university where I now taught.

“Hasn’t anyone ever taken an X-ray of your spine?” this doctor asked.

No, I didn’t think so.

When the X-ray came back, this doctor — an older white man, but one who took me seriously — pointed to the vertebrae in my neck, which were crumbling and impinging on my spinal nerve. “The person who belongs to this X-ray is in a wheelchair,” he said. “I have no idea how you can stand and walk.”

Looking back, I can’t understand why I didn’t tell that orthopedist I hadn’t come for an assessment of my legs, or why I didn’t protest to the rheumatologist that, at 31, I hardly qualified as middle-aged, and that I had just told him I was eager to have a child. As is true for the #MeToo movement, I now kick myself for putting up with so much sexism, for assuming my frustration and mistreatment were my own fault, for thinking if only I were tougher and more stoic, doctors wouldn’t dismiss me the way they dismissed their weaker, more hysterical female patients. Why did I so easily doubt my own experience? Why did I blame myself for my doctors’ refusals to take my ailments seriously?

Like most people, I am easily cowed by authority, especially if that authority is male, has a medical degree, and is standing fully dressed while I am seated half-naked on an examination table. Only in the past 10 years, as my career has led me to study gender bias in the sciences, and more recently, as so many courageous women have stepped forward to describe the sexual abuse, harassment, and rape they previously endured in silence, have I come to understand how deeply pervasive and traumatic the medical establishment’s mistreatment of female patients really is.

Research supports my hunch that the medical establishment pervasively ignores, disbelieves, condescends to, judges, mistreats, and sometimes kills its female patients, especially if they are black.

Even a woman as famous as Serena Williams may not be taken seriously by her doctors. The day after her daughter was delivered, Williams found herself short of breath. Prone to blood clots and knowing she had been taken off her daily anticoagulant, she alerted a nurse that she was suffering an embolism in her lungs and should be put on an IV blood thinner and administered a CT scan.

Oh, the nurse said, you’re probably just confused from all the pain medications you’ve been given. When Williams wouldn’t back down, a doctor agreed to perform an ultrasound — on her legs. Only because she persisted in demanding a CT scan did the clots in her lungs show up, at which point she was put on a heparin drip to thin her blood and restore her breathing.

Serena Williams is my idol. The outrageousness of her experience inspired me to search for evidence that she and I are not anomalies. Sure enough, the research supports my hunch that the medical establishment pervasively ignores, disbelieves, condescends to, judges, mistreats, and sometimes kills its female patients, especially if they are black. Studies conducted in Norway in the early 2000s revealed that doctors and nurses view female hospital patients as more demanding than men because they ask too many questions and “communicate too diffusively.” More recent studies show that men are treated more extensively for coronary heart disease, Parkinson’s, irritable bowel syndrome, neck pain, arthritis, and tuberculosis than women who complain of similar symptoms.

Standing up to a doctor, especially if you are suffering from a spinal cord injury and can barely stand up at all, is far from easy.

In 2018, the New York Times ran a lengthy exposé on the disturbingly high rate of maternal mortality among African-American mothers, who are three to four times as likely to die of pregnancy or childbirth than white women, even if they are well educated and middle class, and the terrible truth that black infants in the United States are more than twice as likely to die as white babies.

Despite this rising tide of evidence, I think women will need even more encouragement and support to stand up to their doctors than they might require to resist the sexism and racism in other arenas of their lives. Standing up to a doctor, especially if you are suffering from a spinal cord injury and can barely stand up at all, is far from easy. If you are continually gaslighted about what your body is telling you, you grow less and less able to trust those signals.

After the grueling surgery to replace a section of my cervical spine with a graft from a cadaver, I awoke to a completely new form of agony. “Something is really, really wrong,” I told the surgeon. To reach my vertebrae through my throat, the medical team had pinned back my shoulders. Maybe lying in that position so many hours had dislocated my joints?

The surgeon scoffed. At my follow-up visit, I thanked him for what seemed a miraculous recovery of my ability to walk and the alleviation of the numbness in my arms and legs. Except, I still felt this agonizing new pain, as if someone were jabbing a red-hot poker beneath my shoulder blades.

“You just had major surgery,” the surgeon said.

I went back to teaching full-time, keeping house, and raising my son. But the pain continued to be so severe that I could barely concentrate. Finally, I convinced the surgeon to refer me to a physical therapist, just to humor me. “Wow,” the therapist exclaimed. “Did you know you have a bunch of dislocated ribs? How long have you been walking around like this?”

Six months, I said.

“Are you kidding me?” She told me to grit my teeth, then popped each of three ribs in place.

Sadly, being proved right about one ailment doesn’t make it easier to convince the next doctor about another set of symptoms. The more a patient sticks up for herself, the more difficult she can seem. Whenever I would explain to a new doctor that I’d had several major illnesses and injuries that previous doctors didn’t believe to be real, I could see them regard me with alarm. Then again, most of the physicians I saw accurately diagnosed and treated me. How could I figure out which ones to trust?

Just after I began to heal from the surgery on my spine, I began fainting two or three times a week. A cardiologist found nothing wrong with my heart. The neurologist couldn’t pinpoint a cause for my fainting either, except that I was a “thin, high-strung female writer” who tended to get “overexcited” and respond to surprises by passing out.

“So often?” I said. “And why now? I’ve been a thin, high-strung writer all my life.”

The neurologist shrugged, and I left his office.

A few days later, having passed out a few more times, I began to suffer such debilitating cramps that I crawled to the bathroom in my boyfriend’s house, where I passed out. The propensity to believe one’s doctors is so strong that I was unwilling to attribute my condition to anything worse than food poisoning.

The neurologist couldn’t pinpoint a cause for my fainting, except that I was a “thin, high-strung female writer” who tended to get “overexcited” and respond to surprises by passing out.

My boyfriend rushed me to the hospital anyway. In the ER, my OB-GYN decided I had advanced ovarian cancer and asked permission to remove everything she could remove to give me a few months to live. Luckily, once she opened me up, she discovered not cancer but a ruptured ovarian cyst that had been causing me to bleed internally for months. I would prefer to have been spared the hours I lay thinking I was going to die from ovarian cancer. But what bothers me even more is the neurologist believing it was normal for anyone to faint two or three times a week because she was a thin, high-strung, female writer.

At least I was white and middle class. If a woman is poor or black, she is even less likely to be taken seriously.

In my mid-thirties, I entered one of Boston’s top teaching hospitals to give birth and was assigned an African-American roommate. I was two weeks overdue, and even though I insisted I had finally gone into labor on my own, my OB shot me full of Pitocin, a drug that induces childbirth. All day, I kept trying to convince the staff I was experiencing nonstop contractions, without a moment’s rest in between. But the monitor I was hooked up to wasn’t registering any contractions, so they kept administering more Pitocin. By evening, I would have welcomed dying. But the doctor told my husband to take me home and bring me back the next day to try again.

No, I said. I’m not leaving. And if they didn’t do something to make me feel better soon, I was going to jump out the window.

By now, there was a new OB on call, and she reluctantly agreed to examine my cervix. “Oh, my goodness!” she said. “You are very widely dilated! Have you been having any contractions?”

Yes, I said. All day. At which point, someone figured out the monitor wasn’t working and finally administered an epidural.

In the days that followed, as I recovered from an emergency C-section, I discovered that the condescension with which the staff treated me was nothing compared to how they treated my African-American roommate.

Unlike me, Coreen refused to allow anyone to take her infant to the nursery. At first, this seemed unreasonable. How could she not trust the nurses? But the more I overheard, the more I understood.

The baby, who had curly auburn hair and lustrous coppery-brown skin, wore a frilly pink dress. “She’s beautiful,” I said.

“Huh,” Coreen said, “that ain’t no girl. He’s a boy.” The doctors had taken a sonogram and told her the fetus was female, so she had gone out and bought dresses. Worse, she and the baby’s father had picked out a girl’s name, and since the father was a long-distance trucker and didn’t yet know about the delivery, Coreen hadn’t been able to consult him to pick out a new name. All this made perfect sense. And yet, whenever the nurses asked my roommate why her son was wearing a dress or why she hadn’t named him, I could hear their derision, as if only an ignorant black woman would buy her child clothes for the wrong gender and be too lazy to pick out a name.

One nurse hovered so obsessively while I was trying to breastfeed that I demanded she leave, but she couldn’t be bothered to tend to my roommate. Years before, Coreen had given birth to twin boys, returning home — and to work — without the slightest trouble. Now, despite having given birth naturally to a smaller-than-average child, she was in terrible pain “down there.” But no matter what Coreen said, the nurse ignored her.

Then, in the middle of the night, I heard my roommate cry out: “Help me. Lord, help me. I’m freezing. I’m dying.”

I wobbled out of bed and pushed aside the curtain, only to find Coreen shaking so violently the bed creaked beneath her. I covered her with her blanket, then rang for the nurse. Coreen was very sick, I said.

The nurse led me back behind the curtain and said in a voice my roommate could hear that she was just being melodramatic. Her symptoms were due to her refusal to breastfeed, a decision the nurse attributed to black people being unable to resist the formula the state provided for free. Having overheard Coreen on the phone, I knew she was drying up her milk because she needed to get back to work. I told the nurse if she didn’t get a doctor, I would get one myself. Finally, a physician appeared, examined Coreen, and offhandedly explained that she was suffering from endometritis — an infection women used to die from before antibiotics.

Later, an intern came to put in an intravenous line.

“The needle,” Coreen said. “It ain’t in right. You missed my vein.”

The intern assured her everything was fine. But the next day, the frazzled OB who ran the clinic in Roxbury where my roommate had received her prenatal care stopped by to check on her. “What’s this?” she said. Apparently, the IV line hadn’t been inserted correctly and the fluid had been draining into everything but Coreen’s vein.

After that, I was sure the staff would change their attitude. But when Coreen tried to convince the pediatrician her son’s bowel movements were “the wrong color,” he brushed aside her concerns. Late that night, she rang for the nurse, yelling that “no baby’s shit” was supposed to be red. This time, the nurse ran out and returned with another pediatrician, who told Coreen her son might have an infection in his bowel and that they were rushing him to Children’s Hospital, down the street.

After I got home from the hospital, I wrote a short story in which I tried to convey the horrors Coreen and her baby had experienced. My friends found the racism and sexism so extreme — even though I was transcribing what I had seen and heard—that I needed to keep toning down the details to make the story seem believable. Strangely, I never considered writing a nonfiction book about the way the medical establishment mistreats women. Maybe I was struggling too hard to support myself and raise my son while battling so many supposedly imaginary ailments. Also, I still barely believed those ailments were real myself.

Thankfully, not one but three excellent books about women and the medical establishment were published this year. Invisible, by Michele Lent Hirsch, focuses on young women who suffer from chronic illnesses. In Ask Me About My Uterus, Abby Norman details her struggle to be treated for endometritis. Most comprehensively, Maya Dusenbery’s Doing Harm shows how and why doctors routinely dismiss women’s complaints as being caused by depression or stress or attribute a patient’s symptoms to getting her period, becoming pregnant, not wanting to become a mother, becoming a new mother, going into menopause, being black, Muslim, Hispanic, or a lesbian, being too fat, too thin, too young, too old, too rich, too poor, too educated, or not educated enough.

From the earliest times, male physicians dismissed women as too frail or irrational to practice medicine, while not so coincidentally viewing these same women as hypochondriacs who made good-paying clients.

Dusenbery cites studies to the effect that men with Crohn’s disease require, on average, 12 months to receive the correct diagnosis, while women need a full 20 months; men with Ehlers-Danlos syndrome usually need four years to be diagnosed, while women with the same syndrome can go 16 years before doctors figure out what’s wrong. Black patients are 22 percent less likely than whites to receive medication for their pain — not surprising, given that half of the 200 white medical students surveyed in a recent study believed it possible that “black people’s skin is thicker than white people’s skin” or “black people have fewer nerve endings than whites.”

Despite the dramatic rise in female internists, the medical establishment remains overwhelmingly male. As Dusenbery notes, only 21 percent of the full professors, 15 percent of the department chairs, and 16 percent of the deans at U.S. medical schools are women, while fewer than a third of researchers who receive NIH funding are female. Given that scientists tend to study illnesses that might someday strike them, male researchers are far more prone to study heart disease or prostate cancer than, say, endometritis.

Medical researchers still regularly claim they can’t study female subjects — even female mice — because female bodies are so much more complicated than male bodies. Which means doctors have little data about the ways a condition might manifest itself differently in women or how women’s bodies might react to various medications. “Never mind,” doctors claim. “Women’s bodies are the same as men’s!”

What Dusenbery’s book makes maddeningly clear is how often women find themselves trapped in illogical paradoxes and self-defeating cycles, even when the people who create those traps are supposedly logical, kindhearted scientists. For decades, older male doctors taught medical students that rich white women feigned their “diseases” because they were bored, desirous of attention, or reluctant to accept their roles as wives and mothers. According to this theory, a middle-class woman who chose to work outside her home was probably suffering the ills brought on by delayed or reduced pregnancies. A woman who wanted to have it all but wasn’t smart, talented, or tough enough to achieve her goals would fake a disease that granted her the excuse to give up and stay home.

The supposed proof for this assessment was that poor, black, and working-class women never complained of the “diseases” that afflicted their richer, whiter counterparts. Of course, poor women, black women, and working-class women did suffer the same symptoms; they just couldn’t afford to visit a doctor.

From the earliest times, male physicians dismissed women as too frail or irrational to practice medicine, while not so coincidentally viewing these same women as hypochondriacs who made good-paying clients. In the early 20th century, Freud provided a “scientific” framework for ascribing a woman’s complaints to repressed trauma or neuroses, which the patient wouldn’t be able to recognize; this allowed doctors to feel fine about their biases even as they couldn’t explain why a patient felt the way she felt, let alone cure her.

As Dusenbery points out, physicians rarely find out that the women they dismiss as fakers are actually suffering from multiple sclerosis or an autoimmune disease (or, in my case, a spinal cord injury or ruptured ovarian cyst). As a result, most doctors are able to keep believing that their colleagues are the ones making all the misdiagnoses.

Women get diagnosed with mental illness more often than men, perhaps because society inflicts more pressures on women, or because mental health professionals are more apt to view women as crazy, or because society discourages men from admitting they have problems. Whatever the cause, if your medical record indicates you are prone to depression, any physical symptoms you profess are more likely to be attributed to your mental illness.

Here’s the real mindfuck: Medical professionals tend to dismiss as hypochondriacs people who visit doctors frequently, use pain medications excessively, ask for surgery, and generally act in ways an invalid would act—all of which correspond with the behavior of someone who suffers from a real disease no one believes she has.

As I wrote the previous paragraph, it occurred to me the word “invalid” is spelled the same as “invalid.”

Understanding the ways in which a system mistreats women doesn’t necessarily explain what makes women so ready to accept that mistreatment. Why didn’t I trust what my body was telling me? Why do I still find myself doubting the medical complaints of so many other women?

In part, the problem is generational. Society drives mothers crazy, and they, in turn, drive their daughters nuts. Women who endure the pain of endometritis are told they are experiencing normal periods, so when their daughters complain of their own exceedingly painful, hemorrhagic periods (the condition can be genetic), their mothers insist, “You’re having a normal period. You just haven’t learned to endure the pain and bleeding.”

For most of my childhood, my mother suffered terribly from an undiagnosed gallbladder problem. Doctor after doctor told her nothing was wrong. My father would urge her to eat a hot dog, after which she would spend the entire night throwing up. Her weight dropped until she was emaciated, her mood as bitter as the bile that caused her misery. Even after she finally received the surgery that relieved her pain, she continued to obsess about her health.

Why didn’t I trust what my body was telling me? Why do I still find myself doubting the medical complaints of so many other women?

Why wouldn’t she? Her father had died young of heart disease, as had her eldest brother. The next two brothers and her one older sister inherited the same faulty gene and were stricken by multiple heart attacks. My mother must have lived in fear that she would be next. (She ended up undergoing not one but two bypasses and still was struck with a heart attack of her own.) And yet, I saw her as a hypochondriac and vowed I would never complain about my own aches and pains or see a doctor unless I was certain I was ill with a life-threatening disease.

Here’s an uncomfortable confession: To this day, I find it difficult to accept fibromyalgia is a real disease. Why? Because so many doctors and journalists in the 1990s mocked it as the “yuppie flu,” and so many more women than men tend to get it.

Even though I sympathize with Abby Norman, the author of Ask Me About My Uterus, I caught myself dismissing her complaints as having been induced by her extremely traumatic childhood—before I reminded myself that a very high percentage of women, with or without chronic diseases, probably have endured traumatic childhoods.

Given the nature of implicit bias, women and minorities, raised as they are in a sexist, racist culture, are as likely to exhibit racist or sexist attitudes as straight white doctors.

For years, whenever I visited my dentist, I noticed that the office next door belonged to something called WomanSafeHealth, a “woman care” and gynecology practice. Even after all my bad experiences with the medical establishment, it never occurred to me to step inside. I couldn’t imagine that a practice made up of female doctors would be as effective as the large, impressive hospital at the university where I taught.

Recently, the founder of that clinic, Elizabeth Shadigian, MD, published a book called WomanSafeHealth: An Antidote to Status Quo Health Care, in which she details the way “the manstitute of medicine” systemically disbelieves, condescends to, and mistreats its female patients. According to Shadigian, the system that trained her is compromised by a hierarchical bureaucracy whose values are distorted by hidden political agendas, sexism, racism, a quest for profits, and an endless search for funding from pharmaceutical companies and other powerful donors. In 2007, Shadigian took the leap and opened her own practice in Ann Arbor, Michigan, a city with three large medical institutions that she sees as complicit in maintaining “status quo health care.” Instead of putting doctors first, Shadigian and her colleagues make clients their top priority. The center welcomes all women, young or old, transgender, gender nonconforming, large and small, of every race, ethnicity, or family background.

Patients are never addressed by their first names or “honey,” “sweetie,” or “dear.” They are never ridiculed for asking questions or disparaged as “Google-ologists” for having looked up information on the internet. They are never cut off as they describe their histories, never lectured to by a doctor who is fully clothed and standing while they sit half-naked on an examination table.

I couldn’t imagine that a practice made up of female doctors would be as effective as the large, impressive hospital at the university where I taught.

Best of all, female clients aren’t dismissed as hypochondriacs. Often, Shadigian says, a woman can sense something is wrong before a tumor is large enough to be detected. A patient’s complaints about painful sex are likely not a sign of “frigidity” but of a serious physical condition. Even if a client is lying or withholding information, Shadigian believes the woman deserves to be taken seriously. Such stonewalling might be the result of a patient’s fears for her safety, an earlier experience of a doctor’s sexism or racism, or the client’s expectation she will be judged or disparaged for her behavior.

“Belief is not necessarily agreement,” Shadigian writes. Rather, “belief begets understanding.” She promises to look at the truth “alongside” her clients, to never give up until she has figured out the reason for their symptoms and done her utmost to alleviate what is wrong.

Although skeptics warned that such a client-centered clinic could never succeed financially, WomanSafeHealth recently celebrated its tenth anniversary.

For the medical establishment to change — by training doctors of all genders and races to recognize their implicit biases (as several pioneering medical schools are already doing), by investing more in research to study illnesses that afflict women more often than men and whose symptoms are difficult to detect or link to a physical cause, and by offering the sort of care Shadigian provides her clients — women need to come forward and tell their stories. And that won’t happen unless each of us learns to believe other women when they talk about their symptoms and to believe what our own bodies tell us.