“It’s frustrating to have questions that don’t get answered. It’s altogether disturbing to find out that those questions haven’t even been asked. When I was diagnosed with endometriosis at age 23, I didn’t know enough to ask the right questions. I assumed my gynaecologist had all the answers…”
“That these conditions are all beset by delayed diagnosis; that a high proportion of women and gender-diverse people eventually diagnosed with these conditions will first be told they have a mental health condition, or are too concerned about their health.”
I find articles like this quite difficult to dissect and rationally discuss because the points raised are so wide-ranging and cover so many topics. Sometimes this approach to addressing problems or projects is termed “trying to boil the ocean.” I also noted a slight undercurrent of hostility toward the field of medicine. I don’t know enough about the author (Gabrielle Jackson) to have an informed opinion as to why this is. For my purpose, I will only address and bring context to some of her points that I feel are truly relevant to the topic of women achieving better care.
Absolutely, women’s health is less understood than men’s. It is because there have been so (comparatively) few clinical studies on women’s health. This of course, is because of sexism in science. And it directly affects healthcare because allopathic medicine is firmly-rooted in evidence-based science. That science comes from observation and hypothesis formation, followed by basic research (think molecular, biochemical and genetic), followed by pre-clinical (animal models) and then clinical (human) studies. This is indeed a very solid framework because it has screened out many horrid and harmful former “medical” practices and treatments (think: leeches, dirty scalpels, and anti-freeze as cough syrup) and brought us innumerable cures. We have increased average Western lifespans by over 30 years in the last century, alone.
Since over 99% of scientists and physicians were, historically, men (who indeed didn’t understand women), they were not deeply curious about the medical conditions of women. The oppression of women and deeply-rooted sexism combined with the typical behavior of women (as so beautifully described by Anna Margolina in her comment) to make the situation even worse.
Thankfully, medical schools are doing a much better job now of training physicians to be more interactive with, respectful of, and responsive to their patients. Many of the personalities, mostly men, who filled those schools (extremely high test scores, poor social skills) decades ago, are no longer admitted, or they are diverted into medical research (a special MD-PhD track) where they are unlikely to have a practice of clinical patients.
Yet there is also real connection between many of the chronic conditions the author mentions (particularly fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, painful bladder syndrome, migraine headache, and chronic tension headache) and mental health conditions. Arguably, those conditions beg addressing for those patients to achieve real healing. So those physicians are not wrong to illustrate that connection. The real challenge here is that physicians do not know enough about mental health and they certainly do not know how to treat it, aside from prescribing certain drugs. And of course as a society, we still have much stigma and shame around mental health, its diagnosis, and treatment.
On top of that, the mental health professions are primarily rooted in the social science system with a very wide range of practitioners and far less rigorous research (mostly observational) supporting their practices. There is very little consensus on the specific and appropriate treatments for specific conditions found in the DSM-5. There is also massive range and variation in the training (and credentialing) of mental health practitioners from rigorous and comprehensive to inadequate and undisciplined with little oversight, nor even basic consensus on what that oversight should be. The fact that mental health conditions manifest differently in every person doesn’t help the situation. And so, the effectiveness of mental healthcare varies accordingly. In my view, we have a lot of reform, cleaning up, and standardization to do to get ourselves to a reliable state of a system of care for mental health.
The other true challenge is that, as our culture continues to become ‘more woke,’ or more aware, we as patients are quite often, putting doctors on the defensive. In increasing numbers, educated and ‘empowered’ patients now go to a medical appointment armed with much research and sometimes memories of past inadequate care. It has become a delicate balancing act for the doctors; working collaboratively with informed patients when some are quite sure that Dr. Google has given them a full diagnosis to their health complaints. They would appreciate confirmation of that and a prescription or treatment for it, thank you very much.
This dynamic is also at the root of the anti-VAX cult; that reliance on the all-powerful Internet to give us answers, facts, and truth. The rest of us need to consider these things and remember that physicians, while extremely well-educated and usually very well-trained, are still human beings, like us. The vast majority are just doing the best that they can; working in the very same broken healthcare system that we rely upon.