For women, medicine can be about miscommunication and mistreatment

Doctors and medical scientists have their hands more than full these days, struggling to get out vital, evidence-based information to benefit the public’s health. They must cope with challenges ranging from  battles with the growing problems of infections and vaccine “hesitance” to how to debunk celebrity humbug on diet and well-being.

The medical establishment’s communication nightmares, though, may be especially bad with women — a group that makes up half the population and plays a huge role in most households with medical decision making. Just consider two recent news reports, including on:

The consequences of how mostly male doctors treat — or mistreat — women can be severe.

Punishing pregnant moms for alcohol, drug problems

Aaron E. Carroll,  a professor of pediatrics at Indiana University School of Medicine and the Regenstrief Institute, reported in the New York Times’ “Upshot” column about the harms for women and children when medical professionals and lawmakers decide to slap at rather than help expectant mothers who drink or abuse drugs:

“Researchers gathered birth certificate data for more than 155 million live births from 1972 to 2015. The researchers were interested in how many children were born at a low birth weight or prematurely. They compared the rates of these undesirable outcomes in times and places when alcohol-pregnancy policies did and did not exist. They controlled for a number of demographic and related factors, including those known to be associated with poorer birth outcomes, like poverty and cigarette smoking. They found that policies that defined alcohol use during pregnancy as child abuse or neglect were associated with an increase of more than 12,000 preterm births. The cost of these were more than $580 million in the first year of life. Policies mandating warning signs where alcohol was sold were associated with an increase of more than 7,000 babies born at low birth weight, at a cost of more than $150 million. A previous study looking at how these policies affected women’s drinking found mixed results. States with punitivepolicies had more drinking, not less. Overall, neither type of policy seemed to be associated with lower levels of drinking … [Instead] policies that punish women for or publicly warn them about harms from alcohol or drug use during pregnancy may lead to further harms by scaring women into forgoing prenatal care … Such policies may even convince them that talking with their physicians isn’t a good idea.”

Are all movement disorders in women’s heads?

David Armstrong, reporting for the Pulitzer Prize-winning ProPublica investigative site, draws a nuanced and painful portrait of Dr. Laura Boylan, a respected New York neurologist. Her own experiences have shaped her view that her specialty presumes that women with movement disorders suffer from “functional” or “psychogenic” or mental issues — not from disease or physical conditions. As many as 80% of women are diagnosed this way in some studies, Armstrong reported.

Boylan suffered for years, battling with male and female colleagues, insisting that they consider whether a cyst in her brain could be responsible for her tremors, spasticity, limb twisting, and walking problems. Instead, they diagnosed her repeatedly with problems that might be helped by therapy, or, perhaps, with medication changes. That didn’t work.

Her situation worsened and she and her life degenerated until a sibling convinced a neurosurgeon across the country from her to look at her case. He agreed with her, performed a demanding and risky brain surgery to remove the cyst, and watched as she, initially, failed to respond. But soon after the procedure, Boylan bounced back. She regained weight, vigor, and her considerable intellectual and professional capacities, returning to her medical school teaching and practice.

She says she now has heightened sensitivity to the potential for gender disparities in health care. She takes extra time with patients, she says, to ensure she does not add to this problem in the profession.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care — notably treatment that does not display inherent bias. For patients, health care has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of medical treatment and prescription medications, too many of which prove to be dangerous drugs.

The medical profession likes the polite term “disparities” to perfume serious problems in the (mis)treatment for women and people of color. The list of harms that women suffer in medical care is, by itself, long and sad. This is a matter that medicine needs to deal with, urgently, and a vital way to do so is to be open and frank about shortcomings.

But, as noted at the outset of this post, this may be a time when direct, candid, and effective communications about health care can be lacking. So, maybe we try a different approach. He’s rude, crude, and he’s aiming to be funny and insightful. It may be worth seeing satirist John Oliver (in the video above) detail — with the help of some well-known personalities — why bias in medicine matters so much. We’ve got a lot of work, to make health care better, including so it serves all patients in optimal fashion.

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