Weight-bias, race bias, gender bias:   It’s part of our society, and even though it should not, it does sometimes follow patients into the clinical space.  I’ve talked in the past about weight-bias – but let’s talk gender bias.

This is a long post and for accessibility also available as a podcast episode (free to download).  Here are 10 ways women can advocate for their own – and their family’s – health:

1. Bring the list. Before going into your doctor, make out a list of what you want/need to discuss. (Unless it is just one thing.)   If you realise the list is getting long, your doctor may be under pressure to address all of that in one appointment.  Bring up the most important thing  – to you –  first but make sure that you mention that you have many concerns, and make a decision with your doctor about whether you might need to schedule a follow-up appointment to continue the conversation.  If you know your doctor well, call ahead and advise that your appointment might need extra time.  Appointments are only so long on any schedule, so things at the bottom of the list will end up getting skipped or rushed. Why does this matter?  You won’t believe how often the smallest symptom (to the patient) was the one I was worried about the most – but was often a throw-away comment as the patient put their hand on the door to leave “Oh, Doctor, one more thing…” I call that a “Columbo” moment — and what follows is almost never good!  “I know I was here about my toe but I’m having these episodes of shortness of breath with crushing chest pain going into my jaw and arm – that’s fine, right?”

Doctor Appointments Need to Be Longer

Yes, they do. And doctors agree. The doctor shortage means that appointment times are getting shorter and shorter. The pressure to shorten appointment times is in response to growing waiting lists. And this isn’t just the HSE – this is a problem in the private sector here and throughout many Western healthcare systems. It’s not your imagination: average primary care appointments have gotten shorter, from 15 minutes down to around 10 minutes. In the NHS, this is often as short as only 7 minutes. The solution to this problem has been increasing the amount of work done by physician extenders (advanced nurse practioners, for example). While this is an excellent idea, the practicalities of this roll out has been fraught with some problems in other healthcare systems

2.  Talk to your doctor.  In studies, more communication – not more tests – improved patient outcomes.  Your doctor is human.  They may be tired or distracted.  You may be in pain or distracted (work ringing on the phone, having to bring a young child with you.) It is your doctor’s professional job to engage.  However, if you feel that you aren’t being listened to, say it (kindly):   “I feel that you aren’t hearing what I am saying.”  If your doctor is tired or distracted (wrong, I agree – but we are human), often this is enough to refocus the conversation.   What else can you do from your side?  Make sure that your phone is put away, the smart watch apps are muted, and do your best to show up for appointments – where possible – without distractions. (It’s tough but if there is someone to mind the baby – even just in the waiting room while you go in – it’s worth it.  I love babies and don’t mind them in an appointment – but it can be difficult to have serious conversations when the toddler is fussing.)

3. Finish – and repeat – with the plan. Multiple studies have shown that at the end of a medical consultation, only a percentage is remembered. There are many reasons for this, like  emotions (fear, relief) or    Sometimes the plan just sounds vague.  “Can you repeat the plan for me?”  You can also try:
1) writing down what your doctor says (just ask us for a pen and paper or ask us to write it down for you)   2) asking your doctor if you can record that part on your phone.  For many reasons, including building trust, ask your doctor first.  Most doctors will happily dictate clear patient care plans/ instructions directly into your phone if you ask.  Way easier than trying to sort through the audio later.   3) ask your doctor to write it down for you. Many of my patients receive a copy of the plan sent to them after their appointment, either by printed letter (HSE) or on a secure portal (private).  If they don’t ask or seem unbothered by my offer to do so, I will still do it if I judge that I think they probably will have questions later or the plan requires some action on their part.

4. “What happens if I don’t feel better?” Make a plan with your doctor about when to follow-up next, especially if it’s not working.  This part often gets missed:  doctors aren’t looking for business.  I often encourage my patients to do “patient-led” follow-up – which means that I see them when they need to see me, not when I want to see them.  However, I’ve noticed many of them will wait for me to call them back.

5. If appropriate, consider bringing another adult with you to an appointment to be back up eyes and ears. This is especially important for specialist appointments for chronic or serious disease.  However, don’t rely on them to answer questions or make decision for you.   They can’t answer questions about how you feel:  pain or tired. It is your decision to bring someone into your appointment.  When might I ask them to step out for a few minutes?  If I suspect domestic abuse (including coercive control), if I need to ask a question that is potentially embarrassing for the patient, or if the patient’s own voice is being lovingly smothered by the other person who is just very talkative and enthusiastic.

6. If you aren’t happy with the plan:  say it, sooner rather than later.  Many patients come back 6 months later and they never took the prescribed tablets they never took or never attended the prescribed therapy because they weren’t happy with the plan.  I don’t expect my patients to always be happy with the plan I suggest — and they never need to do something they don’t want – but if we aren’t talking about that, we aren’t making any progress.  Part of shared decision making is the patient being part of the plan. If we aren’t doing that, it’s just lost time.

7.  If you have a question about your treatment,  ask your doctor there and then – not Dr. Google or social media forums later.  The best example of how this goes wrong:  I have often started patients on drugs used to treat certain types of chronic headache.  There are a variety of drugs, depending on the patient.  Patient went home and Google’d the drug – and Google told them that, in this case, that I had given the anti-depressants.  Patient then – reasonably – thinks that I think that their pain is “in their head” – and not literally.   (Some classes of “antidepressant” drugs are excellent – and widely used – for other conditions, including types of chronic pain, headache, and even certain menopause symptoms.)  So patient doesn’t take medication and is slow to come back to me because they think I don’t believe them – and in the meantime, nothing is getting better.  Had they come back to me sooner, I could have reassured them that using that drug has nothing to do with mood or we could have made a plan for a different drug.

Patient advocacy groups and social media forums have important roles but always remember that one patient’s journey is not another patient’s journey.  If you find them helpful, great.  But if they are increasing your anxiety or encouraging you to break-up with your care team and seek alternative care (usually at a substantial cost), talk about it with your GP. 

8. What if your doctor doesn’t know anything about women’s health or menopause?   Your GP knows the basics, but in fairness, no GP can be an advanced expert in all things:  paediatrics, sports medicine, infectious diseases, diabetes…  Many GPs work in groups, and have a shared skill set among them.    Speak to your GP about your fertility, menstrual, or menopause concerns.  If you feel they aren’t settling, ask if there is a GP in the practice who is the women’s health expert (a GP with extra diploma in women’s health or Obs/gynae).  There very often is.  Your GP can also refer you to specialists, including HSE menopause hubs.  If you have private cover, there are additional women’s health specialist GP hub.  Make sure you are educating yourself from reputable sources about women’s health.  I highly recommend books by Dr. Jen Gunter for my patients. 

9.  Does it matter who your doctor is? In short, it shouldn’t – but honestly, we know that it does.  In short:  studies show that outcomes are better for women who have women doctors. And the good news? Half the doctors in Ireland are women!    Language also matters – if English isn’t your first language, it is worth considering a doctor who speaks your language.  Not always possible but can make a difference where it is an option.  I have patients who don’t go to their GP because they feel they don’t have a good therapeutic relationship.  The relationship between doctor and patient is like that between any 2 humans – sometimes it just doesn’t work. In that case, I encourage patients to find a GP they can work with – not just to substitute with online Dial-A-Doc services.

Did you know?  Health misinformation disproportionately targets women, in particular, mothers. 

10.  There is no “secrets doctors don’t want you to know”:  Ignore the clickbait and be a savvy consumer.  it is the usual story:   things pretending to empowering women are actually just exploiting them. Supplement sellers and alternative “Functional Medicine” practioners** and “at-home testing” have a financial interest in making sure that you are handing them your money no matter what the ads say.  Likewise, telehealth sounds great – a doctor prescribing from your laptop on your lunchbreak. However, this growing business means that safety steps for safe prescribing may get skipped — such as blood pressure checks and blood tests. Telehealth has a role – I follow up some of my own patients with virtual clinics – but we should be careful with its use.  Many health companies see the increasing profit margins in selling virtual medicine services, and again, while this is seen as empowering patients – we need to be savvy.

**There are large and worrying loopholes in Irish Regulation.  This means that the legal safeguards in place to protect patients – including IMC registration for doctors and CORU registration for allied health professionals, like physios and dietitians – don’t work.  Many “clinics” offering medical appointments, especially functional medicine, do not have qualified or registered doctors or healthcare professionals.  And it’s completely legal.