Guest post by Ellie Hopkins, founder & CEO of Chronically Awesome
In long overdue recognition that our healthcare system was designed by men for men, the government is currently running a public consultation as part of the design of the first ever ‘Women’s Health Strategy’.
While I wholeheartedly welcome a stronger input and focus on women’s experiences and needs in healthcare, there are already worrying signs that the input women have given is going to go unheard.
Speaking on BBC Radio 4’s Woman’s Hour programme yesterday, Health Minister Nadine Dorries said the consultation is clearly showing that women are not listened to, something that will not come as a surprise to many of us. In fact, I think her example of being prescribed antidepressants in place of more appropriate treatments spoke to the experiences of many of us, myself included.
“The core theme of most of the enquiries and the reports that we have, the recommendations are: Women are not listened to… They don’t get the treatment they want, not because it isn’t available, because a doctor will prescribe them a course of antidepressants rather than a course of HRT.”
What did come as a surprise, was her response that women need to speak up, even ‘demand’ alternative treatment from their doctors: “I think women actually have a responsibility when they go to the GP practice not to take no for an answer, not to be fobbed off by a doctor, they do not push back, they do not challenge, they are not confident enough to raise an issue so they are very easily dismissed.”
“I want women to be more confident and not to take no for an answer…. And if you are still in pain and if you are not being taken seriously, and if your GP is not referring you on for consultant treatment, then ask for it – demand it – because it is your right to do so.”
I find this, frankly, outrageous.
To begin with, putting the burden on women to demand better care when they feel the care they are getting isn’t right – at a time when they feel unwell and in pain – ignores the underlying systemic problems at play.
What should be being addressed is the fact that the doctor and patient didn’t create a care plan that better addressed the cause of the health problem in the first place. After all, shared decision making is a priority for both the NHS and NICE.
Instead of the emphasis being on the woman going back and pushing for different treatment, could the doctor have done a better job of investigating the cause of the symptoms, or laying out the potential treatment options? Would more time in the initial appointment have allowed for a better relationship to have formed, so that the patient and doctor could have worked together? Could the patient have been made to feel they were empowered and invited to have an input into their care the first time around, rather than having to become ‘demanding’ when it wasn’t the care they felt was appropriate for them?
Did the GP even have a choice in their prescription? Nadine talked about antidepressants being prescribed where other medications would have been more appropriate, but NICE have just created guidelines where the only long-term treatments allowed to be prescribed by GPs for chronic primary pain are CBT and antidepressants.
And when these women go back for a second appointment and demand this different treatment, are they expected to be specific about what they are demanding instead? Because this puts an additional burden on women to come to an appointment having researched and decided what is most appropriate for them and their condition (which at this point may not even be diagnosed); something which should be the doctor’s responsibility.
If you’ve ever gone anywhere near suggesting that you’ve done some research, you’ll know how easy it is to get labelled as hysterical. I have a condition that causes me to have a high heart rate and chest pain. Despite being diagnosed by a cardiologist via several unpleasant tests, a rheumatologist told me – and I quote – to “stop Googling my symptoms” and getting myself “worked up”. That if I stopped doing that, my heart rate and chest pain, which he put down to anxiety, would be resolved.
This response is all too common. If women push back, refuse to be fobbed off, demand different treatment, we are labelled as hormonal, anxious, difficult or hysterical.
In fact, while I was an inpatient in hospital a couple of weeks ago I witnessed a consultant put another inpatient to the bottom of her list to see that morning because that patient had refused to agree to a treatment plan. This patient was actively penalised for having pushed back. There was no subtly, the doctor said this to her colleague as she stood in front of me.
How was I supposed to feel like I could demand different care when I knew I’d be treated different if I did? During that admission I received care I was deeply unhappy and uncomfortable with, and which compromised my physical and mental wellbeing.
And that’s the thing: Nadine’s comments completely ignore the power dynamics of patient-doctor interactions.
For many doctors and patients, the expectation is still that the doctor will make the plan and the patient will agree. To go against this first requires a level of confidence that many women don’t feel they have, and then requires a doctor to be receptive to dissenting opinions, which many doctors aren’t.
Advocating for yourself, be it in a healthcare setting or otherwise, requires a set of skills we rarely have an opportunity to develop elsewhere. Yet we’re expected to be able to walk into medical appointments and talk about how our bodies or minds are struggling, where things hurt and exactly how, what our priorities are, and now, what our demands are, with a level of articulateness and bravery we don’t often need elsewhere, in a setting where the power doesn’t lie in our hands.
It is disingenuous, not to mention disempowering, to say that, in the face of not being heard, women must be louder. And it is worrying to think that the government may hear from many women over the course of creating this new strategy, but won’t actually listen.
The consultation on the women’s health strategy closes on Sunday. You can have your say here.