Professor finds troubled communication between women and their doctors
NPR Illinois' Maureen McKinney recently interviewed Charee Thompson, a communication professor at the University of Illinois Urbana Champaign, about a study she conducted that showed women often have trouble convincing doctors about the existence and severity of health problems. This is an excerpted and edited version of that conversation.
Can you tell me why women seem to be less likely to be taken seriously by the medical profession?
I think the sort of performance of pain or expectations for how we talk about our pain, when we visit medical professionals is very gendered. I mean, there's emotional elements, there's an expectation to be rational. So, to just give the facts and to talk about in sort of very measurable terms, but we know that there's a significant gender bias in medicine, and that there are false beliefs that women are sort of overly emotional and not rational. And that works against them, sort of from the outset.
Is there a common denominator among women who find that they're not being taken seriously?
I would say in the studies that I've done, I mean, they all identify as women, and we've asked for those who feel like they've been dismissed. So, I suppose that is one common denominator. I hesitate to say that there's anything else unilateral or common among every woman. So I can't say though, from research that I've done that there are characteristics or their identities or their health issues that tend to be more prominent.
So, for example, women tend to suffer more from health conditions that are not visible. So they're not readily apparent, perhaps, or they're not measurable, like chronic pain or autoimmune diseases. There's no diagnostic testing for them. And so that uncertainty creates or is a knowledge gap, where often physicians, I think, sometimes rely on heuristics that they have. And sometimes those heuristics are faulty or stereotypical. So, again, I think, for a lot of women, they have non visible, health conditions that are chronic. So they're not curable, and they sort of last over time. They're not well understood by medicine.
And, you know, I think it's important to also recognize that there's a difference between doubting a woman that she has pain. So, that's sort of an existence thing. So ‘you have pain, you don't have pain, or you have this issue, you don't have this issue.’ Women can be believed for something very visible or not visible, but someone may doubt or a health provider may doubt the severity. So they may say, ‘oh, you can't be in that much pain, or it really can't be that bad.’ And so I think some women are just dismissed outright. And they're like, that's not really happening. And some women may experience doubt of the sort of severity of what they're encountering.
What can women themselves do to make them feel credible to the healthcare provider?
It's very important to me to help equip women with the sort of communication tools or strategies to combat health dismissal, particularly in medicine. I can tell you what women say they do and what often works for them, or at least provides them with the support in the moment. I can also share with you a kind of a subset of strategies that I would call more advocacy strategies that if women feel comfortable and have the resources that they can also engage.
So, a lot of women in the research I've done talk about how they always bring someone with them to medical appointments, the person is an advocate for them. They confirm their claims. They could talk to the doctor themselves. So, they talked about bringing someone, they also talked about bringing evidence. If women feel like they're not going to be taken seriously, just by their word, then they bring in evidence, whether it's existing medical records, maybe it's a diary of symptoms that they've kept, because such sort of evidence fits within biomedical or medical understanding of their symptoms, and may be taken more seriously.
And a lot of women don't outright challenge their doctor if they disagree, but they will face save by asking questions. So if a doctor recommends something, or says something to them, and they're not sure, or they feel like they're being dismissed, they may say like, can you explain to me your clinical reasoning or why you think that or why would you recommend that so it's more of like an ask for information.
A second set of strategies, I guess, is a little more on the advocacy side in terms of is more explicitly about sort of pushing back. And so some women can disagree with their providers and say, you know, ‘from the reading that I've done, I don't know if that's the best thing for me. Can we talk about alternatives?’ Women can explicitly state their needs and values often from the outset of the appointment. This sets the tone for the appointment and lets the provider know upfront like ‘hey, this is something important to me and what I want to keep in mind for the rest of our visit together.’
They also can ask doctors to kind of flip the perspective and if they feel like the doctor is not taking them seriously, they can say, you know, ‘My health is really important to me. And I'd really love to know if you were in my position, what would you want to happen? Or what would you recommend?’ And so, that kind of, in some ways, forces the doctor to prospective take. And then finally, if doctors are not taking women seriously, switch doctors. If you can, I know that often, it takes a long time to get into doctors and health coverage. Coverage doesn't sometimes allow for switching of doctors really easily. But if a doctor is not treating you well, switch doctors.
Is there a racial component or other demographic factors that are involved if women are feeling dismissed about their medical concerns?
Yeah, absolutely. It's well documented that there's an intersectional component to women's health dismissals. We know that there's a strong racial bias in medicine, particularly when it comes to pain. For example, studies document how black people are thought to have thicker skin and feel less pain than white folks. And more research, I think, is needed on other racial groups. But that is probably the most frequent, frequently mentioned, research finding in terms of racial bias.
But racial bias and gender bias intersect with other things like class, and stereotypes that we all have. And doctors are not immune to this. About you people who use social programs, or people who are drug-seeking or med-seeking, as they say, I think gender and race intersect with other both visible and nonvisible markers of identity; visible things might be like body size. So there's a pretty large literature talking about fat shaming and medicine. And how health issues particularly for women are often dismissed as sort of, well, you just need to lose weight to more non visible things like perhaps non visible disabilities, or health, literacy and sexuality.
Is there anything I didn't ask that you think we should talk about?
I guess I will leave by saying one of my goals as a researcher and a human in the world, and with the platform I have, is to help patients advocate for themselves and also help physicians be better communicators. I really want to bridge this chasm that is real and perceived between patients and providers. Because providers want to help people and people want relief and help.
And so my goal is not only to draw attention to bias and potential discrimination, in healthcare, particularly among women and intersections they're in, but also help equip patients and physicians with the tools they need. So I do that by creating trainings for physicians, as well as patients so that we can help them both interact with one another in ways that cultivate respect and trust and a shared understanding towards better health and wellness. I think, for me, drawing attention to the issues compels me to also think about what potential solutions can be and to help people be at least for physicians, the best physicians that they can be. And in working with physicians, I think a lot of them recognize and want to be better.