Update: Image changed on 06/01/23
Have you ever come out of a doctor’s appointment feeling frustrated, fobbed off and like the entire endeavour was a colossal waste of time? So many of us have been there. You psych yourself up, make the appointment and book half a day off work to allow for all that time you’ll inevitably spend staring at your phone in the waiting room. Then, when your moment comes, you step up, sit down opposite your friendly neighbourhood GP and prepare to make your case – only to emerge, eight and a half minutes later, feeling like you’re no further forward than when you went in.
It's a pretty mundane experience but five years ago, through my work as a health journalist, I started noticing that it happens a lot – to women with all kinds of symptoms and conditions. After several interviews in which women described feeling dismissed, ignored, gaslit and generally let down by their doctors, I found myself wondering what was going on. Was it a coincidence? Were all these women just hysterical hypochondriacs? Or was there something deeper at play?
The answer, it turns out, was the gender health gap: a term used to describe the inequalities in treatment and health outcomes that men and women experience. This is nothing new. Like many forms of sexism and inequality, it’s been deeply embedded for centuries, since our medical system was first created by men and for men. The more I dug, the more research I unearthed showing that women are more likely than men to be misdiagnosed, denied pain medication, kept waiting in A&E or dismissed as ‘anxious’ when they’re suffering from painful physical symptoms. What’s more, many of the women I spoke to felt utterly alone in their experiences, despite being anything but.
In 2018 I founded feminist health blog Hysterical Women to bring those women and their stories together. What I’ve learned since then is enough to fill a book and so that’s what I wrote next. Rebel Bodies is a guide to the gender health gap and the patient revolution that’s slowly but surely chipping away at it. The issues at play are complex, intersectional and don’t have quick or easy solutions. Historically, health issues that primarily affect women have been neglected in medical research, education and clinical practice. Couple that with sexist and outdated attitudes about women – not to mention racism, homophobia, transphobia, fatphobia, ableism and more – and you have a perfect storm of medical misogyny and ignorance.
The good news is there has been a radical shift in the conversation over the last few years, with campaigners and even the government highlighting just how much work there is to be done. In summer 2022 the Department of Health and Social Care in England (as well as devolved governments in Scotland and Wales) launched a first-of-its-kind strategy for women’s health, following a public consultation which found that 84% of the 100,000 women who responded had felt "ignored or not listened to" by a healthcare professional. The strategy contains bold ambitions to transform the care that women receive but it remains to be seen whether the government will back it up with the funding, resources and workforce needed to make those ambitions a reality.
While it’s vital that change happens from the top down, there’s no getting away from the fact that the single biggest question I’m asked about my work is what we, as patients, can do to make our doctors listen. I wish I had a simple, satisfying answer, or a cheat code to play the system, but sadly I don’t. What I do have is a selection of tips I’ve picked up over the years to help you work around some of the most egregious barriers that women – as well as trans men and non-binary patients who were assigned female at birth – face when accessing healthcare.
The caveat of course is that you shouldn’t bloody have to. The system is stacked against us and no amount of self-advocacy is going to fix that. Frankly I’m sick of the onus being placed on women and other marginalised groups to find the solutions. I truly believe that patient campaigns are an important and powerful force for good but it’s also important to remember that we can’t change the whole broken system by ourselves. Equally, if nothing you try makes any difference, it’s absolutely not your fault.
Know your body and come prepared
All that said, knowledge really is power. Understanding how the system works, as well as learning to recognise what’s normal – and crucially, not normal – in your body can be useful when it comes to navigating healthcare interactions. With your GP in particular, remember that they only get around 10 minutes per consultation so if you want to make the most of that short window of opportunity, it pays to go in prepared. Plan ahead what you want to say, thinking about it in terms of ICE: your ideas, concerns and expectations. What do you think is going on? What impact is it having on your life? What are you hoping to get out of the appointment?
Equip yourself with evidence and knowledge
Try to be specific and objective as you present your evidence and ask your doctor to do the same. A symptom diary can be really useful to give them a clear picture of what’s been going on and how long it’s been going on for, as well as any triggers or patterns. If you suspect a particular condition, don’t be afraid to mention this and explain your reasoning. Doing a bit of research in advance can help you to feel better equipped to steer this conversation but, obviously, proceed with caution. The internet is a wonderful place and Dr Google absolutely has a role to play, but stick to reputable sources like NHS.uk, patient.info and NICE.org.uk, as well as medical royal colleges and healthcare charities, and take care not to fall down any misinformation rabbit holes.
Rule out the worst-case scenarios
Remember, too, that it’s easy to fixate on the worst-case scenario but try to keep an open mind. If the C-word keeps coming up when you Google your symptoms, no matter how unlikely it seems, ask your doctor to rule out cancer first to put your mind at ease, before moving on to other possible causes. Equally, ask them to clearly explain their thinking. Why do they think it is/isn’t a particular condition? Is it worth them examining you? Is there a test they can do or a specialist they can refer you to? On that note, before you book your appointment it’s often worth checking out the list of staff on your surgery website. These usually list each GP and practice nurse’s special interests and additional training so if there’s someone at your practice with added expertise in women’s health (or whatever you want to talk about), getting an appointment with them gives you a bit of a head start.
Another big tip I often give is, if possible, to take someone with you to your consultation – particularly if you’ve had a bad experience in the past and you’re worried about not being taken seriously. There are three possible roles you might want that person to play: an advocate, who can speak up on your behalf if you don’t feel able to; a supporter, who can simply sit there holding your hand for moral support; or a witness, who can validate your experience for you if you come away feeling that you weren’t listened to.
Treat it like a collaboration
However you go into that appointment, it's important to recognise that there are two different, complementary and equally valid forms of expertise in the consultation room. While your doctor has the textbook medical expertise and training, you are the single biggest expert there is in your own body and your own mind. You live in them every day, you know what’s normal and when something doesn’t feel right, so the conversation with your doctor should feel like a partnership or a collaboration, not a dictatorship. If it doesn’t, or you disagree with your doctor’s assessment, you are absolutely within your right to ask to see someone different for a second opinion. If you really feel like you’re getting nowhere, or if their behaviour is unacceptable (including but not limited to making outright sexist, racist or otherwise discriminatory comments), you’re also entitled to make a complaint. For GPs, you’ll find details of their complaints procedure on the practice website, and for specialists you can go via the hospital’s PALS (Patient Advice and Liaison Service).
Try to understand the challenges your doctor faces
Finally, depressing and frustrating as it is, it’s also really important to recognise the limitations of the system. We all know how much pressure the NHS and its staff are under. Doctors, nurses and midwives are overworked, undervalued and struggling to provide good quality care without the time, funding, workforce and other resources they need. Even the very best doctors may find their hands are tied by a lack of specialist services to refer you on to, for example, or agonisingly long waiting lists for treatment. An analysis published shortly before the end of 2022 found that gynaecology waiting times have trebled in the last decade, which certainly isn’t the fault of your individual GP. Sadly, the only real fix for many of these issues is some serious government investment in prioritising women’s health – and we’re not going to see that overnight.
Rebel Bodies: A Guide To The Gender Health Gap Revolution is out now