"It's all in your head." Advocating for Proper Diagnosis for Female Patients

[angeloublue22]

This is going to be a long one but I had an interaction with some providers today that lead to me think about some things. 

I'll start this post by sharing my own experience.

I have Hashimotos and was diagnosed 3 years ago after trying to tell multiple providers that I had a thyroid issue.

My journey started 20 years ago when, my normally energetic self, found it hard to get out of bed. I started gaining weight after losing 100 lbs. Since my teens, I've always followed a strict diet based on recommendations and I loved exercising (I know I'm weird) but I always had trouble with my weight.

Anyway, those years I lost all energy, started losing hair, and gaining weight even though I was still forcing myself to exercise and follow my diet. I went to a doctor, I mentioned my family history. I told her about everything I was doing to lose weight (now I know that was my 1st Hashimotos flair). I kept a food and exercise journal.

My provider told me quote,"I think you are lying to yourself. That's impossible to not lose weight if you're telling the truth."

She said the lack of energy was because I was depressed.

I am a very happy person and loved my life, I just didn't have the energy.

She then gave me a pamphlet about walking a hour a day (I ran, yoga'ED, kickboxed, wt lifted 6 days a week for at least 3 hours a day) and gave me a diet to follow (I already did).

She didn't even run labs. 

I was young and didn't know to fight for myself. I felt defeated and stupid. I did not go to another Dr. for 10 more yrs.

Through that time, I got up to 310 lbs following the same diet and exercise routine. Then I decided to try keto and lost 120 lbs and kept it off and my hair came back and I felt great.

My next doc ran labs and they were all normal at that time.

Four yrs ago, I started losing my hair in clumps, I had no body hair, mood swings, no energy, gaining weight again, brittle nails, brain fog and dry skin (textbook hypothyroid symptoms). So, I decided to see another doc (I had moved) to see what was going on. She said I had low T3 but that's not a big deal and that's nothing to treat.

I told my friend who was becoming a NP about it and she asked if they had done a TPO test as she said it's sounded like Hashimoto's (I didn't actually know much about the disease) and when I asked my provider she didn't see a reason to draw it.

I was so angry and so was my friend.

Two months later, my friend became an NP and said she would make it her mission to find out what was wrong with me and she did! My TPO was in the 50's. I started lio and levo and I'm doing better.

Anyway, this brings me to my frustration with providers not listening to pts, especially women (even if you work in the medical field). 

This has given me unique perspective and now I make it a soapbox issue to advocate for pts and encouraging doctors to not immediately go to - it's all in your head. I have a new job where I facilitate transfer of pts to a large hospital including facilitating provider consults and giving advice.

The other night, I had to advocate hard for a female pt and that's what triggered this post to remind us that we do have some power to change this issue.

It was a really interesting case. I don't want to give too much info but it was a pt that was having paralysis on one side after syncopal episodes upon waking with t wave abnormalities that happened 2 times is 2 days. No history of this and no history of mental health issues.

We had the sending doc, our neurologist and cardio on the line. Both the neuro and cards couldn't really figure out a diagnosis, so both suggested conversion syndrome because she has multiple kids.

I stopped that right in its tracks. I said, "hold on, are you saying that because you can't figure out what is wrong with this woman without any further test, you are going to mental issues?"

I reminded them that she didn't just have 5 kids 2 days ago, and let's not be the providers you hear in the news that chalked pts real symptoms to mental issues and then something really serious happens.

"Can you think of anything else that might be going on?"

(They're are used to me being a little prickly, LOL) 

Thank goodness we have a good team that respect nurses because all 3 told me I was right and brainstormed some more and ended up admitted pt to our seizure unit.

Frankly, I'm getting tired of hearing stories in the news and from women in my own life that were not listened to and ended dying or have serious medical issues that could have been prevented. I would love to hear stories about how you advocated to pts getting a medical diagnosis over mental health and how you approached it. 

[toomuchbaloney]

Emergent said:

Here's an interesting article. Do you all think women are more prone to hypochondria? 

Women 'greater hypochondriacs', research shows

It would be more interesting if they had actually linked to the study.  

[Emergent, RN]

toomuchbaloney said:

It would be more interesting if they had actually linked to the study.  

The article seemed a little slanted to me. They also were dismissing the idea that the man flu was because men get hysterical.

[toomuchbaloney]

Emergent said:

The article seemed a little slanted to me. They also were dismissing the idea that the man flu was because men get hysterical.

It was essentially an opinion piece that offered no actual data or evidence to support the conclusions. 

[Cricket183, BSN, RN]

Emergent said:

Here's an interesting article. Do you all think women are more prone to hypochondria? 

Women 'greater hypochondriacs', research shows

Not super impressed with the article.  Like others mentioned, I would have liked to see actual studies.  But it does raise the question, if that's an assumption-that women are more likely to be hypochondriacs-then do doctors have that in the back of their minds as they are treating patients?  I think the answer may be a resounding yes.  Maybe not a conscious thought that this patient is female and therefore must be lying to me. but more of a subconscious bias to be skeptical if the patient is female.  
I think there is so much that goes into why women feel (and are being) gaslit.  The paternalistic medical system-although it's improving from where it was, it's still definitely exists!-is the first that comes to mind.  Gender expectations-boys are raised to suck it up and ignore injuries while girls are more coddled when hurt.  Girls are also taught to be more caring, more in tune to the needs of the family-perhaps that translates to being more in-tune to their own bodies?   And let's not forget the assumption that women are emotional and just being dramatic.  
With the invent of the internet and with information at our fingertips, I think women are more likely to research health symptoms/conditions before seeking care and I know from personal experience, some doctors are almost offended by that.  I'll never forget being out of town and having to go to the ER and the ER doctor repeatedly dismissing my concerns and then sarcastically commenting, "You seem to have a lot of medical knowledge.” I replied, "I hope so, I'm a RN.”  He took me more seriously then but what if I hadn't been a medical professional?  Would I have just been discharged without my concerns being addressed.  Probably.  
Anyway, just some random thoughts for discussion on a rainy Saturday afternoon.  It's an interesting subject.

[Emergent, RN]

Even if women are more prone to hypochondria, each and every presentation should be taken seriously. We had plenty of drugs seeking frequent flyers in the ER, who had cried wolf many times, but then finally presented with a serious diagnosis.

It is easy to have compassion fatigue, though, in the healthcare field. We encounter a lot of neurotic people, let's face it. It can definitely wear thin and make one careless. And it doesn't just happen with women, it happens to all kinds of different people.

[Cricket183, BSN, RN]

Emergent said:

Even if women are more prone to hypochondria, each and every presentation should be taken seriously. We had plenty of drugs seeking frequent flyers in the ER, who had cried wolf many times, but then finally presented with a serious diagnosis.

It is easy to have compassion fatigue, though, in the healthcare field. We encounter a lot of neurotic people, let's face it. It can definitely wear thin and make one careless. And it doesn't just happen with women, it happens to all kinds of different people.

Yes!  This ?!