Smart Woman Online

The Medical Brush-off

How to prevent it

May 29, 2007
By Dr. Vicki A. Lucas, Ph.D, RNC

Why do women frequently feel that they are getting the brush-off from their health care providers, or that their providers believe their problems are simply all in their heads? Let’s start with a few facts: Women use more health services than men and are also more likely to be misdiagnosed and treated incorrectly. Moreover, they are also more likely to be diagnosed with and treated for anxiety and depression when a “real” problem can’t be diagnosed.

This “it’s all in your head” syndrome occurs for several reasons. Women more frequently have complex problems that are difficult to diagnose, such as autoimmune disorders, pelvic pain, chronic fatigue syndrome and fibromyalgia. These disorders are often referred to as a “diagnosis of exclusion.” This means that health care providers must continue to exclude various disorders until they pinpoint the correct diagnosis. It can be a long, frustrating process for doctors as well as patients. Women tend to be intolerant of ambiguity, especially when it comes to their health.

Women are also very complex communicators. They use many descriptive words and share their subjective experience in great detail with their doctor, nurse or other health care provider. Women also often describe multiple problems at the same time, which can be confusing to the provider. The provider is like a detective trying to sort through a mound of information to discern what is important to the diagnosis. Women are good at subjective descriptions of their disorders, but they are frequently less proficient at providing more objective information.

Another cause of the brush-off syndrome is the medical model of diagnosis. It is a male model of thinking that often encourages providers to draw a conclusion before they have all of the necessary data.

Last, health care providers pride themselves on making diagnoses quickly and on finding a cure. That is what they spend years of training learning to do. If a problem eludes immediate diagnosis and resolution, not only the patient become anxious and frustrated — the provider does, too. The provider may become “deaf” to the patient’s complaints. That is why women are often offered antidepressant and antianxiety medications. But health care providers must go further and refer patients to specialists or other providers when they reach a roadblock.

So, what can women do to prevent “the great brush-off” by their health care providers? First, let’s discuss preparing for your appointment. You will have only a limited time with your provider and you need to make the most of it. A patient who is prepared and communicates clearly is very helpful. As much as 70 percent of the progress toward a diagnosis and treatment is determined by the communication process.

The history — I prefer to call it the “herstory” — is the first step in the process. Usually it begins with a form that asks you a lot of questions. (Refer to Table below.) It is critically important that you fill out the form completely, accurately and honestly. All information is confidential!

The written information is then clarified and verified verbally by a health care provider. He or she will investigate in detail why you are seeking care. Providers will also ask you about specific symptoms. They will clarify past personal and family health history. You need to be as specific and detailed as possible. Follow my “3C” rule: Be Clear, Concise and Cogent. Completely communicate each problem separately.

Health care providers are like Sherlock Holmes. They need to go from the general to the very specific when asking questions. The more information gleaned from your history, the more appropriate your physical exam and diagnostic tests will be. Preparation is key. If you are concerned about forgetting your information, write it down and bring it with you.

Following the history verification and clarification, your provider should explain what type of physical exam and diagnostic tests will take place. Throughout the process, you should feel free to ask questions.

After the exam, your providers should communicate their findings, what these findings mean and the plan of care. Again, please ask questions! The best plan of care is one developed collaboratively between the patient and provider. It is a provider’s responsibility to thoroughly explain his or her findings and your treatment options and to answer any questions you may have. It is the patient’s responsibility to completely disclose all information accurately and honestly; to make an effort to inform themselves about their health; and to participate in decisions about their health.

Strategies To Enhance Communication With Health Care Providers

• Collect objective information on your problem prior to your appointment
• Simplify your information
• Write down your information in an organized manner
• Stay focused on one problem at a time
• Write down instructions
• Write down questions and bring them with you
• Draw simple pictures to clarify information
• Be specific
• Be detailed
• Be accurate
• Be honest
• Use three-dimensional models to explain information
• Ask questions
• Bring another person with you
• Clarify information you don’t understand
• Talk to your provider first in their office while fully dressed before moving to the exam room
• Don’t pre-diagnose yourself
• Don’t pre-treat yourself

Smart women know their bodies better than anyone else. They intuitively know if something is wrong, and they should leave no stone unturned in their quest to find an answer.

Your life truly depends on it!

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