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Why there are times a woman really should demand to see a female doctor

After all she has endured at the hands of male doctors, Jean Hatchet couldn’t be clearer.

‘If there was a man and a woman, each similarly qualified in the area of medicine I needed, I would choose the woman,’ says the 55-year-old former teacher from Sheffield.

‘I look back in horror at what I’ve experienced over the years, and would never let a male medic touch my body now. At all.’

Jean’s ordeal began in November 2017 when a male radiographer carried out a ‘rough’ internal scan – and failed to spot tumours that had developed in her ovaries, liver and bowel. She was eventually diagnosed six months later.

Then, during the operation to remove the growths, one surgeon – who also happened to be male – suggested it was necessary to remove a section of her bowel and fit a stoma bag, which collects waste products outside the body.

In many cases they are permanent and carry risks including serious infection and hernia.

This was despite Jean’s decision – which she had put in writing before the procedure – to refuse a stoma, whatever happened.

Jean Hatchet’s ordeal began in November 2017 when a male radiographer carried out a ‘rough’ internal scan – and failed to spot tumours that had developed in her ovaries, liver and bowel. The 55-year-old former teacher from Sheffield was eventually diagnosed six months later

Thankfully, her oncologist – a woman – was also present, and had ‘fought her corner’ to make sure her wishes were respected.

‘After the surgery, I learned that – because my amazing oncologist stuck it out – he was forced to make that extra effort, and they managed to cut the tumour away without removing any of the bowel.

‘She made him work harder when he wanted to take the easy route. I tell everyone: if you can, ask for a woman.’

Jean’s experience is, she believes, a good example of the different care patients can receive at the hands of a female surgeon. They are strong words, but is Jean right? Are there times a woman would be better off demanding a female doctor?

A major study published this month suggests there might be. Canadian researchers looked at 1.3 million case reports and discovered something they rightly described as ‘troubling’: that women are 15 per cent more likely to have a bad outcome from surgery, and 32 per cent more likely to die, with a male surgeon.

The type of operation doesn’t seem to matter, the researchers found – the same outcome held true for a knee op, weight-loss surgery or complex procedures on the brain or heart.

A major study published this month suggests there might be. Canadian researchers looked at 1.3 million case reports and discovered something they rightly described as 'troubling': that women are 15 per cent more likely to have a bad outcome from surgery, and 32 per cent more likely to die, with a male surgeon (stock photo)

A major study published this month suggests there might be. Canadian researchers looked at 1.3 million case reports and discovered something they rightly described as ‘troubling’: that women are 15 per cent more likely to have a bad outcome from surgery, and 32 per cent more likely to die, with a male surgeon (stock photo)

For men, however, whether they had a male or female surgeon made no difference at all to their outcome.

As about 80 per cent of surgeons are men, it raises the concerning prospect of a deep inequality at the heart of the NHS. As the study’s authors put it: ‘We are failing some female patients with fatal consequences.’

The obvious question is why. The Canadian team suggested male surgeons may be acting on ‘subconscious, deeply ingrained biases, stereotypes and attitudes’.

Could this translate into a more freewheeling attitude towards female patients, or female conditions, and then worse outcomes? The sad truth is that it already does.

For instance, the average time it takes to diagnosis endometriosis – when the womb lining grows uncontrollably outside the womb in regions such as the pelvis or bowel – is eight years.

Many women with endometriosis are initially misdiagnosed or offered painkillers, and not investigated to find the real cause.

Untreated, endometriosis can worsen to the point where patients are left with organ damage.

In 2020, The Mail on Sunday reported on a landmark legal case in which endometriosis patient Fran Bell was awarded a record £500,000 payout from Nottingham University Hospitals after ‘patronising and condescending’ male doctors failed to spot the warning signs of the disease for 18 years.

IT’S A FACT

Female GPs earn 15 per cent less than their male counterparts on average, a 2021 independent review found.

Shockingly, they called her ‘highly strung’. Having read about endometriosis, she suggested it to one of them – but it was ignored.

By the time she was diagnosed in her early 30s, the abnormal tissue was in her bowel and spine and on the sciatic nerve, which runs from the back down the legs. The disease had, in her words, ‘obliterated’ her insides, leaving her infertile.

Most disturbingly, her solicitors suggested that her experience was ‘not untypical’. And campaigners say other female conditions, such as polycystic ovary syndrome, or illnesses which predominantly affect women, such as painful fibromyalgia, are also under-researched and poorly understood.

‘Women suffering pain are often labelled as attention-seeking, not very brave,’ says Dr Stephanie deGiorgio, a GP specialising in women’s health. ‘Anyone who’s ever had pelvic pain from endometriosis knows just getting up in the morning is really hard. Women’s pain isn’t seen as serious.’

As for the disturbing findings of the Canadian study, Dr deGiorgio told the Medical Minefield podcast last week: ‘There’s clearly something going wrong. I wouldn’t like to say that it’s male doctors doing something wrong, but it might be something to do with communication. It might be that there is easier communication between a female patient and a female doctor.’

This is backed up by research. One recent study found women GPs had better clinical knowledge and used their listening skills more regularly than men, asking more questions about patients’ mood, loneliness, relationships or about recent bereavements – which could pick up hidden clues to health problems.

Other US-based research, which involved observing consultations, has found male GPs interrupt their patients after just 47 seconds, whereas female doctors waited on average nearly three minutes.

The effects go beyond letting patients feel cared for. Studies have shown patients who feel ‘listened to’ suffer less severe pain, less anxiety and are more likely to take medication.

This empathy itself can be life-saving, as an Oxford University report in 2017 found.

‘Unfriendly doctors are less likely to get enough information from patients to make the right diagnosis or prescribe the right treatments,’ it said.

‘One study even showed unempathetic doctors cause harm by scaring patients away from medical care when they need it.’

Of course, no one would suggest male doctors were, by default, unempathetic. However, it isn’t difficult to gather anecdotes from women who felt male doctors had failed spectacularly to understand their problems.

Rowena Jeffries believes she is a case in point.

The 30-year-old from Hackney, East London, has had six cervical examinations – colposcopies – over the past few years to investigate abnormal cervical smear-test results and check for the presence of pre-cancerous cells.

On two occasions she had a male doctor – and both of these examinations left her feeling ‘traumatised and vulnerable’.

Rowena, who runs an analytics company, tells the podcast: ‘One accidentally cut me when putting in the speculum, which made me bleed, and then accused me of being on my period.

‘His tone was incredibly accusatory, which made me feel a lot of shame, especially when you’re in such a vulnerable position.

‘The other took multiple biopsies, and the nurse could see I was in pain and crying. Halfway through she had to ask him to stop and use an anaesthetic. He tried to continue before it had time to work, and she had to ask him again to wait.’

Female doctors treated her differently, she says. ‘The women talked me through the process, checked I was OK, and paused when I needed pain relief.

IT’S A FACT

Women suffering with the common pelvic-pain condition endometriosis wait on average seven to nine years before being diagnosed.

‘With the male consultants it felt a lot more transactional, and they didn’t seem to take consideration for what I was feeling.’

Asked if men should not carry out such procedures, Rowena says: ‘All doctors are professionals and equally qualified to do it. But I’m definitely going to request a female doctor, as they do seem to show more empathy. For male doctors, who don’t have a womb, maybe they don’t empathise with the vulnerability and pain of this seemingly routine procedure.’

Jean points out it’s ‘a language and humour issue, too’.

‘You can laugh about your vagina being a bit shorter than other people’s with a woman doctor,’ she says. ‘It’s uncomfortable talking about and having procedures on your reproductive system, and humour can make a difficult situation more bearable. You can’t joke about that kind of thing with a man.’

Female empathy may also help with surgery. Experts suggest female doctors might be better at persuading patients to prepare for surgery – such as by losing weight or making lifestyle changes – which can affect how successful it is.

But it doesn’t wholly explain why female patients have such worse outcomes with male surgeons.

Communication and working style might play a significant role in the operating theatre itself.

Dr Clare Gerada, past president of the Royal College of General Practitioners, suggests female-led surgical teams can be more collegiate and therefore perform better. Evidence shows team-working and good patient preparation can cut the risk of surgical complications by 50 per cent.

‘In a crisis, I’d rather be operated on by a female surgeon than a male one,’ says Dr Gerada.

‘Women tend to work as part of a group than as an individual, as a man might be more inclined to do.’

Women are ‘probably not’ simply better at surgery than men, Dr deGiorgio suggests. But the challenges women face in reaching the top may mean that the ones who do are the very best – or at least the most determined.

Surgery is traditionally a male-dominated field, and women still report ‘endemic misogyny’, being belittled by male doctors and bullied by more senior staff, as well as being overlooked for promotion.

The hours are also long, often unpredictable and not compatible with family life.

Dr Gerada explains: ‘Any female surgeon who succeeds is likely to be the absolute creme de la creme.

‘Surgery has the longest training and the most unpredictable working hours. So it may be those women who do stick it out and succeed in this area may have something quite extraordinary about them which translates into better results.’

A Government consultation on women’s experiences in the NHS recently found the system often fails to listen to women and keep them safe. A strategy for women’s health will be published in spring, and a ‘woman’s health ambassador’ appointed to deliver changes.

The consultation follows similar concerns raised in inquiries into rogue breast surgeon Ian Paterson – who was jailed for 20 years in 2017 for a catalogue of botched operations – and into the use of pregnancy test drug Primodos, epilepsy medication sodium valproate and the devastating impact of vaginal mesh implants. In all cases, women’s concerns were ignored.

Dr deGiorgio says: ‘What we really need to do is get a lot more female doctors into senior level so that we can make sure they can influence the system.’

This will not be quick. In the meantime, experts agree that women should be able to request a female doctor. The Royal College of Obstetricians and Gynaecologists says hospitals will ‘do their best’ if a woman requests a female medic. But in practice, there are simply not enough of them – and insisting may mean women wait weeks or months for an appointment.

‘There is no harm is asking,’ adds Dr deGiorgio. ‘But it might not always be possible. This isn’t ideal, but is unfortunately the way the health service is at the moment.’

Any female surgeon who succeeds is likely to be the absolute creme de la creme… which translates into better results. 

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