Why Do Doctors Tell Women: "Its All In Your Head"?
All in Your Head?
Many women experience the problem of having their medical concerns dismissed by their own doctors as being "all in your head". Physicians more often label women patients' complaints as emotionally based. Women's problems are not imaginary nor are their perceptions about the treatment of women as patients. This is thought to be due to several factors.
One is that women often express themselves with more emotion, especially when stressed. This expression gets confused with the source of the problem by some doctors and health providers, because of their own learned gender biases. Women have higher rates of depression than men, so this also pulls the doctor towards this diagnosis. Lastly, people in chronic pain tend to become depressed as a result of their conditions and may communicate this depression to their doctors, which is in turn misread as the source rather than the result of a person's pain.
Secondly, women have higher rates of Chronic Fatigue Syndrome, Fibromyalgia and auto-immune diseases. All of these conditions may present with vague, generalized symptoms. There are either no concrete tests for many of these conditions or the tests are often negative in spite of the presence of disease. The symptoms presented are part of a huge number of conditions, and in lieu of tests the diagnosis becomes a judgement call on the part of the doctor. Quite frankly, many physician's diagnostic skills are not that great. They are unable to do the complex intellectual task of recognizing complex patterns of symptoms imperfect fit with the various diseases.
Physical health problems emerge or are exacerbated by psychological stress. These are called somatoform disorders. They are not primarily psychiatric in origin, but rather problems in which the physical and the psychological issues need to be addressed to get full recovery.
There are ways to get better, more attentive care from your doctor or provider; your first line of defense is in choosing your doctor.
Degrees, credentials and affiliations don't often tell you about a doctor's ability to listen and to avoid stereotyping women patients. Word of mouth is best. Ask other women, many other women, who they see. Ask specifically about interpersonal skills.
One credential that is very predictive of a good rapport and good attention to your complaints is specialized training in Women's Health. This is not to be confused with OB/Gyn. It is training in how women show symptoms of disease, have occurrences of particular diseases, and respond to treatments differently than men. It addresses all areas of health, not merely those of the reproductive system. Women's Health training can be gotten as Continuing Medical Education through the American Medical Women's Association.
Here are some other clues that will tell you on first visit as to whether or not your doctor is likely to take your complaints seriously.
- The doctor's staff is courteous when you call.
- Lets you dress and undress in private.
- Explains what s/he is doing and is about to do as s/he examines you.
Basically, these are clues to finding a doctor who will listen and is respectful.
There are also methods for improving communication.
Keep a complete health diary.
Try to determine your Chief Complaint. In plain English, what is the one single thing that bothers you the most? When did it start? How has it changed since it started? Does anything make it better or worse? Can you take one finger and point to one spot where it hurts the most?
Work with Your Doctor
For difficult to diagnose problems:
Ask for a referral to a specialist, if you haven't been improving or diagnosed for some time. Be patient though, the diagnosis of a rare condition can take time. Also, it takes time to determine whether or not treatments are effective.
Try to limit the likely origins to one or two organ systems. Often difficult to define symptoms and general symptoms, in women, have diagnoses in the areas of immunology and allergy, rheumatology, or endocrinology. Occasionally the answer is found in infectious disease or cancer.
You may want to travel to a major medical center in your region of the country. A University-based program in a large metropolitan area nearest you with a population of about 1 million or a major medical center is what you want. Do not rely on magazines, such as U.S News and World Report or similar local versions for referrals. These are compiled by editors and journalists who do not have the scientific background necessary to do this.
When all else fails try this and then move on to another physician.
DOCTOR: All the tests are negative. I can't figure out what's wrong with you. I think it's due to psychiatric problems.
PATIENT: Oh I'm sorry to hear that, Doctor. I'll come back after you've been to a psychiatrist.