In my experience it's not the doctors, who without exception have always been pretty good - but the clerical / reception staff. I've rarely been made to feel so unwelcome anywhere else.
It's gotten to the point where I just stump up the cash and go private, although now I feel things have gotten better with the introduction of app based consultations via the NHS, which I'm registered for but haven't needed to try out yet.
You assume that that is not only an option, that it is easy to do so, and that changing GP will make a difference when you are in a monopolistic system like a government captured and controlled healthcare where there is little to approaching zero incentive to differentiate and be exceptional.
I frequently find myself confronted with the reality that most people don't seem to be able to fully refactor their thinking about things. They are unable to fully realize and consider the consequences and impacts of their actions on all aspects of the system they are proposing massive changes too. What's even more baffling is that this mentality is not only seemingly extremely well represented in the tech community, but that it can exist in the tech community at all without even the slightest pause about the impact of massive changes and zero appreciation for reflexive unintended (which really should be called unrealized) consequences.
Another great example of this is the socialist/communist/marxist/progressive/liberal types' apparent inherently inability to comprehend that the policies and actions they advance and support will have equal and opposite reaction. There is so frequently today this assumption that "all other things will remain equal", which is absolutely never the case in a system, let alone a complex one.
I think it's both. The GP doesn't seem to take you seriously if you appear to be a young healthy dude.
I once hurt my ankle really bad while doing surfing and the doctor made fun of me "being girly" and to go home and put some ice on it.
I just wanted to make sure there was nothing broken.
Only recently while thinking about it I realised how bad his attitude was and it certainly made me think at that time that it is in my head and I shouldn't go to the doctor.
I remember reading psychologist studies where doctors are twice as likely to diagnose a woman with depression compared to a man with an identical profile, and on average women have a higher chance of correctly getting an diagnose of depression.
I also remember seeing a study that sent identical profiles to general doctors but with the profile gender randomized. The result as I recall was that female patients were more likely to be believed in regard to pain and self-reported symptoms, but those men that did still get diagnosed were more likely to get active treatments.
Women are on average more neurotic than men, therefore physicians will be more skeptical of their claims; psychosomatic symptoms are more common for females.
Sex differences in the genetic sense exist, and are founded on physics, chemistry and biology. Let's not hide from them either, veiled behind ideological double-speak.
Suppose for the sake of argument that on average women have higher rates of thinking something is physically wrong with them when there isn't. Is it not rational for doctors to take a Bayesian approach and weight their diagnoses accordingly?
Is it not rational for doctors to take a Bayesian approach and weight their diagnoses accordingly?
Not without having very detailed information on exactly how big the difference is and, equally important, how these differences are distributed within each sub-population.
Bayesian reasoning is good when applied rigorously, but can be dangerous when applied sloppily and lazily, since people are terrible at subjectively estimating probabilities and tend to be way over optimistic when updating their priors with any new information they receive.
Basically people will treat information that should realistically cause them to update their priors from 50-50 to 51-49 as if it was information that should cause them to update to 80-20 (and then they round off too 100-0).
Group differences are real, and burying or ignoring that truth is doomed to failure, since it is obvious. However, we have a moral responsibility to evaluate every person as an individual - to give each the benefit of the doubt, regardless of how people who look like them tend to behave.
I myself think this is a two way street. If you belong to a group with a particular characteristic and you're an exception, you may need to make an effort to make that explicit - with a statement, via behavior, via dress. And it is not evil when people make assumptions about you; it's understandable. At the same time, we should try to be fair to everyone, to keep in mind that exceptions exist to every rule, and to allow others to change our first perceptions of them easily. I think this approach walks the line between truth and justice, though I am certainly open to hearing a better strategy.
Unfortunately there is another dimension here which is that we're allocating a scarce resource (medical care). If one group has significantly higher rates of hypocondria (again, I don't know for sure whether this is true, but assume for argument's sake that it is), and we're forced to treat everyone as an individual (i.e. ignore this fact), then this necessarily deprives other groups of resources (medical care).
Bayesian reasoning is a terrible fit for healthcare because it ignores risks.
Suppose 99% of the time a set of symptoms is harmless and 1% of the time it's deadly. A 1% risk of death is extremely high and needs to be taken seriously even if ignoring it would be correct 99% of the time.
That's describing probabilities of truth, not the correct responses to those probables. I did not say false positives or false negatives etc, I simply said the post diagnosis odds.
Doctors and patients have little reason to care about odds directly they care about Risk which is ~= odds * harm. Odds going from say 10 to 15% or 0.015% to 0.02% don't have big impacts on your net Risk.
The other time I went to the doctor to complain about back pain, and get an appointment for a physio. The doctor asked me to do some movements that didn't seem directly related to my issues. Then she explained that they have to check for a specific condition (like a spinal bulge or something) that, albeit very rare, absolutely needs to be operated on as soon as possible.
Comments like this don't say anything. Obviously sex differences "in the genetic sense" exist; we have different sets of organs to prove it. That doesn't mean every attribute assigned to women on message boards is worth entertaining.
I fully agree they exist, but it is very hard to separate which are just culture from those that are real differences. You can measure hormone differences of course, and there are other measurable things, but you quickly get into measurable differences but no idea if they are nature or nurture.
Edit: this isn't to say that there isn't a bias... maybe doctors know this already, but assume that the effect is bigger than it is? Alternatively, they don't know this, and could treat their patients better if they had known. In any case, nothing good comes from denying the truth.
> ...it took another few years to find another set of doctors who would take her symptoms seriously. “I had a lot of, ‘You’re just hysterical,’ ” she remembers. “One of the more common things, especially in emergency rooms, was ‘You’re just drug seeking.’”
> As a woman of colour, Jackie was facing more than gender bias.
A friend of mine (black, female) was shooed away by doctors as "drug seeking" and later told she had lyme disease, was even put on a treatment for it before someone listened carefully and discovered the gigantic tumors growing on her liver!
Meanwhile I (white, male) went in for a 2-week cough that was keeping me up at night. Never been to this office or met the doc before but was given a script for codeine (!!) after about 2 minutes in the exam room.
Your story sounds worse to me -- you sought medical attention for a problem, received a dangerous drug with no meaningful diagnosis. I'm sure your insurance company still received a big bill for those 2 minutes.
I (white, male) have had similar experiences to your friend, minus the "drug seeking" accusation. Things like cysts and tumors are difficult to diagnose without imaging, and imaging is difficult to justify without symptoms. Lyme disease is often doctor-speak for "no idea".
If your friend, like you, had received a powerful narcotic painkiller instead of a diagnosis, might the painkillers have covered up her symptoms and caused her tumors to go unnoticed longer?
I'm very skeptical of the medical industry. Modern medical science is fantastic stuff but as an industry there is something seriously wrong. I think they over-prescribe painkillers on a scale few people would find believable. It's disappointing they aren't applying the skepticism your friend received universally across the board. It would do a lot of good if they did.
There might be bias at play, but this kind of different treatment happens to all sexes and races. It depends on doctors. I'd like to bring up people with ADHD being treated as drug-seekers, but I can't seem to find any real data on it. All I have are collections of anecdotes anyone could read up on by googling it and reading forums or simply reading reddit about it. On the other hand, that's going to be very biased.
So the way I see it, there's one of two (mostly useless) ways to eliminate gender bias.
The first is bias training, to get people to recognize and react to their implicit biases. You see one patient that is rude, non-compliant, etc, and you implicitly assume that patients that have the same features will act the same, and you act accordingly. This is usually within the context of racial bias ("the black patient isn't compliant, so all black patients must also not be compliant and thus I'll not give them the best care"). Not-so-fun-fact: most people hate going to these sort of training workshops (me included), and so I don't think these are very effective.
The second is having more women in healthcare. With cultural/racial/ethnic bias, we have seen a decrease in that bias when physicians of that culture/ethnicity are involved in that patient's care. Problem is, I don't believe this has worked all that well when applied to gender bias. You may argue that women are severely under-represented in areas of healthcare (surgery for example), and we should strive for there to be more female surgeons. However, look at obstetrics/gynecology in the US. We have a predominantly female workforce, and there's still bias against women during/after pregnancy. Look at how many patients presenting with symptoms of pre-eclampsia (leading to a potentially fatal condition HELLP) are missed or disregarded. What about the rates of pulmonary embolism after overlooked deep vein thrombosis symptoms post-childbirth?
The healthcare industry has in recent times made it hard to spend the time or resources needed to really "care" for a patient. Doctors have to keep their visits short to maintain their volume (and job), nurse shortages are prevalent, and everyone is overworked. I don't know if or when we're going to end up solving this problem, but maybe starting an honest conversation with colleagues will help.
It’s not clear if gender bias is the right word given that it’s such a loaded term. Women visit doctors more frequently and as the article states have higher rates of mood disorders. Given this, it seems obviously that misdiagnosis would be higher in women than men. It falls out of the Baysean statistics. If AI we’re doing the evaluation you could remove the gender parameter, but it could lead to even more frequent misdiagnoses. Alternatively we could be more exhaustive with diagnosing women but at what cost to the healthcare system? But then wouldn’t we be biasing against men? There is no free lunch here.
40 comments
[ 2.9 ms ] story [ 63.1 ms ] threadhttp://bmjopen.bmj.com/content/3/8/e003320
http://news.bbc.co.uk/1/hi/health/8588686.stm
When I go to the GP she makes me feel like I'm intruding and wasting her time, like you're a man in your 20s, nothing could be wrong..
Seriously, I've never encountered this attitude. Doctors seem to be generally fairly clinical and professional.
I frequently find myself confronted with the reality that most people don't seem to be able to fully refactor their thinking about things. They are unable to fully realize and consider the consequences and impacts of their actions on all aspects of the system they are proposing massive changes too. What's even more baffling is that this mentality is not only seemingly extremely well represented in the tech community, but that it can exist in the tech community at all without even the slightest pause about the impact of massive changes and zero appreciation for reflexive unintended (which really should be called unrealized) consequences.
Another great example of this is the socialist/communist/marxist/progressive/liberal types' apparent inherently inability to comprehend that the policies and actions they advance and support will have equal and opposite reaction. There is so frequently today this assumption that "all other things will remain equal", which is absolutely never the case in a system, let alone a complex one.
Are you claiming that this fact is explained by the doctors actions and not by the gender norm that men should just bear with minor illness?
I once hurt my ankle really bad while doing surfing and the doctor made fun of me "being girly" and to go home and put some ice on it.
I just wanted to make sure there was nothing broken.
Only recently while thinking about it I realised how bad his attitude was and it certainly made me think at that time that it is in my head and I shouldn't go to the doctor.
I also remember seeing a study that sent identical profiles to general doctors but with the profile gender randomized. The result as I recall was that female patients were more likely to be believed in regard to pain and self-reported symptoms, but those men that did still get diagnosed were more likely to get active treatments.
Balance.
Sexist: "I'm going to be more skeptical of this particular woman's experience because she's a woman and probably is just hysterical."
Not without having very detailed information on exactly how big the difference is and, equally important, how these differences are distributed within each sub-population.
Basically people will treat information that should realistically cause them to update their priors from 50-50 to 51-49 as if it was information that should cause them to update to 80-20 (and then they round off too 100-0).
Group differences are real, and burying or ignoring that truth is doomed to failure, since it is obvious. However, we have a moral responsibility to evaluate every person as an individual - to give each the benefit of the doubt, regardless of how people who look like them tend to behave.
I myself think this is a two way street. If you belong to a group with a particular characteristic and you're an exception, you may need to make an effort to make that explicit - with a statement, via behavior, via dress. And it is not evil when people make assumptions about you; it's understandable. At the same time, we should try to be fair to everyone, to keep in mind that exceptions exist to every rule, and to allow others to change our first perceptions of them easily. I think this approach walks the line between truth and justice, though I am certainly open to hearing a better strategy.
Suppose 99% of the time a set of symptoms is harmless and 1% of the time it's deadly. A 1% risk of death is extremely high and needs to be taken seriously even if ignoring it would be correct 99% of the time.
[0] http://yudkowsky.net/rational/bayes
Doctors and patients have little reason to care about odds directly they care about Risk which is ~= odds * harm. Odds going from say 10 to 15% or 0.015% to 0.02% don't have big impacts on your net Risk.
The other time I went to the doctor to complain about back pain, and get an appointment for a physio. The doctor asked me to do some movements that didn't seem directly related to my issues. Then she explained that they have to check for a specific condition (like a spinal bulge or something) that, albeit very rare, absolutely needs to be operated on as soon as possible.
I fully agree they exist, but it is very hard to separate which are just culture from those that are real differences. You can measure hormone differences of course, and there are other measurable things, but you quickly get into measurable differences but no idea if they are nature or nurture.
from https://en.wikipedia.org/wiki/Neuroticism
Edit: this isn't to say that there isn't a bias... maybe doctors know this already, but assume that the effect is bigger than it is? Alternatively, they don't know this, and could treat their patients better if they had known. In any case, nothing good comes from denying the truth.
https://news.ycombinator.com/newsguidelines.html
> As a woman of colour, Jackie was facing more than gender bias.
A friend of mine (black, female) was shooed away by doctors as "drug seeking" and later told she had lyme disease, was even put on a treatment for it before someone listened carefully and discovered the gigantic tumors growing on her liver!
Meanwhile I (white, male) went in for a 2-week cough that was keeping me up at night. Never been to this office or met the doc before but was given a script for codeine (!!) after about 2 minutes in the exam room.
I (white, male) have had similar experiences to your friend, minus the "drug seeking" accusation. Things like cysts and tumors are difficult to diagnose without imaging, and imaging is difficult to justify without symptoms. Lyme disease is often doctor-speak for "no idea".
I'm very skeptical of the medical industry. Modern medical science is fantastic stuff but as an industry there is something seriously wrong. I think they over-prescribe painkillers on a scale few people would find believable. It's disappointing they aren't applying the skepticism your friend received universally across the board. It would do a lot of good if they did.
The first is bias training, to get people to recognize and react to their implicit biases. You see one patient that is rude, non-compliant, etc, and you implicitly assume that patients that have the same features will act the same, and you act accordingly. This is usually within the context of racial bias ("the black patient isn't compliant, so all black patients must also not be compliant and thus I'll not give them the best care"). Not-so-fun-fact: most people hate going to these sort of training workshops (me included), and so I don't think these are very effective.
The second is having more women in healthcare. With cultural/racial/ethnic bias, we have seen a decrease in that bias when physicians of that culture/ethnicity are involved in that patient's care. Problem is, I don't believe this has worked all that well when applied to gender bias. You may argue that women are severely under-represented in areas of healthcare (surgery for example), and we should strive for there to be more female surgeons. However, look at obstetrics/gynecology in the US. We have a predominantly female workforce, and there's still bias against women during/after pregnancy. Look at how many patients presenting with symptoms of pre-eclampsia (leading to a potentially fatal condition HELLP) are missed or disregarded. What about the rates of pulmonary embolism after overlooked deep vein thrombosis symptoms post-childbirth?
The healthcare industry has in recent times made it hard to spend the time or resources needed to really "care" for a patient. Doctors have to keep their visits short to maintain their volume (and job), nurse shortages are prevalent, and everyone is overworked. I don't know if or when we're going to end up solving this problem, but maybe starting an honest conversation with colleagues will help.
Edit: changed some words for clarity.