Guest post: Higher tolerance
Originally a comment by Pliny on Risks.
As a retired surgeon I can offer a couple of thoughts. When I was teaching residents I used to tell them that we didn’t have a healthcare system but rather a methodology for treating middle-aged white guys. Much of the medical literature of my formative years described signs in symptoms in men predominantly. One of my proudest moments was when an AI system I was developing identified a variant presentation of a deadly condition in a woman because it recognized the significance of sex and ethnicity in disease and injury presentation.
I also told the residents that if men had to carry a fetus to term our species would be long extinct. Despite the cliches associated with such things, women in both my experience and the literature, tend to have much higher tolerances for symptoms like pain. Higher tolerance can lead to diagnostic delays which lead to more advanced disease and hence higher mortality.
Also, up until recently, many women had their symptoms pooh-poohed as well which lead to the same delays and consequences.
I agree entirely with your summary. Indeed, I have struggled a lot because it has always seemed to be hard for medical personnel to believe the amount of pain I’m in (it appears to me that they believe women exaggerate, when we actually understate), or considered that a young, slim, woman could have heart disorders (those are the province of obese middle-aged and older men) or auto-immune arthritis. The sheer time taken from onset of symptoms to correct diagnosis was astonishing; although at least partly explained by doctors assuming I had mental health disorders such as panic attacks (although they somehow missed my autism). Even the congenital disorders weren’t diagnosed until I was middle-aged.
I did notice that it was female doctors (of any age), and younger male doctors, who picked up the things which the older doctors missed or were too arrogant to acknowledge. In that sense, I hope that many of the problems are retiring with the God-Surgeons.
I now have an awesome set of doctors taking care of my various conditions, and I no longer have complaints in that regard. I should be grateful that eventually everything has been sort-of sorted out. Well, I’m still in constant pain in every joint in my body (except the ones in my ears), I’m pretty much immobile, and I can’t see in normal light without eye pain (it has to be gloomy to be tolerable) unless I wear a weird assembly of filters over my eyes (I have f.lux running on my laptop, plus the internal screen colour set to ‘warm’, and the screen on its dimmest setting, so everything is dark orange), but I’m still here!
Unfortunately the retirement of the God surgeons isn’t entirely a reason to celebrate. Those generations of surgeons had a level of experience that far exceeds that of the current generation. Yes, it was pathological, but when I graduated from my residency in the bad old days, I was starting out in practice with a volume of experience that current residents may achieve in 5 to 10 years after graduation. More than knowing when to do surgery, I had the experience to know when not to do it.
My training took place in an interesting time. When i was in medical school most training programs were still segregated. The first African American resident admitted to my program was 4 years ahead of me – the first woman – 2. While I was Chief Resident our first resident became pregnant. The uproar in our monthly meeting with the attendings was heated. I was labelled a communist for suggesting that if we ever intended to include the other half of the population in surgery we were just going to have to deal with it and provide coverage (that was in 19bloody90!). ( FYI: she worked and took call until 4 days before delivery.) Yes, I know – I’ve always been a pain in the ass.
Also, one of the other things I taught the residents about surgery was that as long as you weren’t a total ass, the bar was so low for expectations that most people would view you as a saint ;)
tigger, I have a younger male doctor currently, and he is top notch. He never treats me like I’m hysterical, and he takes my complaints seriously. It might help that he knows I’m a biologist, but that has never stopped doctors talking down to me in the past. But…my previous doctor, also male, was older, and retired about two years ago. He was the same way. Took things seriously, was willing to accept that I knew how I felt, and listened when I talked to him. So I’m not sure it’s about age at all, though I do believe there are differences in training now that might make the younger doctors less inclined to dismiss women’s complaints. It might be more about just being aware, and caring, that there are differences.
I have had woman doctors in the past; I didn’t notice much difference in the attitudes when the doctor was a GP. I do think woman specialists are more likely to take me seriously than man specialists.
I apologise for giving the impression that I thought all older doctors were bad. I didn’t mean that, just that there seemed to be a greater proportion of narcissists, who entered medicine and then surgery for the feeling of power it gave them, in the older cohort. Younger narcissists seem to have gone into other professions. Also, training has improved as the differences between male and female anatomy etc. have started making it into the training materials. Many older male doctors I have dealt with have been very nice indeed, and some young ones of both sexes have been dismissive. In my experience, race and nationality aren’t predictors of anything.
But when it comes to surgeons in particular, I suspect that it is the narcissistic men who disproportionately go into that particular discipline.
Sorry that was your experience. Mine was very different. Like all groupings of people, there isn’t one type of surgeon or personality type that finds that work rewarding. I believe I went into medicine for the right reasons and like most docs, my experiences on clinical rotations ended up having a tremendous influence on the specialty I chose. I was privileged to train under some outstanding surgeons and human beings. My mentors really were bigger than life and their skill was inspiring. In practice again I was surrounded by outstanding clinicians. They were generous to their community . All their practices averaged around 30-45% free care. I ended up in trauma surgery because I turned out to be good at it, I had the opportunity to work closely with some of the pioneers of the field, and it was (and still is) the most egalitarian area of medicine in this country. Trauma was blind to economics, class, race, gender, even criminality. Everybody got the same care. We also worked hard to identify the roots of trauma and a lot of the safety improvements that make us all safer came from the efforts of the American College of Surgeons. It was a hard life but rewarding. Yes, many of those pioneers in trauma care were very sure of themselves (with reason) but nothing they did ever struck me as narcissistic.