‘All in her head’: Doctor confronts sexism in women’s healthcare

Six years ago, Dr. Elizabeth Comen, a breast cancer specialist at Memorial Sloan Kettering Hospital in Manhattan, held the hand of a patient who was hours away from dying.

As Dr. Comen leaned in to say a final goodbye, she pressed her cheek against her patient’s wet face. “Then she said it,” Dr. Comen recalled.

“’I’m so sorry for sweating with you.’”

In her two decades as a doctor, Dr. Comen has found that women constantly apologize to her: for sweating, for asking follow-up questions, for not detecting their own cancers sooner.

“Women apologize for being sick or seeking care or advocating for themselves,” she said during an interview in her office: “‘I’m so sorry, but it hurts. I’m so sorry, this seems disgusting..’”

These exam room experiences are part of what prompted Dr. Comen to write “All in Your Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why They Matter Today” . In it, she traces the roots of women’s tendency to apologize for their sick or unruly bodies to centuries of belittlement by the medical establishment. It’s a legacy that continues to shape patients’ lives, she maintains.

Today, women are more like be misdiagnosed than men and take longer to be diagnosed heart disease and something cancers; They may be least likely being offered pain relievers; His symptoms are more likely to be dismissed as anxiety or, as the book’s title suggests, as if they were all in his head.

“The anxious woman, the hysterical woman, has been a ghost that haunts and weaves through all of medical history,” Dr. Comen said. “It’s a predetermined diagnosis.”

Collectively, she argues in the book, these injustices help explain why many women say they feel invisible, frustrated or embarrassed in doctors’ offices. Shame may be the symptom, but Dr. Comen believes a deeply misogynistic medical system is the disease.

Dr. Comen, a mother of three in her 40s, is quick with a camera-ready smile, which has helped her become a fixture in breast cancer media coverage. She occasionally cries when she talks about her patients.

She once cried at her job at medical school, and a resident responded by telling her to “get it together.”

“I felt like I had to excuse my response,” she said, sitting behind her desk. “And now I cry with patients all the time.”

Her approach has been shaped by decades of experience, as well as what she learned about the place of the female body in medicine while studying the history of science at Harvard.

“The sense that women’s bodies were not only different but broken is obvious not only in the way doctors talked about female anatomy but in the medical vocabulary itself: the female external genitalia were called ‘pudenda.’ , a Latin word meaning ‘things to be ashamed of,’” he writes.

In “All in Her Head,” Dr. Comen offers a broad look at the ways she believes modern medicine has ignored women. For centuries, she writes, early medical authorities believed that women were simply “little men”—although it lacks external genitalia and comparable mental capacity, governed by harmful humors and hormones.

For too long, doctors dismissed “what could be legitimate physiological problems as irrelevant, hormonal and therefore not important,” said Wendy Kline, a professor of the history of medicine at Purdue University.

And this was the case for white women of means, Dr. Comen writes in the book. If you were a woman of color or poor, medical authorities considered you even less authority over your own body and therefore less worthy of care and compassion.

“For Black women, when we enter a clinical setting, we have to think about race. and gender discrimination,” said Keisha Ray, an associate professor of humanities and bioethics at UTHealth Houston, who studies the effects of institutional racism on Black health. “The lack of compassion and the lack of attention you receive tends to be more exaggerated.”

Take heart disease as an example. In the late 19th century, Dr. William Osler, one of the founding fathers of modern medicine, declared that women who presented with what we now know as symptoms of heart attacks or arrhythmias (including difficulty breathing and palpitations) were almost certainly suffers from “pseudoangina” or false angina, “a set of neurosis-induced symptoms masquerading as a genuine illness,” Dr. Comen writes.

Only in the last 25 years have cardiology studies included women in significant numbers. Nowadays, some heart attack symptoms that are more common in women, such as jaw and back painThey are still described as “atypical“Simply because doctors don’t see them as often in men and are less likely to take them seriously, although 44 percent of women will.” develop heart disease at some point in her life and one in five women will die from it.

“We’ve used the male model for diagnosis and treatment as the gold standard,” said Dr. Jennifer Mieres, a cardiologist at Northwell Health and co-author of the book “Heart Smarter for Women.” This has “led to continued misrepresentations, misdiagnoses, and underrecognition of heart attack in women.”

In each episode of “All in Your Head,” Dr. Comen interviews doctors who are working to improve the system, starting by taking female patients’ complaints seriously, not just noting physical symptoms, from chest pain to fatigue and gastrointestinal discomfort, up to anxiety until all other causes are ruled out, for example.

Dr. Comen also shares practical tools to better collaborate with an imperfect system.

First, she writes, it is essential that all patients trust their knowledge of their own bodies and advocate for themselves. Before an appointment ask yourself: What really worries you about your body?

“It’s not what you think you should be worried about,” Dr. Comen writes. “It’s not what you think your doctor will be able to address most comfortably and easily.”

Then, if you feel anxious about your health or because you are No To be heard, ask a friend or family member to accompany you to your appointments. This person can act as an advocate and an extra set of eyes and ears.

Finally, if you don’t like your doctor, find a new one. This may be easier said than done, she acknowledged, but a relationship of trust and respect with your healthcare provider is every patient’s right.

Audio produced by sara diamond.