How to Empower Female Patients’ Advocacy & Avoid the Yentl Syndrome

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In observance of National Women’s Health Week, we’re focusing on issues in healthcare that affect more than half the country’s population. Though the field has made huge gains recently, there are still hurdles. It’s difficult to disentangle these challenges from larger, systemic problems so pervasive in our society. Women wait longer in the ER before receiving pain medication. Women are more than twice as likely as men to live with depression. Women are disproportionately diagnosed with Alzheimer’s disease, osteoporosis, and autoimmune disorders. Their symptoms are often discredited, chalked up as overstatement. Such a dismissal can lead to misdiagnosis with severe, sometimes fatal, consequences.
These are massive issues that will require years to remedy. What can physicians do today to chip away at this juggernaut?
In short: encourage patients’ self-advocacy.

Advocacy Tip #1: Build Comfort and Rapport through Communication

According to Dr. Kay Stout, president of Virginia Women’s Center, “The real critical issue is the relationship and being comfortable to communicate.” Transparent, candid communication in feedback is the quintessence of high-quality interactions, both inside and outside the office. Patients can often feel reduced to a checklist of symptoms rather than a complex person, and active listening helps to ease these concerns.
With female patients, be on the lookout for biases. A Yale cardiology study found that many women were reluctant to seek treatment for a heart attack for fear of being labeled a hypochondriac (but more on that in the final section). Ever since the groundbreaking study of medical ethics, “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” this field of medical ethics has been discussed more openly and seriously. Consciously or not, deeming the symptoms exaggerations has quantifiable effects.

Advocacy Tip #2: Encourage Independent Research

“Back in the days before internet, smartphones, and social media, there was an information asymmetry,” Dr. Stout says. “Educated doctors knew and patients just listened. That’s no longer the case. Today, whether patients are accurately or inaccurately informed, it drives the patient-provider conversation and any misconceptions can be corrected.”
Encourage patients to share advice gleaned from friends, social media posts, or even the occasionally over-the-top self-diagnoses from WebMD; by doing so you can create a stronger connection with your patient, promote dialogue, and correct misperceptions by replacing them with fact-based science.
Furthermore, education does not need to come from outside research. Ensure patients are familiar with their baselines. This goes beyond blood pressure, cholesterol, and list of medications. If they get headaches, has the rate or severity changed? Are they normally this sensitive to light or noise? This nuanced understanding of oneself is critical.

Advocacy Tip #3: Ask Questions

In Doing Harm: The Truth about How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, author Maya Dusenbery advises that female patients ask questions that reference their sex as—due to variance in hormones, enzymes, and metabolism—treatment plans and medication regimens differ between women and men, whom testing generally favors. Examples include, “Has this drug been tested in women?” and “Are you aware of any differences [for men and women]?” Since patients may not know to ask these specific questions, aim to provide this information freely.
Dr. Stout says, “One of the best ways to end a visit is to simply ask, ‘Do you have any other questions or concerns, and is there anything else I should know about?’ Those questions frequently get to the purpose of the visit.”
A great resource for patients is the Institute for Healthcare Improvement’s Ask Me 3® campaign, which soothes the anxiety patients experience and condenses their uncertainty into three simple questions: What is my main problem? What do I need to do? Why is it important for me to do this?
Together, these three steps engender a team-based approach; doctors and patients divide their responsibilities, time, and capabilities to collaboratively solve the patient’s health issues.
Case Study: The Yentl Syndrome
The Yentl Syndrome derives its name from the 1983 musical film, Yentl, starring Barbra Streisand as a young Polish woman who, in order to receive an education in law, must impersonate a man. In the medical community, it refers to the focus on the symptoms of heart attacks among males,  which differ from female symptoms, during a heart attack. This emphasis is so pervasive that particularly lethal heart attacks are even referred to as “widowmakers,” which perfectly encapsulates the gendered discrepancy.
This imbalanced societal script has real-world, harmful consequences. Although heart disease is the leading cause of death for both women and men, a 2000 study showed that women are seven times more likely than men to receive a misdiagnosis and hospital discharge while in the middle of having a heart attack. According to CNN, “Nearly half of women in one study didn’t have the classic warning signs of a heart attack. Instead of chest pain, they were more likely than men to describe symptoms like nausea and vomiting, trouble breathing and pain in the jaw, arm or back.”
Education and representation can dispel these myths and encourage reform. Women are perennially underrepresented in clinical trials for heart-disease medication. (In fact, the landmark 1995 study which discovered the correlation between aspirin and reduced risk of heart attack involved 22,071 test subjects, and not a single one of them was a female.) However, the combination of education and patient advocacy can kickstart a positive feedback loop: together they lead to greater awareness, legislation reform, and increased testing.
There is hope on the horizon. Campaigns such as the American Heart Association’s “Go Red for Women” have galvanized awareness, and in 2013, fewer women than men died of cardiovascular disease for the first time in nearly 30 years.
To quote author and retired OB-GYN Dr. Lissa Rankin, “Whether you’re an empowered patient or a conscious health care provider, it’s our responsibility to take back the power of our healthcare into our own hands … and do what we can.”
We’re excited to announce that Privia Women’s Health is now live! Visit our site to access the resources, technology, and support you need to not only achieve better financial outcomes, but to nurture your relationship with the women you serve.

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