Letters: When It Comes to Health Care, ‘Women Must Be Vocal, Be Militant, Be Vigilant, and Be Political’

Readers discuss the challenges of being a patient in the American health-care system.

Mike Blake / Reuters

The Doctor Doesn’t Listen to Her. But the Media Is Starting To.

Doctors have historically dismissed women’s sexual- and reproductive-health concerns. But lately, Ashley Fetters wrote recently, public discourse has begun to take those concerns more seriously.

I am 60 years old. In 1976, my university required women’s studies courses for undergraduates. In those courses, instructors presented the very same issue as this article, with the same stories and similar “people are just beginning to wake up” messages.

Here we are, 42 years later. Nobody woke up. What I’ve learned after those 42 years is that it’s not going to get better. To think that it is, to think that we can relax, that it’s all right now, that we can assume we’ll be respected and heard, could be life-threatening. Women must be vocal, be militant, be vigilant, and be political about their right to receive accurate diagnoses and appropriate health care. I think that’s going to continue to be the case for a long, long time.

Colleen Gallagher
El Dorado Hills, Calif.

Just as pediatric health care is separate from adult health care, I believe it’s about time women’s health care should be classified as a separate discipline, independent from men’s health care.

Sharon Scanlon
Cherry Hill, N.J.

I was so happy to see the article about gaslighting, women’s issues, The Bleeding Edge, and more. I would add that these problems occur among patients of all socioeconomic classes, genders, ages, and races. Looking at Facebook groups like ProPublica Patient Safety, Medical Error Transparency Plan, and Mothers Against Medical Error, I don’t think it’s just women in danger in the U.S.

Emily Paterson
Charlotte, N.C.

Ashley Fetters’s commentary on patients being dismissed by their doctor is on point. Yes, it is rampant in reproductive health, but not purely isolated to this field.

After working as an OB-GYN nurse for 16 years, and then a registered nurse-patient advocate for the past 14, I’ve processed and managed many patient complaints inside and outside the hospital setting. Patients feeling dismissed is very common. Emergency departments are an especially high-risk area for the type of clinician behavior that leads to this grievance. Although sexism can play a part, in my experience it has more to do with clinician training and the culture in which they have been educated, mentored, and work. It also has to do with the volume of patients they are expected to care for.

In the American health-care system, doctors and hospitals are financially rewarded for the volume of patients they see and the diagnostic tests they order. They are not (financially) rewarded on par for the time they spend with patients. Diagnosis can be an iterative process that takes time and patience. If we want better care and better patient outcomes, we have to fix these perverse incentives.

The change also has to start in medical-school classrooms with role-playing and real-life practice that includes active listening, and questions that engage patients and welcome their input. Hospitals and health systems will need to step up their game with retraining and implement zero-tolerance policies around dismissiveness and patient blaming.

There are some wonderful clinicians out there who excel at this every day. These skills can be taught, but they have to be valued by hospital and facility leaders and be a standard that clinicians are consistently coached in and held accountable to.

Lori Nerbonne, RN, BSN
Concord, N.H.