machado: being told that 'there's going be a little discomfort' is not good enough when we're talking about pain
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hundreds of studies have shown that the pain women experience is often treated differently than men's pain. getty
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my twitter feed got a little fast and furious this past week around the topic of pain. particularly, women’s pain.
kicking off the heated thread was a post about a recent episode of cbc’s white coat, black art with dr. brian goldman that explored not only the pain of the insertion of birth control devices (iuds) — which the women interviewed described as “searing,” “intense,” “unbearable,” and “horrific” — but also the tendency for health care providers to minimize and dismiss women’s pain.
in fact, although each woman — even those who called in to comment — had a slightly different experience, they all said the same thing: that, despite the fact it was known that the pain of the procedure could potentially be “searing” “intense” and “unbearable,” they were told to expect just “a pinch,” “a little discomfort,” or something “similar to what happens during a pap test.”
none of which was true for any of these women.
the discussion raised a lot of questions on twitter. first, why do so few doctors take the time to explain truthfully how a procedure might feel — after all, we have consented to have it done, don’t we have the right to know the level of pain we may experience? and wouldn’t such a conversation give us the opportunity to explore ways to manage the pain like sedation, or pain medication? and why on earth haven’t we yet found a better way to insert iuds, and do all other things gynecologic?
it’s no secret — to women, at least, — that women’s pain has long been misunderstood, ignored, and pushed to the side by health-care professionals, and also by society.
“there’s still this pervasive belief in the medical community that anytime a woman complains about her health, it’s either related to her hormones or all in her head,” dr. stephanie trentacost mcnally told northwell health, adding, “how often does a woman get angry, only to be asked if she’s about to get her period?”
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it’s no secret, to women at least, that their pain is ignored
this is a dangerous form of gaslighting that not only increases the chance of misdiagnoses and the time to diagnosis, but it also makes women less likely to seek medical attention when they need it. one doctor interviewed by the cbc, calgary’s dr. fiona mattatall, said that she worries patients who had painful iud experiences may opt out of gynecological care because they are scared.
also worrying is the fact that hundreds of studies have also shown that the pain women experience is often treated differently than men’s pain. for example, one 2008 study found that women who showed up in the emergency room with acute pain were less likely than men to receive the most effective painkillers. women also wait longer in emergency departments than men, and are less likely to be classified as requiring urgent attention. and in a study by the society for academic medicine, researchers found that women with exactly the same symptoms as men waited an average of 16 minutes longer to see a doctor. it’s hard to read those stats without getting at least little bit angry because, well, that’s bananas.
but understanding the gender disparities that exist in health care don’t tell us much about why many medical professionals seem to gloss over the deets when it comes to how much something should or shouldn’t hurt.
perhaps it has something to do with a bid to reduce anxiety, writes esther smith in the mighty, but she says that downplaying pain or “relabeling” it actually increases anxiety, fear and worry.
“i wish doctors would be more direct. they may think being straight with us will scare us, but in reality, it can do just the opposite,” she writes. “they may think using lighter terminology will help us not catastrophize, but this just makes me fearful that no one believes me and i won’t get the help i need.”
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if it’s going to pinch, then tell me it’s going to pinch
you nailed it, esther. lay it on the line. if it’s going to pinch, then tell me it’s going to pinch. if it’s going to make me scream bloody murder, well, i want to know that too. will i be anxious and scared? hell, ya. but letting me know what to expect not only allows me to prepare myself, and also shows respect for me as a human with feelings and fears, who is part of the health care team. most importantly, it validates my pain.
when doctors suspected that i had leukemia, i needed a bone marrow biopsy to confirm it. as a resident explained the process, which involved pushing a needle deep into my hip bone, i could feel my stomach clench with worry.
“how much is it going to hurt?” i asked. he looked at me for a moment, his forehead furrowed and then said, “a lot.” then he suggested that i take some painkillers beforehand.
and while knowing what was coming neither eased the pain nor my anxiety, it did help me prepare for the worst and also have a management plan — i brought along a loved one to hold my hand, one of my favourite magazines to read in the waiting room, and earphones to listen to music. knowing what to expect also gave me confidence, a feeling of control and the sense that we — the doctor and i — were working together.
but i don’t know that i have ever experienced the same kind of clarity and honesty since.
a few years ago, after an abnormal pap test, i had a cervical biopsy to check for cancer. my family doctor brushed the procedure off as routine — “a quick scrape of your cervix, they do it all the time,” he said, waving his hand around dismissively.
the gynecologist, however, didn’t use the word “scrape,” which would have been way more appropriate. instead, she said it would be “a little uncomfortable,” with “maybe a little burning” and “some pressure.”
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i remember lying underneath a thin white sheet on the examining table, naked from the waist down with my feet in stirrups, hearing the snap of the latex gloves as she put them on — first one hand, then the other. i was shivering, a little because i was cold (why are those examining rooms always so cold?), but also because i was nervous. it felt a little like that breath-taking anticipation — but not in an exciting way — when you are on the top of a hill on a rollercoaster, just waiting for the inevitable to happen. plus, since i couldn’t see what was going on down there, my brain had nothing to do except conjure it’s own brand of terrifying version of what was about to happen. so i just laid there. waiting.
as i stared at the giant sunflower painted on the ceiling — one green leaf had turned a splotchy brown colour from the stain of a water leak — i figured, how bad could it be? after all, as someone who has endured many bone marrow biopsies, i consider myself to have a pretty good ability to get through some serious pain. what’s a little “discomfort, burning and some pressure”?
each scrape was like a cactus being rubbed along my insides
turns out the procedure was all of those things multiplied by about a million. i can’t remember what i said — i am almost certain that i yelled — and as the nurse firmly held my legs as they began to shake uncontrollably, i could feel my forehead damp with sweat. a wave of nausea floated over me with each “scrape” that felt like a giant cactus being rubbed up and down my insides. when i asked how much longer, the doctor looked up from between my knees and said, “just one more minute,” but it felt like a very long, awful hour.
when she was finally done she looked at me with a sympathetic face. “i’m sorry, hun,” as she handed me a big fat maxi pad. “there may be some bleeding, so use this. take advil if you get any cramping.” and she walked out of the room.
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as the nurse wrapped the label with my name onto a small vial, i asked her if the biopsy was that painful for everyone. she looked up and smiled, “sometimes.”
and just like mattatall told the cbc, when it came time for my next appointment, i stressed for weeks leading up to it and i even thought of cancelling.
it’s clear we have a long way to go in terms of legitimizing and validating pain in our health care system. and it’s not only health-care providers who need to have these conversations, but patients should also feel comfortable asking tough questions about procedures and pain — and then feel safe discussing how to manage it. after all, we deserve to have the chance to make a plan around our health — especially when it comes to pain.
lisa machado is the executive producer of healthing.ca
this story originally appeared in the healthing weekender. subscribe here.
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