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how women can have better conversations with doctors
7 minute read
you are an equal partner in your care. ask questions, seek clarity and remember your voice matters.
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people get nervous about seeing their doctor. appointments have a limited time window to raise any concerns, so there’s pressure going in. also, they might feel vulnerable and anxious about receiving bad news or having tests that make them uncomfortable.
for women, a doctor’s appointment can be even more stressful because there’s a long history of bias regarding “women’s issues,” where symptoms may be dismissed or misinterpreted. while that’s changing, there are still challenges for women (and other populations) to access care.
“the healthcare system is not the safest place for everybody, unfortunately, due to systemic racism, misogyny and homophobia and transphobia and all sorts of things, so i have the privilege of doing that work,” says dr. sheila wijayasinghe, a family physician in toronto at st. michael’s hospital who works with a multidisciplinary team, and medical director of primary care outreach at women’s college hospital.
“i’ve noticed that women are dismissed in the healthcare setting, often they are taught not to trust their own symptoms. so, we do a lot of affirming: trust your symptoms, know your body, you know your body best, and it’s ok for you to seek out care. you don’t have to suffer through things.”
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her outreach team is building pathways to address care gaps with culturally sensitive connections and education.
just as important, when women give themselves permission to seek care, how can they advocate for themselves and have a meaningful conversation with their doctor?
how to talk to your doctor
dr. wijayasinghe is well-versed in this area because she understands that women need support and practical guidance. “we all have an opportunity to advocate for ourselves, and it’s our right as patients to get the care that we need. but there are differences in how people are treated in the healthcare system. so acknowledging that is really important upfront,” she continues, “to advocate for ourselves and bring in support to level that playing field.”
she’s even created an acronym to help women approach their doctor called partner:
p—prepare for your appointment. track your symptoms and set some goals for the visit to make the most of your time with your doctor. “a prepared patient can express the symptoms that they’re having and the effect that it’s having on their life. so not just, ‘i have fatigue,’ but ‘i’m unable to do the things that i normally would be able to do.’”
she explains the need to describe symptoms, how long they’ve been occurring and the possible triggers, working with a symptom tracker ahead of time. for example, perimenopause and menopause symptom trackers are common. writing out symptoms over time is more effective because you don’t always remember details and “blank out” because of nerves during the doctor appointment.
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a—ask for the right support. find the support that works for you through virtual care options or specialist clinics with trained clinicians. “ask about who you need to see to get help? what kind of tests do you need to get? is there someone else that you need to see? is there an allied health professional that might also be well-suited?” it could be seeing a social worker to connect you with community services or a therapist if you’re having mood issues.
r—recognize your rights. you are an equal partner in your care. ask questions, seek clarity and remember your voice matters. dr. wijayasinghe says that the role of a family doctor is to help understand who is available to you in the community and where we can refer you. “asking for the right support is recognizing your rights, and i think this is one that we often forget as patients. asking questions, requesting clarification, that’s all part of it because your input is essential in this relationship.” she also highlights the need to share in the decision-making, so your health plan fits your life plan and makes sense for your situation.
“it’s ok to ask those questions. and again, those are hard to do in a short appointment. but knowing that you can pause for a second and say, ‘i didn’t understand what you said. what do you mean? or what’s next for me? i want to write it down.’ that’s ok to do that. and if someone is not allowing that, then that’s not you. that’s the system.”
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t—talk openly about tough topics like finances, work or sex because even the hard topics matter. leaning into the discomfort with these conversations can improve your health outcomes. she notes that this is challenging because healthcare spaces are where we’re most vulnerable. clinicians should be asking if you can afford your medication. what’s happening at home? are you having difficulty making ends meet?
“a lot of my patients will skip a medication every now and then so they can afford it and stretch it out,” she says of people who don’t have a drug benefit plan or are not on government support programs to help cover the medication. “i need to know that because maybe there’s some financial support programs or another medication that is cheaper and just as effective. maybe i can work with a pharmacy team to actually decrease your dispensing costs. so there are practical things that we can do.”
income and social determinants of health are important pieces that need to be discussed.
another tough topic that should be brought forward is sexual health, if you’re having pain or if it’s uncomfortable. these open conversations can help change outcomes, even if you’re nervous to share. she points out that your doctor appointment is meant to be a judgment-free zone. “i say this with the caveat that not everybody has a relationship with their family doctor that feels safe. and so that’s unfortunate, but you do have rights as a patient.”
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n—numbers are important. as women age, they face increased risks for heart and bone health. prevention starts with awareness, so know your blood pressure, cholesterol and blood sugar.
“often patients will say, ‘oh, my blood pressure’s normal.’ i’m like, ‘ok, what’s normal?’ normal may not be normal depending on your risk factors, if you have diabetes, if you have kidney disease, for example, you may need to have a lower blood pressure.”
e—ensure what you’re experiencing is not menopause (for mid-life women). not every symptom is due to menopause, so ask your doctor to explore other possible causes. she talks about asking your doctor to check your iron and b12 levels, determine whether symptoms are related to sleep apnea and rule out whether chest pain is linked to heart issues.
dr. wijayasinghe participates in podcasts to spread awareness of health advocacy, often pointing out that night sweats and heart palpitations are classic symptoms of perimenopause and menopause, but they also are signs of heart disease. one listener wrote to let her know that she went to the hospital with these symptoms and was sent home. having heard the podcast, she returned to get checked out again with a diagnosis related to heart disease.
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r—review all treatment options, including medication, psychotherapy and lifestyle changes. your health plan needs to be personalized to your health history, preferences and goals.
“before you go out of the office, ask what’s next? what am i expecting? what is the medication? do i understand what the side effects are? because setting expectations is a really important thing in terms of women’s health.” she cites the cases where she’s starting someone on the birth control pill and preempts any fear by telling them they may have spotting in the first few months. also, for mammograms that are done at an earlier age when breast density is higher, she tells her patients they might be recalled for more views because of higher density.
“that’s a scary call to get from the breast screening department, so i want to give them a heads-up so they’re not losing sleep as they normally would have. setting that expectation, reviewing those options for treatment, knowing side effects, expected time to outcome, all help you be more secure.”
a final important tip is to bring “safety” with you to appointments by listing questions in writing so you’re prepared, taking notes, or bringing someone with you in person or on the phone for support.
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“sometimes bringing somebody with you for an extra set of ears is really important. my own mother-in-law goes to her doctor and i’ve said, ‘let us call in with you,’ because she comes out of it and she’s not sure what happened sometimes. she’s like, ‘i didn’t know i could ask for you to be in the appointment.’ you absolutely can. some places say no. that’s where you have the conversation ahead of time to let them know you’re bringing someone with you. a caring provider will allow that because they know that that impact is not just on you as a patient, but also for your caregivers and support people. it ends up being better care because then everybody’s on the same page.”
there’s another challenge that makes outreach, podcasts and other awareness initiatives on health advocacy so important:
“people may not be able to ask their family doctor. and with over 6,000,000 canadians without a family doctor, we need to have these conversations.”
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