Sexism in medicine? It’s not ‘all in her head’.

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 several hours from death.

As Dr. Comen leaned in for a final farewell, she pressed her cheek against her patient’s damp face. “That’s when she said it,” Dr. recalled. Comen themselves.

“’I’m so sorry to sweat on you.’”

In her twenty years as a physician, Dr. Comen discovers that women apologize to her all the time: for sweating, for asking follow-up questions, for not discovering their own cancer sooner.

“Women apologize for being sick, seeking care or standing up for themselves,” she said during an interview in her office:I’m so sorry, but I’m in pain. I’m so sorry, this looks disgusting.’”

These experiences in the exam room are part of what Dr. Comen wrote, “It’s All in Her 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 degradation by the medical establishment. It’s a legacy that continues to shape the lives of female patients, she argues.

Nowadays women are more likely are misdiagnosed than men and takes longer to be diagnosed heart disease and a little cancers; they could be less likely being offered pain medication; it’s more likely that their symptoms will be written off as anxiety – or, as the book’s title suggests, as something that’s just in their heads.

“The anxious woman, the hysterical woman, is a specter that looms and interweaves throughout medical history,” said Dr. Comen. “It’s a standard diagnosis.”

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

A history of exclusion

Dr. Comen, a mother of three in her mid-40s, is quick with a camera-ready smile, which makes her frequent breast cancer media appearances. She occasionally cries when she talks about her patients.

She once cried at her job at the medical school, and a male resident responded by telling her to “keep herself together.”

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

Her approach is shaped by decades of experience, but also by what she learned about the place of the female body in medicine as a history of science major at Harvard.

“The sense that women’s bodies were not only different but also broken is evident not only in the way doctors spoke of female anatomy, but also in the medical vocabulary itself: the female external genitalia were called ‘pudenda’, a Latin word meaning ‘things to do’. ashamed of it,” she wrote.

In ‘All in Her Head’, Dr. Comen is an in-depth look at the ways she believes modern medicine has ignored women. For centuries, she writes, early medical authorities believed that women were merely “small Gentlemen” – although it has no external sexual organs and a similar mental capacity, governed by harmful humors and hormones.

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

And this was the case for white, affluent women, writes Dr. Comen in the book. If you were a woman of color, or poor, you were seen by medical authorities as having 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 need to think about race And gender discrimination,” said Keisha Ray, associate professor of humanities and bioethics at UTHealth Houston, who studies the effects of institutional racism on the health of Black people. “It’s often exaggerated, the lack of compassion and the lack of care you receive.”

Take heart disease, for example. At the end of the 19th century, Dr. William Osler, one of the founders of modern medicine, that women who presented with what we now know as symptoms of heart attacks or cardiac arrhythmias – including shortness of breath and palpitations – almost certainly suffering from ‘pseudo-angina’ or false angina, ‘a collection of symptoms caused by neurosis masquerading as a real disease’, writes Dr. Comen.

It is only in the past 25 years that cardiological studies have been included women in significant numbers. Nowadays, there are some heart attack symptoms that are more common in women, such as: jaw and back painare still described as “atypicalSimply because doctors don’t see them as often in men and are less likely to be taken seriously, even though 44 percent of women will. develop heart disease one in five women will die from it at some point in their lives.

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

How to advocate for yourself

In each chapter of ‘All in Her Head’ Dr. interviews. Come doctors working to improve the system, starting with taking the complaints of female patients seriously – not just writing down physical symptoms, from chest pain to fatigue to gastrointestinal complaints, to anxiety until, for example, all other causes have been excluded.

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 concerns you about your body?

“Not what you think you need to worry about,” writes Dr. Comen. “Not what you think your doctor will be able to address most comfortably and easily.”

Then if you are concerned about your health or if you are concerned about your health not are heard, enlist a friend or family member to accompany you to appointments. This person can serve as an advocate and as an extra pair of eyes and ears.

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