Six years ago, Dr. Elizabeth Komen, a breast cancer specialist at Memorial Sloan Kettering Hospital in Manhattan, held the hand of a patient who was hours away from dying.
Dr. Komen bent down to say a final goodbye, pressing his cheek against his patient’s damp face. “And she said,” Dr. Komen recalled.
“”I’m really sorry for sweating”
In her 20 years as a doctor, Dr. Komen has noticed women constantly apologizing to her for sweating, for asking additional questions, for not catching their cancer sooner. .
“Women apologize for getting sick, for seeking care, for advocating for themselves,” she said in an interview at her office.Sorry, it hurts.Sorry, this seems disgusting”
These experiences in the doctor’s office are part of the impetus for Dr. Komen to write Everything in Your Head: The Truths and Lies Early Medicine Told Us About Women’s Bodies and Why It Matters Today. It becomes. In it, she traces the roots of women’s tendency to apologize for their sick bodies and their unruly bodies to centuries of neglect by the medical establishment. It’s a legacy that continues to shape the lives of her female patients, she argues.
Today, women are more likely than men to be misdiagnosed and take longer to be diagnosed with heart disease and some cancers. They may be less likely to be provided with pain medication. Their symptoms are more likely to be dismissed as anxiety, or, as the book’s title suggests, as something that’s all in their heads.
“The anxious woman, the hysterical woman, is a haunting ghost that has been woven into the fabric of all medical history,” Dr. Komen said. “That’s the default diagnosis.”
Taken together, these misconducts help explain why so many women report feeling invisible, frustrated, and embarrassed at the doctor’s office, she argues in her book. There is. While shame may be a symptom, Dr. Komen believes the disease is a deeply misogynistic health care system.
history of exclusion
Dr. Komen, a mother of three in her mid-40s, is quick to smile for the camera, which has made her a fixture in media coverage of breast cancer. She sometimes sheds tears when talking about her patients.
She said she once cried while working at medical school, and a male resident told her to “brace yourself.”
“I felt I had to apologize for my response,” she said, sitting behind her desk. “And now I cry with my patients all the time.”
Her approach has been shaped by decades of experience and what she learned about the place of women’s bodies in medicine while majoring in the history of science as an undergraduate at Harvard University.
“The sense that women’s bodies are not just altered, but broken, is evident not only in how doctors talk about female anatomy, but also in the medical terminology itself. Female external genitalia are It was called “pudenda”, which means “something” in Latin. Shame on you,” she wrote.
In “All in Her Head,” Dr. Komen provides a comprehensive look at the ways she says modern medicine has ignored women. She says that for centuries, early medical authorities believed that women were simply “little men,” despite having no external genitalia or equivalent mental capacity and being dominated by harmful bodily fluids and hormones. He believed that it was not too much.
For too long, doctors have dismissed what could be a legitimate physiological problem as irrelevant and unimportant because it’s a hormonal problem, said Wendy Klein, a professor of medical history at Purdue University. said.
And this was true even for wealthy white women, Dr. Komen writes in her book. If you were a woman of color or poor, medical authorities deemed you even less authoritative over your own body and therefore unworthy of care and compassion.
“For Black women, when you go into a clinical setting, you have to think about race. and It’s sexism,” said Keisha Ray, an associate professor of humanities and bioethics at UT Health Houston who studies the impact of institutional racism on the health of Black people. “It tends to be more exaggerated, the lack of compassion, the lack of care that they’re receiving.”
Let’s take heart disease as an example. In the late 19th century, Dr. William Osler, one of the founders of modern medicine, said that a woman exhibiting symptoms we now know as symptoms of a heart attack or arrhythmia, such as shortness of breath or palpitations, would almost certainly: He declared that he was suffering from severe symptoms. “Pseudoangina,” or pseudoangina, is “a collection of neurotic-inducing symptoms disguised as a real illness,” Dr. Komen writes.
It is only in the last 25 years that cardiology research has begun to include women in significant numbers. Today, some of the more common heart attack symptoms in women, such as jaw and back pain, are still seen simply because doctors don’t see them as often as men and are less likely to be taken seriously. It is called “atypical.” However, 44 percent of women will develop heart disease at some point in their lives, and one in five women will die from heart disease.
“We’ve always used the male model as the gold standard for diagnosis and treatment,” said Dr. Jennifer Mier, a cardiologist at Northwell Health and co-author of the book Heart Smarter for Women. Ta. This “leads to continued misrepresentation, misdiagnosis, and underrecognition of heart attacks in women.”
how to assert yourself
In each chapter of “All in Her Head,” Dr. Komen begins by taking her female patients’ complaints seriously, and goes beyond just listing physical symptoms ranging from chest pain to fatigue to gastrointestinal discomfort. , interviews doctors working to improve the system. For example, eliminate anxiety until all other causes are ruled out.
Dr. Komen also shares practical tools for better working with imperfect systems.
First, she writes, it is imperative that all patients trust their knowledge of their bodies and advocate for themselves. Before you go to the doctor, ask yourself these questions: What are you really worried about about your body?
“It’s not something you think you need to worry about,” Dr. Komen writes. “It’s not something you think a doctor would be most comfortable and easiest to deal with.”
Next, if you feel anxious or worried about your health, do not have Once you’re heard, ask a friend or family member to accompany you to the appointment. This person can serve as a spokesperson and additional eyes and ears.
Finally, if you don’t like your doctor, find a new one. She acknowledged that this is easier said than done, but a trusting and respectful relationship with a health care provider is a right of every patient.
