The dermatologist did a quick scan of my body, barely opening the back of my medical gown that ballooned over my pregnant belly. “What about this?” I asked him, pointing to a growth on my shoulder. “It appeared a few months ago.” He looked at my shoulder and smiled. “It’s just a growth from pregnancy. I wouldn’t worry about it. I’ll bet it goes away on its own.”
I was relieved, and even laughed with him about the strange things that women’s bodies do while pregnant. But this wasn’t an obvious result of pregnancy like the varicose veins that pulsed from the expanding weight of my uterus. As much as I wanted the growth to be nothing, the ease at which he blamed pregnancy without even considering a biopsy nagged at me.
A year and a half later, the growth on my shoulder still there, I made an appointment with a new dermatologist. I was comforted by the time she took to inspect my body, the magnifying glass she used, and her confident, “We should biopsy that,” when she got to my shoulder.
But I cried days later when the nurse called to tell me it was skin cancer. Even though I was assured that basal cell carcinoma was the most common and “best” kind to have—slow growing, easily treated, and minimal damage—I couldn’t shake the fear of what might have been if I’d never sought a second opinion.
Until this point, I had always given doctors absolute authority and knowledge over my body. I strived to be a “good” patient—never complaining, enduring discomfort in exams with a smile, and not questioning a diagnosis even when I felt in my gut that it was wrong.
According to Elinor Cleghorn, author of Unwell Women: Misdiagnosis and Myth in a Man-Made World, women have faced gender bias in medicine from as far back as ancient Greece. “Women’s illnesses and diseases were consistently related back to the “secrets” and “curiosities” of her reproductive organs,” Cleghorn writes in Time magazine. While my doctor didn’t go as far as leeching me for my wandering uterus, it was clear that my mysterious, understudied pregnant female body wasn’t being taken seriously.
Recent studies have uncovered dangerous outcomes for women in the ER: women with abdominal pain are 13 percent to 25 percent less likely than men to receive pain medication, and wait nearly 20 minutes longer for care; chest pain in women was misdiagnosed five percent of the time, and it took an average of 12 hours longer to be admitted. Women are also less likely to obtain a correct stroke diagnosis. Women of color experience even more bias; a 2021 article in the International Journal of Women’s Dermatology shows the limited data collected for women of color causes suspicion from providers and hinders appropriate evaluation and care.
As a woman in my twenties, I never thought about my medical care as being anything different than my male counterparts. But when I look back over my medical history, I realized my skin cancer misdiagnosis was not the first time my symptoms were downplayed. In January 2013, after weeks of feeling weak and nauseated, I dragged myself to my doctor’s office. She all but rolled her eyes, telling me it was most likely anxiety over my upcoming wedding. When I asked, apologetically, if she could order a mono test, she reluctantly agreed. It came back positive. That night in the bath I felt two swollen lymph nodes in the creases of my groin, my body sending SOS signals.
Eight years later, with eight fresh stitches in my shoulder following the removal of the cancerous mole, I considered contacting my original dermatologist to tell him he was wrong. When I broached the idea with Dr. Sareh Parangi, a professor of surgery at Harvard Medical School and Chair of Surgery at Newton-Wellesley Hospital in Newton, Massachusetts, she encouraged me to follow through. “Ninety-nine percent of physicians will really, really want the information, so that they can improve their care for the next set of patients,” she says. “Physicians know we’re not perfect—we are always listening and learning, which ultimately makes us better doctors.” Doctors are considered the authority in medical care, but as Dr. Parangi points out, “patients know themselves the best and should rely on their own gut feeling and intuition about their health.”
For years I dreamed of contacting the doctor who dismissed my mono symptoms as anxiety, and now I had my new skin cancer misdiagnosis to reconcile. But Dr. Michelle E. Flaum, EdD, LPCCs, DCMHS, and associate professor in the Department of Counseling at Xavier University, encourages patients to have realistic expectations when reaching out to a misdiagnosing doctor. Patients may want an apology, but the physician may become defensive. “The patient could walk away feeling like they are being minimized or invalidated,” explains Dr. Flaum. But, with expectations in check and a good support system, Dr. Flaum adds there is strength in speaking up: “Advocacy can be really powerful for us as patients.”
Maya Dusenbery, author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, understood my pause in approaching the doctor, and emphasized another issue: “We need a systemic way that the feedback happens, and one that doesn’t put so much of the burden on the patient.” In reporting her book, Dusenbery asked experts how to make progress against misdiagnosis in women and found the consensus was that the lack of feedback is making doctors overly confident in their diagnostic skills. “It’s a huge part of the problem,” Dusenbery says. If women are told by a doctor that their symptoms are a result of anxiety—or in my case, pregnancy—the misdiagnosing doctor’s biases about women and such symptoms will never be questioned. “That in turn affects how they view the next woman who comes into their office,” Dusenbery explains.
I eventually worked up the courage to send an email to my original dermatologist. With a friend’s help and encouragement, I drafted a letter that felt informative, but not confrontational. “Dear Doctor X: I wanted to let you know that the growth on my shoulder was not a result of pregnancy. After getting a second opinion and biopsy it was found to be basal carcinoma. I am writing with the intention that this note can help inform care for all of your future patients. Thank you.”
I nervously waited for his response, worried I’d find a defensive message in my inbox, maybe even an insinuation that I misunderstood him. The response came quickly. “Thank you for letting me know!” he wrote. “It’s always helpful to get follow up and feedback. I’m so glad you had it reevaluated and biopsied.”
I breathed a sigh of relief. I was grateful that not only did the doctor appreciate my feedback, but I was proud that I advocated for myself, and in the process, perhaps opened the door for at least one healthcare professional to think twice before dismissing a woman’s symptoms again.
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Source : Elle