Being a Nasty Woman Might Save Your Life
By: Elle C.
Tags: Gender Equality, Healthcare, Women, Feminism, Racism

Being a Nasty Woman Might Save Your Life

Self-Advocacy Against Gender Bias & Racism in Medical Care

Recently, I was a nasty woman patient, asserting my medical rights and taking no prisoners. For this tirade, I make no apologies. Gender biased roles implied I should submit to the rules, like a nice, quiet girl. But this isn’t a situation for my docile compliance. Time is of the essence. I had to aggressively push back against the system.

I didn’t always see these encounters as prejudice. But in totality of the healthcare experience, it is another brick in the thick wall of gender discrimination, causing women to forcefully self-advocate, even when some are gravely ill. This is one of many forms of gender-bias subterfuge that female patients frequently face in healthcare.

Unfortunately, my experiences are common and shared by many women.

Statistically, more than half the women obtaining medical care will discover similar gender-bias, either in suppressive gender roles which demand meek obedience or interactions where patients are treated differently and given poorer quality of care due to gender. The implications are serious.

My own history, as well as other women’s tragic events, demonstrate the need for awareness and self-advocacy. It shouldn’t be this way.

Women should not have to fight to be heard in the healthcare setting.

But we do.

The Nuclear Option

The subject of my recent outrage was hospital bureaucracy, and the receiving end was a condescending receptionist at my local oncology center. A mass in the front part of my chest — situated in the mediastinum area where I’ve had cancer previously — was found in recent scans. It is imperative my healthcare team is responsive.

Instead, I’d encountered dismissive attitudes and frustrating administrative policies, which inferred I was to sit down and shut up. Comply and be a good girl. I wasn’t calling and rudely demanding an immediate visit. I merely wanted to schedule it. Given the circumstances, this seemed a reasonable request. Even my internist wanted this addressed quickly. Upon reviewing the radiology report, that doctor had submitted an emergency oncology referral.

However, in this maddening hospital, the patient cannot initiate appointments. It isn’t as simple as phoning in and arranging the required visit. Instead, the patient must wait for the elusive scheduling personnel to make contact — even with an emergency referral created by a staff physician.

Patient scheduling here is a mysterious, separate hospital division, likely hidden in some black ops location, and apparently known to a handful of people who hold security clearances. I assume anyone who divulges the scheduling department’s contact information is swiftly eliminated. It appears a deep, closely guarded secret.

My faith in the urgency of these scheduling methods is nil. Five weeks had passed this fall while my health deteriorated, and I awaited the magical call to arrange a visit with an internist and begin re-assessing my illness. I was tolerant and waited calmly through this whole process. Had my current situation been a discussion about a routine checkup or an investigation into diagnosis, my crazy button wouldn’t have been triggered.

But this is different. Now it’s all hands-on deck.

A week passed. I phoned oncology twice and, and politely prodded, “Is there a problem? I was told scheduling would contact me within 24-hours to make this appointment. I’ve not heard from them yet. Would you please look into this?” Each time, my requests were ignored, and I subjected to the cold indifference of the gatekeeper at the oncology center. “Scheduling will call you,” she reiterated briskly, as if I was unable to grasp instructions without much repetition.

I don’t endorse arbitrarily venting on healthcare workers, especially during this stressful pandemic climate. But I’m the only person who can effectively advocate for my care. And I will apply the proper level of assertiveness when required.

I’d already called the hospital’s advocacy department and had left a message complaining about the scheduling debacle at this healthcare campus. My sole response was a text asking about my patient experience.

Finally, I pointed out that it was inconceivable that I couldn’t directly speak to someone to make this appointment. “I’m sorry,” said the oncology receptionist. But it was clear from her dismissive tone, she wasn’t apologetic, and again concluded by parroting the hospital scheduling policies.

This was the tipping point for my frustration.

The nuclear option was required and duly applied. “I take offense at my health being trivialized. Save your platitudes. I’ve heard these from you each time I’ve asked about this issue. When oncology patients call with an urgent request, we do not want rehearsed speeches and indifference. I need action and I need it RIGHT now. Either you look into this delay or get me to someone who can.”

I was so incensed, I also commented that either we did this by phone, or I’d drive there. An appointment could be made in person or security could drag me out. Her choice.

One way or another, I was getting action. No more passive waiting like a submissive woman.

Yes, I AM insane. I’m totally fine with that. But at least I’m a living, breathing, crazy person. I’d like to keep it this way.

In less than five minutes, I was transferred to the all-powerful Nurse Manager. These professionals have significant patient care responsibilities and managerial clout. An internal error was found in the scheduling system causing delays. The emergency request wasn’t entered properly. “Oh dear. I’m so sorry. We made a mistake. I’m glad you called so we could correct this,” the Nurse Manager stated.

Hopefully, this blob in my chest is benign. But if not, mere weeks can change the outcome of certain malignancies. Now my oncology team is moving speedily, as I knew they should. I’m pleased with the medical staff. Had I not aggressively pushed back, the administrative error could have been costly.

The nuclear option should not have necessary. But it was.

Odds are I’ll need to use it again at some point in my medical future. And this was a small event compared to the totality of my previous gender biased encounters.

In my medical history, I’ve had an assortment of healthcare providers and medical approaches. Gender bias has always been my biggest obstacle to receiving appropriate, timely care. From my personal experiences two examples stand out. I nearly died twice due to this bias.

The Physician Who Misdiagnosed Cancer as Motherhood, Mental Illness, & Housework

Prior to 1996, I didn’t know gender bias existed in healthcare. There weren’t women doctors in my small town at this time. Grey-haired authoritative male physicians dominated the local area. I had always trusted their wisdom. In my young twenty-something brain, I was replaying the healthcare version of Father Knows Best. I wasn’t a highly educated person. Who was I to question these brilliant professional fatherly men?

Then my intuition got the better of me and I questioned everything.

For most of 1996, I had a series of strange infections. It was as if my immune system had suddenly gone AWOL. Nearly every month, I trudged into the doctor’s office with a new complaint. My all-knowing family doctor would pat my hand reassuringly and tell me that I was rundown from the demanding tasks of parenting. I’d receive another round of antibiotics, only to return again and again.

A pearl-sized lump appeared in my clavicle area. Without a biopsy or imaging, my physician informed me it was, “Nothing to worry about.” Yet, it remained for months, while other small nodules began popping up in my neck.

I became increasingly aware that something was wrong. And I began to doubt the wisdom of my grey-haired male doctor. My trust waivered.

He diagnosed my intense fatigue as depression and prescribed medication. I was “a young mother, with many busy, active children” and “stressed from all the household chaos and chores.” Combined with a diagnosed mental health disorder, it had to be motherhood, housework, and depression.

I do suffer clinical depression. That mind-numbing exhaustion I was experiencing was not a mental health issue. I knew the difference. I never filled that prescription. I’d become a willful resister to the gender-biased system.

I finally demanded a biopsy in an outburst of tears and rage. He relented with an actual eyeroll. Now his patient was also a hypochondriac.

That small pearl nodule was indeed malignant, sending me and my late-stage cancer on a twelve-month treatment journey to the hostile lands of chemotherapy and radiation.

The Physician Who Gave Me a Paper Bag for a DVT

A year after I entered remission, I suddenly had terrible pressure in my head. It had become so severe, I slept sitting upright. Huge veins popped out on my neck when I leaned slightly forward, like a powerlifter grappling a thousand-pound dead lift. Dizziness increased steadily.

I called a close girlfriend, who is a RN and nursing professor, “Something is terribly wrong.” She babysat my kids while I went to the family doctor.

The physician listened to my complaints, nodded complacently, and left the room briefly. When he returned, he brought a paper bag for me to breathe into. Clearly, I was suffering a panic attack. Post-cancer anxieties and mental health issues were the rationale for this diagnosis. No doubt the stress of life was getting to me.

I knew this wasn’t true. But I felt so ill, all my assertiveness had left.

I could barely drive home. The pounding cranial pressure was incapacitating. When I walked in the house, my friend looked at me and only said one sentence. “Kids, get your coats and shoes on.”

She loaded all of us up in her van and dropped me off at the ER. In less than an hour, I was in a fast-moving ambulance, headed to a nearby metropolitan hospital for emergency surgery. The implanted port used to deliver chemo had caused a blood clot that occluded eighty percent of the connected venous system. I had a deep vein thrombosis (DVT) and it was life-threatening.

I’d have died if I’d waited at home, while breathing in my paper bag.

My friend trusted my intuition when my attending doctor didn’t.

The Discrimination Is Complex & Pervasive

The battle for regaining health can be significant. For women, often at least some of our energy will also be expended resisting discrimination in healthcare — a system designed to heal patients, but frequently works against us.

According to an editorial in the Journal of Critical Care Nurse, by JoAnn Grif Alspach, RN, MSN, EdD, gender bias in healthcare refers to situations where patients are assessed, diagnosed, and treated differently and at a lower quality level because of their gender than others with the same complaints. The inequality in care can cause women to have complications, morbidities, and mortalities — all at greater rates than male patients.

This discrimination is real, as well as pervasive in healthcare.

Fifty-two percent of the 2,105 woman in a 2019 Today survey, cited discrimination in the doctor’s office as a serious gender issue, compared to only thirty-six percent of the men surveyed. Gender discrimination surfaces on several levels. Confining, archaic gender roles attempt to silence women who question doctors or administrative bureaucracy. Healthcare providers may ignore or dismiss symptoms and minimize the pain women experience. Female patients feel they must repeatedly validate their complaints. Mental health issues are held against women who suffer unrelated physical complaints.

It’s injurious and demeaning to encounter such discriminatory treatment — especially from healthcare providers.

And I’m white. My experience diminishes to that of Black and Brown women, who must fight both gender bias and systemic racism, alongside health issues. Women of color suffer greater and more frequent discrimination than white women.

Women — particularly those who haven’t yet experienced major health problems — need to understand this gender bias exists in healthcare. Be ready to act, advocate, and consistently seek appropriate care.

But even then, some educated, informed, and assertive patients don’t win the battle.

Tragic for Women of Color: Say Her Name: Dr. Susan Moore

As I started writing this article, I learned about Dr. Susan Moore, a dedicated Black physician who tested positive for COVID-19 and was admitted to IU Health North Hospital in Carmel, Indiana.

Dr. Moore updated her social media account several times as she battled both the virus and the healthcare system where she was treated. In her posts, Dr. Moore stated she had to repeatedly “beg” for Remdesivir — the antiviral treatment vital for some COVID patients — as well as plead for pain medication, a proper evaluation, and critical diagnostic tests.

Dr. Moore wrote about the attending physician, “He did not even listen to my lungs. He didn’t touch me in any way. He performed no physical exam.” She continued, “Why do I have to prove that there’s something wrong with me in order for my pain to be treated?”

She also posted an agonizing and raw video. In it, Dr. Moore, while laboring to breathe stated, “I put forth, and I maintain, if I was white, I wouldn’t have to go through that. This is how Black people get killed — when you send them home and they don’t know how to fight for themselves.” You can see the fear in her eyes as she spoke. This was a healthcare professional who knew her situation was dire.

Twelve hours after she was dismissed from the hospital, her blood pressure plummeted.

She was taken by ambulance to a different hospital, and despite their efforts, Dr. Susan Moore — skilled physician, and mother of a nineteen-year son — died at the age of fifty-two.

Her friend and colleague, Dr. Alicia Sanders, wrote in tribute, “Susan was a phenomenal doctor. She loved practicing medicine, she loved being a member of Delta Sigma Theta Sorority, Inc, she loved helping people, and she was unapologetic about it.”

Sisters of Color, I cannot even begin to understand how complex and painful it is for you. But I recognize your fight against gender bias and racial discrimination is real, present, and horrific. Systemic racism is widespread and exists everywhere. When it impacts healthcare, it’s absolutely catastrophic.

The Sobering Bias Detailed by Women Medium Writers

In a Facebook group for women Medium writers, I’d discussed healthcare and gender bias as I researched this article. The responses are sobering evidence of the frequency these events occur.

Just as studies and patient surveys have found, the running themes in the comments — healthcare providers assumed women were riddled with mental health illnesses or wouldn’t hear their very real physical complaints.

Among those sharing was Maria, a woman with a blood disorder and a progressive neuromuscular disease. She saw fourteen doctors as she slowly became physically debilitated over two years — the first twelve physicians attributed her symptoms to anxiety.

For Madeline, the brain cyst and cerebral inflammation she suffered were undiagnosed. She spent two years in the UK’s National Health System, treated for “anxiety and psychosis.” Madeline had to go to a private medical hospital for the lifesaving care she needed.

Others, like Heather, a young woman with a diagnosed heart condition, must fight with ER doctors to get Adenosine, the medicine required for her cardiac arrhythmia emergencies. Often physicians don’t believe her when she describes her medical illness. Some have implied Heather’s rapid heart rate was due to menstrual cycles.

Vena Moore, a tireless advocate for women’s rights and editor of Living By The Word, expressed gender bias and systemic racism she’d encountered, noting several occasions where she got subpar care. “It wasn’t only because I was a woman, but because I am Black as well.”

In a heartbreaking comment, one woman discussed her mother’s ovarian cancer, which was repeatedly dismissed by doctors as symptomatic of menopause. The delay in diagnosis caused her mother’s tragic death at age sixty-one. Krystal stated, “It is SO frustrating that they won’t SEE and HEAR us when we are in their offices over and over saying, ‘SOMETHING IS WRONG.” “God, it’s tragic. This way of thinking stole my mother from me.”

Therapist, Dr. Marina Harris, described gender bias encountered in her personal medical care and then summarized the situation by stating, “It’s shameful that women are forced into a medical system that delays them from getting healthcare. Even worse, gender bias from an early age teaches women to stay quiet. This, paired with a system that withholds equal treatment for women, clearly threatens quality of life.”

Carol Lennox, a psychotherapist, added her personal and professional experiences, “I’ve had to fight, and so have some of my clients. I often have to urge them to stand up for themselves.”

Women commenting reported degrading treatment and unprofessional opinions. Pelvic exams were described as humiliating. One woman was told by a physician, “You’ll never have kids. You’re so messed up.” Eight years later, Carolyn gave birth to two children.

And Keara Lou, editor of several Medium publications, including the Partnered Pen, detailed her healthcare battle against gender bias in a moving article titled, “I Wish the Doctors Believed My Pain.”

My heart breaks for these sisters. And I’m furious we must endure this.

Be A Nasty Woman & Advocate for Yourselves & Others

Culturally, women are told to comply and be polite, gentle, and submissive. An assertive woman who questions status quo, verbalizes displeasure, or makes demands for her rights is considered bitchy. She is a nasty woman. Female patients who demand to be heard, insist on appropriate care, and question authority are also viewed as equally problematic and nasty.

The Urban Dictionary defines a nasty woman as, “a confident, poised woman who strikes fear in the hearts of man-babies when she clearly articulates rational arguments and/or takes action.”

There isn’t a more important reason to be confident, articulate, and actionable, than your own health. Trust your intuition. Only you know how you feel. Do not allow yourself to be silenced. You have the right to make your voice heard. You are a consumer of health services.

I’ll take the title of Nasty Woman Patient if it delivers results. I refuse to be silenced. I will demand suitable care.

And each woman must do the same.

Be the patient version of other strong, assertive “nasty women” like Hillary Clinton, Kamala Harris, Nancy Pelosi, Elizabeth Warren, and Alexandria Ocasio-Cortez. Strike fear in the hearts of man-babies who do not hear your medical needs and are dismissive. Do whatever it takes.

Advocate for other sisters, just as my friend did for me.

Share your stories so women understand the travesty and depth of this situation. Your experience represents countless others who have endured healthcare discrimination, some of whom no longer have a voice.

Be prepared to take your complaints up the food chain. Seek Nurse Managers, Chief Medical Officers, and patient advocates. For egregious situations, you may be able to file a Medicare formal complaint. The Agency for Healthcare Research and Quality (AHRQ) also has compiled useful resources for advocating or filing a complaint.

Find healthcare providers with good reviews and compassionate care. My original oncologist told me, “My patients who are labeled as demanding seem more likely to live. They fight for their rights and care. I think women have a better understanding of their bodies and physicians should trust these female patients more.”

Those words impacted me so much, I’d written them in my journal on April 28, 1997. It was also the date I’d started chemo for a Stage 3 cancer. Prior to this, I had just gone through an entire year attempting to prove my illness to my family doctor, who had assumed I was a crazy, depressed, stressed mommy. The relief I felt to be under the care of someone who listened to me was medicinal. All my energy went into healing.

Can I have an amen for wonderful doctors like this?

Women, these are the types of caregivers we need to tirelessly seek.

And please consider contributing to Dr. Susan Moore’s fundraiser. Both her parents have dementia and her young son is left alone while caring for his ailing grandparents. Keep this brave physician’s story alive and advocate to prevent further losses of strong and courageous women. #SayHerNameDrSusanMoore