One hour with a women's health expert and finally I felt seen

Summary

In this anonymous blog, a patient reflects on her recent appointment with a women's health expert. After decades of enduring both long-term debilitating symptoms and a history peppered with poorly recorded health incidences, she says that she finally felt 'seen'.

She argues that investing in longer, women's health consultations like this would likely save the NHS money by reducing inefficiencies and improving outcomes. 

Content

I have just got off a call with a GP and women's health expert, and after more than 20 years worth of symptoms and events I finally feel seen and heard. 

I am 41 years old and have never received any private healthcare treatment before today. During my life, I have been seen by some of the most compassionate, skilled and effective NHS healthcare professionals. My closest friends and family work for the NHS and are brilliantly determined and patient-focused. I have however also been seen by some of the most dismissive and ineffective healthcare professionals, many of these during appointments relating to gynaecological or female-focused issues. 

As I relayed my full history via video call to the GP today, I became quite emotional. The experiences I recounted of the healthcare' provided to me during teenage years, early postpartum hours, an IUD insertion, perimenopausal symptoms, concerning and debilitating gynaecological symptoms, and a year-long-wait for a gynaecological referral, all carried a level of trauma. Talking about them made me realise how I had been repeatedly let down, dismissed or inappropriately treated. 

Key points: looking back at my history

• I had not been offered local anaesthetic for an IUD procedure where I should have been, and I went on to feel extremely high levels of pain (which had not been recorded in my notes).
•  Going by my description, it was likely after giving birth that I had experienced a postpartum haemorrhage, which had not been recorded or treated appropriately. 
• A internal scan that had been deemed unnecessary and cancelled, should have been done to investigate key causal factors for some of my gynaecological symptoms. 

I had made the private appointment because I knew this woman was a well known expert in the full spectrum of women's health issues. I wanted guidance that came from a place of knowledge and passion. I wanted the next steps I took to be the right ones for my health. I wanted to understand what my array of symptoms meant and the role my medical history had to play. I wanted to make sure I, and my regular GP weren't missing something important. I wanted to feel better. 

Can most people afford to access this service? No. Can I afford to do it again? No. Was it worth every penny? Absolutely for me personally, but the NHS will benefit too.  

Key points: looking at next steps

• She gave me advice for which investigations and blood tests were needed to be able to determine the causal factors of my gynaecological symptoms.
• She confirmed many of my symptoms related to perimenopause and provided an explanation as to how this was affecting my body. 
• I was given a breakdown of options for HRT and advice on which to try first - explaining carefully which element of the treatment addressed which of my symptoms. 

I came away with so much support, guidance and knowledge that I can honestly say this appointment, which had taken at least 6 times as long as an NHS slot, would undoubtedly save the system money in the long run (considering the multiple appointments I'd had over the years). And more importantly, I am confident it has set me on the path to receive the right investigations, symptom management and treatment options. These two points obviously go hand-in-hand when striving for an efficient health care system that gives value for money and leads to improved outcomes. 

Was it because she is a private doctor and provides a better service? Of course not. She simply had the right expertise, attitude and, crucially, time to properly navigate my health needs. She works for the NHS too.

While she spent much longer with me than an NHS GP would have been able to, I do feel this sort of approach could actually save the NHS time and money if they were to offer longer consultations for women's health issues. I came away understanding my health better, armed with knowledge that would help guide the next steps of my health journey in a way that would be more efficient for the healthcare professionals I would be communicating to. 

In just 40 minutes...

In just 40 minutes (it took far less time than we had allotted) she had done 6 key things:

1. listened to my summary of 30 years worth of events and relevant history (I had put this in writing for her to read at the start, which I felt would aid us to use the time efficiently)
2. asked many questions to gain further detail...and listened
3. found time to medically explain my symptoms and likely causes, in plain English
4. offered next steps advice
5. communicated with compassion and respect
6. made notes that would form the basis of a letter for my GP. 

I am an assertive and confident person, but reflecting on my appointment and the events I retold, I realised there was a common and surprising theme running through. Whenever something hadn't felt right with my body, I had felt uncomfortable speaking up. Or I had very quickly accepted a poorly executed follow-up or a dismissal of my concerns entirely. This resulted in long-lasting symptoms and traumatic healthcare experiences being accepted. Two things that I had learnt to endure, to the detriment of my health. 

We have got to help girls and women of all ages feel confident and enabled to speak up about their health. From an early age they need to hear us all (men and women) using the right language, with no shame. Only then can we set girls up to confidently advocate for themselves and their own health. 

But confidently speaking up isn't enough if no one listens. We need to really listen to girls and women. Not just for the obvious reasons of humane and compassionate treatment, but also because it is more efficient for the system. And let's be honest, medical history somewhat shafted us, so the data that lies within women's experiences should be welcomed and encouraged if we are to have any chance of catching up.  

Only by genuinely hearing, respecting and responding to their voices and their experiences relating to their bodies, can women be enabled to influence the diagnostic and care planning process.

A process that surely we should be central to?

Related reading

• The normalisation of women’s pain
• Sex bias in pain management decisions
• Misogyny is a safety issue: a blog by Saira Sundar
• Medicines, research and female hormones: a dangerous knowledge gap
• Dangerous exclusions: The risk to patient safety of sex and gender bias
• Unconscious bias: gynaecological pain, the elephant in the womb!
• Pain bias: The health inequality rarely discussed