Berkeley Wellness: When Medical Symptoms Are Dismissed as "All in Your Head" (David Tuller interviews Maya Dusenbery)

yes it can be very confusing. Isn't this the thread about the Christine Ford-Brett Kavanaugh 9-hour mini-series that ran yesterday? Or am I in the wrong place??

 

Perhaps we should merge some comments here with the other thread on sexism and advocacy ? I think with this topic though it’s always going to be quite broad and prone to deviation.

 

Good, good...

Spoiler: Excellent...

Yes, I tried to ask a focused question on the other one but it ballooned quickly.

 

Maybe not. That's why I put the why in paranthesis.

But I still think the questions that first needed to be answered is whether there generally is a gap between the medical knowledge about women and the medical knowledge about men and whether it is really known in which medical conditions sex differences are relevant and in which not?

I understand your answer as a "most probably no knowledge gap" and "most probably the relevant sex differences mostly are known."

You provide another highly interesting example from research. I don't understand yet how it could confirm your answer, thoogh. If there are surprises like the one you described, how can we be sure that these are rare exceptions that will sooner or later be identified by researchers anyway?

With regard to different heart attack symptoms (or perception of symptoms) I meant the second acrticle that Trish provided (which is no scientific paper ) :

https://www.s4me.info/threads/berke...rviews-maya-dusenbery.5887/page-3#post-107339

Do you know Marianne Legato's and other gender medicine proponents' work on this topic?

 

Yes, that is what I was calling a 'paper'. This to me tells us nothing particularly important. I was responsible for diagnosing and treating heart attacks starting from 1974 as an intern and then as a registrar in A/E for about ten years. The range of symptoms given there was very familiar. The fact that some symptoms are more common in women than men made no difference because you had to take note of all of them. If the person was clearly acutely unwell you had to make a diagnosis. A sense of impending doom would be included in that - a clue to pulmonary embolism too, or stroke maybe. Stomach pain occurred in both sexes. An unusual stomach pain of acute onset meant an ECG was done.

So the fact that there is some difference in pattern between sexes is of no real importance. It is a bit like saying to a tailor that it matters that men are taller than women. It doesn't because a tailor is interested in the exact leg length in everyone.

 

Perhaps your own advice to Chris Ponting to consider male and females separately is relevent on this thread.
The fact that it seemed necessary as a suggestion is important.
Statistical significance for many things may be lost in a larger group.
If data was mined, what more could be found for this and many other conditions.

 

Yes, that crossed my mind. For me it was bog standard advice from an old clinical researcher to a younger researcher who might not have any direct clinical background.

 

Yes, that's correct, you're right on track ...

 

@Jonathan Edwards, each time you write about how you handled specific medical problems and that this was how it was usually done in your professional setting, I think: Yeah, that's how it should be!

But what did you do when you were not sure about a diagnosis? Or did it never happen that you or your colleagues did not find a diagnosis? And did it never happen that your first diagnosis was wrong?

In any case, your descriptions seem quite the opposite of my experience as a patient.

When I try to recall how often I have been treated as a patient in similarly ideal ways your examples describe, these are very rare moments. In particular, few doctors made a proper clinical examination of those parts of my body where I had symptoms, but instead ordered laboratory work, x-ray or MRIs, on which they "found" diagnoses that in the end were ruled out. And I was left with the suggestion that I had been over-diagnosed, so there either could be nothing wrong with me at all or I probably had a psychosomatic condition.

Before I luckily found my current family doctor three years ago, I estimate that 5-10% of the medical encounters I had during the three decades since my early adolescence were professionally accurate practice. This small number most probably is somewhat distorted by selective perception, but put that aside, I could write a book about worst practice examples. For each good medical encounter I recall, an additional bad example pops up. This is distressing, so I won’t write that book.

In any case, all the anecdotes I know from me, my friends and relatives together would be outnumbered by the medical encounters you had with patients during your professional career.

Nevertheless, I think there remains a discrepancy between the examples of invariably excellent medical practice you describe on the one hand, and my and my family's and friends' experiences on the other hand.

Maybe national medical education and practice in the UK and in the past were better than in Germany since the mid-1980s? But could this be a sufficient explanation?

Are you sure, that your medical teachers and colleagues were the rule and not only the better or even outstanding examples? Are you sure the expertise you gained and applied was due to the established national medical education (e. g. textbooks, curricula) and it mirrored the widely shared medical practice at your time in the UK?

Did you and your colleagues already know and practice everything that the proponents of gender medicine have been investigating since the turn of the millennium? Or what do you think about gender medicine as a medical subdiscipline at all?

Apologies for being persistent in this matter, I promise to not ask any further questions about this topic.

(I am aware these might be difficult and too many questions to answer, so if you prefer to answer on the members only section or not at all, I will understand, of course.)

 

If we were not sure about the diagnosis we covered all the important and reasonably likely options - often by a period of observation and monitoring vital signs. Not getting the diagnosis straight away was common and provisional diagnoses were sometimes wrong. But I am not sure what any of that has to do with gender!

I realise this has become more and more common since about 1985. And to be fair, physical examination has become less critical in comparison to history and investigations. Many traditional techniques of physical examination were unreliable. Nevertheless, the core physical examination remains relevant for situations like myocardial infarction.

What I see as a very major problem is that a lot of medicine is done in general practice by doctors with no particular expertise for most of the serious problems they encounter. In my view there should be no general practice outside hospitals for most districts of Western Europe. General Practitioners have fought to maintain the right to practice incompetent medicine in heath centres when competent medicine could be offered in hospitals with properly trained individuals with investigations close at hand.

There is a lot of incompetent doctoring about but again I am not sure what it has to do with gender?

I can only recount my experience in a university hospital. The standard was high, I agree. And it has deteriorated in some respects since 1985 but probably improved more because of better infrastructure in intensive care and investigations available.

I am not sure I can compare countries but in rheumatology high quality practice seemed to be focused in Holland, Scandinavia, UK and a few parts of the US (by no means all). German rheumatologists seemed half asleep to me, but that is just how it seemed.

'Gender medicine' is a nonsense for me. And looking at the stuff produced it looks politically driven. I worked in a field where most patients were women. We understood gender differences for all the conditions we treated. There may be more to find but the example of women with heart attacks having more stomach pain seems to me be something of no great interest and nothing to do with good care. I think it would be bad to make students think that somehow 'gender medicine' was a separate topic or that gender differences were somehow different from their basic studies. In my time gender differences were an essential part of all basic knowledge. When we studied for the MRCP final physicians' exam we had to know gender differences for every condition - as far as they were known and relevant.

To me this is exactly the same politically driven stuff as drives the BPS brigade and MUS and all that nonsense. ME got put under women's health in the US because it was seen as an important aspect of 'gender medicine' - that did not work out too well.

Edit: And my wife agrees and I am pretty sure so does my mother, who was a founder member of the Medical Women's Federation in the UK about sixty years ago.

 

My nearest hospital is over 20 miles away, and I have no transport. I hate going there - I get lost, and it's a nightmare to figure out how to get there and back.

My local doctors were incompetent, and I transferred to one about 3 miles away. They are quite good, but no good for ME/CFS, due to decades of neglect of the illness.

 

I said most districts because it does not always apply. However, if there were no health centres there could be twice as many hospitals. And for those outside town doctors based in hospitals (where they can keep up to date on knowing what they are doing) can do local clinics or old fashioned domiciliary visits - which I often used to do thirty years ago. Even in 2000 I was making a half hour trip to visit one patient at home when she needed it. She lived next to Covent Garden Opera House so I walked down from UCH. It was a very efficient system because I could take blood tests when I saw her and she never had to wait to be seen in clinic.

The current situation is just bonkers, as I am sure you are aware!

 

There's a programme on BBC World Service tonight of which about half (at a guess) will be dedicated to this person:

"Paula Johnson is an American cardiologist who has dedicated her whole career to thinking about health from a woman's perspective, focussing on the different ways men and women respond to diseases. When Paula learnt that medical research and trials traditionally were only tested on men, she decided she had to fight for the inclusion of women. Paula believes the lack of testing on women, combined with sex differences, can lead to women not receiving effective diagnosis and treatment. Paula thinks that we should be focusing on women's health and well-being as central to women's equality."

Mon 1 Oct 2018 22:32 Local time
BBC World Service

Fighting For Women's Health

https://www.bbc.co.uk/programmes/w3cswp21

 

I am sorry but this lady sees to be in cloud cuckoo land - and sexist.
This stuff about trials only being on men is nonsense. Women are excluded if they cannot guarantee not to be pregnant and the treatment might be dangerous for a foetus. Otherwise there has never been any discrimination during my career.

This seems to me to be just fake news to be honest.

 

People were commenting earlier about sensing an attitude of misogyny in Edward Shorter's work, but maybe he just wants to be abused by women!

Maybe. Who knows, but some of his recent blogs seem a bit revealing.

https://edwardshorterauthor.com/2020/02/14/youd-be-lucky-to-find-a-valentine-like-stormy-daniels/

https://edwardshorterauthor.com/2019/06/10/good-sex/

https://edwardshorterauthor.com/2019/07/30/career-paths-for-strippers/

https://twitter.com/user/status/1232004273052868609

 

Could explain a lot. Perhaps he sees chronic fatigue as something to strive for.

 

When you are a child MUS has .ore serious overtones.
FII guidance has had a major Bath/ Bristol input over the last 2- 4 years widely disseminated to police and social services
Tweet below highlights some of the issues
https://twitter.com/user/status/1105451416280330240


@Tilly has highlighted this many times, and perhaps explains why charities gave to step in so often when kids have ME

Relevant for NICE too ?

 

There seems to be a basic conceptual flaw in that sheet.

Patient presents with MUS

Either no patients present with MUS , or all patients present with MUS. A patient presents with as yet undiagnosed symptoms. That is why he/she has gone to a doctor. This is not the same as presenting with MUS. This suggests that paeds are encouraged to view a case as one of MUS before taking a history or undertaking tests which would lead to some other diagnosis. It seems that MUS is the presumed diagnosis upon presentation.

What is wrong with people? Is it just that supposedly educated people were never educated to express ideas in lucid manner?