Why We Need a “Body Reform” in Healthcare
by Katie McBeth
Doctor stereotyping of patients is far too common — and it can be deadly.
I’m going to share a story with you. It’s not any particular person’s story, but it’s a sort of mash-up of a recurring story I’ve heard far too often; both from friends and online communities.
Doctor: “What brings you in today, Miss?”
Patient: “Well I’ve been having some really bad stomach pains, and my back has been pinching in the middle. I don’t know if they’re related…”
Doctor: “Well, have you had this issue for long?”
Patient: “For a few months, actually, but I’m not sure if anything specific triggered it.”
Doctor: “You weigh about, what, 200 pounds? Have you gained any weight in the past few months?”
Patient: “What? Well, maybe. I don’t know what that has to do with this — ”
Doctor: “I would say there’s just a diet change in order. You’re probably eating too many fatty foods, causing gas, which would upset your stomach. The weight gain would explain your back ache, too.”
Patient: “My weight has nothing to do with this. I’ve been ‘plus size’ most of my life, and it’s never been an issue.”
Doctor: “Well, maybe your body is finally catching up to you! I’ll write you a script for some stomach pills to help ease the cramps, but otherwise you should just focus on exercise and…”
Does this sound familiar to you? Or maybe you’ve heard this story from a friend before?
American healthcare is in serious need of “Body Reform.” Far too often, the health needs of patients like the fictional one are disregarded in their health needs when doctors (typically male, but not always) make diagnostic assumptions based on gender identity, weight or sexual orientation. As if enough discrimination didn’t already exist in life, we have to get it from our doctors, too. Great.
(Cis)Female Bodies in Healthcare
My frustration over this issue was reignited recently when a study out of France found that male doctors were overlooking heart disease risks in their female patients because they believed they were less susceptible than male patients. Yes, cisgendered male patients are typically more likely to suffer from a heart attack, but the number one health concern for women (outside of STD’s and partner violence) is — wait for it — HEART DISEASE. And these male doctors were completely disregarding the need to screen for risks.
Talk about a malpractice suit waiting to happen.
Of course, this isn’t the only type of discrimination women have experienced in the doctor’s office. Misdiagnosis of serious medical issues — such as discrediting the signs of Polycystic Ovarian Syndrome in patients with heavy periods and weight gain, or assuming that a patient’s pain is “all in their head” — plague women across the globe. Prior to the Affordable Care Act, women were even required by medical insurance programs to pay more for basic services in their healthcare needs, such as OBGYN wellness visits, gestational diabetes screenings and contraceptives. Thanks to Obama (no, really — thanks, Obama!) overpriced medical care is no longer an issue for most women, although more changes need to be made to make health insurance more accessible for everyone.
Luckily for many women, there are female nurses in the healthcare field that can provide patients with information on the warning signs for a heart attack. According to the University of Cincinnati’s Master of Science in Nursing program, female nurses remain the primary source of health information for female patients in the United States. “Today’s nurses serve as educators and supporters for their female patients, leveraging the ability to recognize problem areas, arrange for screening tests and provide follow-up care.” So where the doctors may fall short, there is at least the expertise of nurses in the field.
Trans Bodies in Health Care
However, there is a different story for trans women (and trans men) when it comes to relying on information provided by nurses. Unless the nurses have experience with the unique needs of trans patients, they may struggle to give proper advice or treatment. The American Medical Student Association (AMSA) has put together a healthful guide for doctors and nurses on how to approach medical treatment for a transgender patients. Despite this, the amount of issues I’ve heard about medical care from trans individuals leads me to believe that very few doctors are familiar with the recommended approach to their unique treatment needs.
A wonderfully helpful and kind friend of mine, Thumper, offered words of advice on the matter. Thumper is a transgender individual living in a normally progressive state on the West coast, but has been experiencing medical bias from doctors even in recent months. They were willing to answer a few of my prying question on the issue to give a more authentic perspective on the “body problem” for transgender people within healthcare:
Me: “I found this guide on the American Medical Student Association about how doctors/nurses should approach transgender patients. What are your feelings on Doctors being told to focus on the body parts of trans individuals, even if the parts don’t correlate with their identified gender? What’s your opinion on the whole thing? And what have you experienced that’s super sh*tty from a doctor or nurse?”
Thumper: “Well, for one, I think it is important to take care of someone’s whole body, regardless of their gender identity. For example, trans men can frequently still get pregnant and still require gynecological care. So I don’t think that wording is particularly discriminatory and some doctors do need to be informed of this fact. And as far as discrimination that I’ve experienced goes, I don’t know if you’re familiar with the term “Transgender broken arm syndrome?””
Me: “No, I’m not!”
Thumper: “Well, that term refers to health care professionals assuming anything someone comes in for has to do with their queerness. Full disclosure: right now I’m dealing with some really scary abdominal sh*t that includes sharp pain and very frequent vomiting. The last time I went in to see a doctor, I was asked all sorts of very personal sexual questions and treated with skepticism when I stated that I only have sex with one partner. Then, I was made to do an STI screening and that’s literally the only thing the doctor did. No referrals to a GI doc, no scans, not even a urine analysis. […] and it’s even worse for people who are physically transitioning. Mostly, the first thing a biased doctor will do is recommend ceasing hormone therapy for any little thing. It’s f*cked up.”
There are not many doctors who are familiar with the specific needs of trans individuals, and due to the recurrence of “transgender broken arm syndrome,” organizations like World Professional Association for Transgender Health (WPATH) have been created. Their sole purpose is to ensure proper access to experienced (non-discriminatory) health providers, and health coverage for trans folks across the globe.
WPATH recognizes that the main issue with transgender body discrimination in health care is a lack of knowledge. Even now, a limited few university medical programs offer specific studies on LGBTQIA medical needs; which leads to a cycle of misinformation and bias within the industry. WPATH — and groups like it — aim to change that cycle.
Plus-Size Bodies in Healthcare
Probably the most common and intersectional issue of body-discrimination in health stems from body size. Fatphobia in medicine is all too common and affects anyone with a high body mass index (BMI) that is determined “overweight” or “obese.” The BMI count is where the main problem lies in mistreatment, where doctors often rely on the numbers more than the patient’s actual needs. This results in a recurring treatment plan of “lose some weight” instead of actually taking patient’s concerns seriously.
However, the BMI has been proven to be misleading and completely inaccurate in determining the health of a person. The readers here at Wear Your Voice know that people of any size can be athletic and healthy. What the BMI count determines is based on only two aspects of a body — height and weight — not taking into account the importance of bone density, muscle mass, body composition and racial and sex differences. That’s a problem, and the BMI needs to be taken out of medical practice completely or it will continue to do harm.
Let’s Demand a Body Reform in Healthcare Now
These are the issues facing bodies across the world when they are trying to seek medical help from professionals, and this discrimination needs to end. If you hear about mistreatment from a doctor, don’t support them. If you experience discrimination from a professional, report them to organizations like WPATH or HealthFinder.Gov.
Doctors and health professionals have a code of ethics they need to follow to ensure they meet the needs of all patients that come through their doors. Whether it’s through properly educating the next generation of nurses and doctors or by weeding through the current one, somehow the healthcare world needs to achieve a total “Body Reform.”
Katie McBeth is a Freelance writer out of Boise, ID. She is an intersectional feminist, owner of a small private zoo, and can occasionally be found at music festivals cheering on her favorite indie acts. You can follow her animal and writing adventures on Instagram or Twitter.
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