"Assume all patients are lying," my professor told my class during my first year of medical school.
I have since switched fields to become a PhD-holding biomedical researcher and academic. But this phrase stuck with me, and I often remember it whenever I visit a doctor's office.
I remembered it the most 6 summers ago when I almost died due to an ineffective diagnosis. I had appendicitis; something my great aunt died of decades before I was born.
You might imagine I had pain and ignored it, but that was not the case. In the months preceding the surgery that saved my life, I had been in pain to the point of being unable to walk.
I had seen a doctor, several in fact. I felt as if I was a ping pong ball and the players were the gastroenterology and gynecology-obstetrics departments at a health science center.
After doing tests, both departments sent me back to each other and ultimately to the psychiatry department. They said I was depressed and that was the root of my issues. The psychiatrist told me that being a grad student is stressful. But I was also at a great point in my life: I had finalized my graduate work, I was about to defend my thesis, and had a job lined up a month after graduation.
More importantly, my mental health assessment indicated I was not depressed. It wasn't enough to convince the other physicians that there was indeed something physically wrong with me.
I'm not the only woman and definitely not the only person of color to have been ignored when pointing out potential medical issues during a healthcare appointment.
As Elinor Cleghorn, PhD, states in her 2021 book, , "Health-care providers and the health-care system are failing women in their responses to and treatment of women's pain."
I know several people who were sent to a psychiatrist instead of being tested further or even told to seek another medical opinion within the same branch. Cases like mine are unfortunately found all around the world.
- A blogger that as a 21-year-old she was misdiagnosed as having psychosis, instead of recognizing she was intoxicated with St. John's wort
- In the U.K. recently, a musician was with sleep apnea and died of a stage four tumor after some of his symptoms were initially ignored
- In the U.S., a woman's uterus was due to a cancer diagnosis without further testing; she had a benign fibroid mass
- A Canadian woman who suffered severe headaches postpartum allegedly from dangerously low hormone levels because hospital personnel dismissed her symptoms, resulting in a misdiagnosis
- A 2022 shows the high number of misdiagnoses due to medical personnel's inability to really listen to their patients is alarming
The list goes on.
In my case, how did trained physicians miss something as straightforward as appendicitis? Research shows that, among many other reasons, and bias can give way to that ignore the patient's experience and knowledge of their own bodies.
To be fair to my physicians, I was a special case since I had atypical left-sided appendicitis. But the real reason I spent 2 months in daily pain is because the physicians chose not to believe me.
What is perhaps most concerning is that, in my case, I was certain I was physically ill. I have a PhD in physiology, and though I may not be a physician, I had spent more than half my life surrounded by medical research personnel in different capacities. I trusted myself and my knowledge base, so I didn't dismiss my symptoms. What happens if you don't have the background knowledge to back you up?
As in the field of biomedical research, there is push toward being by implementing , especially with people outside the medical profession.
Following by the Association of American Medical Colleges in 1998, medical schools across the U.S. worked to improve medical doctors' ability to communicate with their patients by employing some form of empathy training in their . Studies that more empathy and compassion seems to lead to better health outcomes.
Unfortunately, there is conflicting information regarding the efficacy of training. A came to the conclusion that you can, indeed, successfully teach medical professionals to increase their empathy and compassion. The research suggests this training -- which includes use of body language and supportive statements -- needs to be included in the regular curricula. Other there is little evidence that physicians can be successfully empathy-trained after only a short period of training.
More recently, the Clinical Skills component of the Step 2 exam by the United States Medical Licensing Examination (USMLE) -- which tests a physician's ability to communicate with their patients, and should probably have been revised to more effectively measure empathy-based interactions -- was discontinued.
This leaves it up to institutions to decide on modes of training, and whether effective communication with patients is a relevant component to assess.
It is urgent for the Association of American Medical Colleges and the USMLE to invest in their medical students to help them become better doctors through comprehensive empathy training and communications assessment. Medical doctors need to rely on their patient's knowledge of their own body as well as their expertise. They must be able to listen and understand that they may not "know better" despite their extensive training.
Healthcare providers have chosen a service profession. Being in charge of someone's health is a privilege as well.
is a professor of biology at Huston-Tillotson University and a public voices fellow through The OpEd Project.