Thursday, August 13, 2009

Health Care Reform Should Include Reform in Attitudes About Women

I was 22 and newly married (which, looking back, is scary in itself), and I was excited to be moving across the country to begin my studies in a top graduate program that fall. I’d already heard inane and sexist comments at my wedding. In the course of one day, I had been told that I looked “just like a fairy princess” (always a goal of mine) and that we “would have beautiful children” (because isn’t this the goal of marriage—good looks and procreation?), and this was just in the receiving line at my very wealthy, very Jewish, very Southern wedding. I’d come to expect this type of ignorance in Alabama, actually. I had to remind myself that when I had wanted to go to the Wal-Mart nearer to the college rather than the one all the way across town my first day alone in Montgomery, a classmate pointed out to me, “But that’s the black Wal-Mart.” And later on, my own mother-in-law (now, my former mother-in-law, Thank G-d) once swelled up in self-righteous indignation and hissed, “How dare you say I’m racist. All of our maids have always been black.” But the one lesson I’ve learned in life, if nothing else, is always to be prepared for the next shock.

A few weeks later, I was going through my end of the appointment polite good byes with my fatherly gynecologist—a giant, goofily rotund man with a swirl of gray hair and thick glasses. He knew I had just been accepted to the University of Chicago. He knew that I had only come to his office for my annual exam to get my yearly prescription for birth control pills and that I was here because I didn’t want to add the pressure of finding a new doctor immediately to the pressure of moving cross-country and starting graduate school. All of this had been covered in the polite but awkward chit-chat during the gynecological exam. Yet he looked directly at my husband and patted him on the shoulder and said, “Bring her back in six months when she’s pregnant.” Rarely have I felt so invisible. Or so undervalued. Or, rather, valued for just one thing. I am fairly sure that this is how strippers feel, except that they do have a sense of power, arguably. This one statement meant that my doctor thought now that I was married, I wasn’t in charge of my reproductive health. I wasn’t in charge of my life. My husband was supposed to “get me pregnant” and “bring me back,” and there was supposedly nothing I could do about it. I was absent from the equation, other than being a receptacle for sperm and an incubator. It was enough to make me conspiracy-theory crazy. Were these really birth control pills he had given me or a new tiny type of Pez, complete with compact daily dispenser? My college friends and I had always thought Saturday Night Live should do a spoof of those old Folger’s Crystals commercials where instead of replacing gourmet coffee with Folger’s Crystals, they replace someone’s birth control with Pez and see how the couple likes it. It’s not so funny when you think it may be happening to you.

Looking back, in a for-profit capitalist health care system, who can blame the doctor? He could have stood to make about $12,000 if I had come back pregnant, in need of prenatal care and delivery, not to mention all of those lab fees for blood work and ultrasounds. By requiring only a yearly exam and $20 a month in birth control pills, I might have been depriving him of a new Mercedes or a Hawaiian vacation; who knows? Not me personally, but imagine how broke he would be if more women decided not to have children.

Stories abound on the internet of women who have told their doctors they have no interest in having children being given information on fertility and condescendingly being told that they will “change their minds.” One woman on the blog entry “Construction of the Female Body in Gynecology” at Feministing.com, was asked by her gynecologist when she was seeking treatment for PCOS (Polycystic Ovary Syndrome): "But what happens when you meet a nice man and he wants to make you pregnant?" The blogger felt the same confusion and powerlessness I did, all those years ago. “I can't begin to explain all the things wrong with that sentence, and from my doctor no less,” she laments in the comments section.

Flash forward to about five years later. I am sitting “almost naked” on another exam table, this time in the suburbs of Chicago. I say “almost naked” because I am wearing one of those paper disposable gowns, which people in the 1960s thought were the wave of the future. My doctor has just made a drawing for me. Apparently, I am female, and, therefore, simple. Drawing—good; words—bad. It is of a flight of stairs and a landing. On the landing, sits CANCER in all capital letters. There is an X on the top step, so close to the landing, just a stride away, not even a full stride if that X is one of those over-achievers who takes stairs two at a time. He says, “This is you,” and taps the eraser end of the pencil on the X, then he says, “And this is CANCER,” and taps the word “CANCER.” Then, his cell phone rings, and he takes the call. I know that doctors have demanding jobs and multiple people in need of their services at the same time, but doesn’t this seem like a reasonable time not to take a call? Isn’t this a time when you would finish talking to your patient? I remember taking deep breaths to slow my pounding heart and my armpits instantly sweating into the sleeveless opening of the paper robe. My doctor patted my back while he talked jovially into the phone. I know it’s a stereotype to think this, but he could have been making a golf date with a friend. He certainly wasn’t talking about anything serious.

After he finished his call, he told me to get dressed, and he would be back to talk about treatment options. I remember I was dressed sweetly that day—a pale yellow sweater and a long flowery yellow “teacher skirt.” I was an adjunct professor of English masquerading as a second grade teacher, but I let him have it—politely. “In the future, you might not want to answer your phone when the last word you’ve said to a patient is ‘Cancer.’” He chuckled. How cute that I was attempting to stand up for myself.

“I was right here. I was only on the phone for a minute.” He went back to rubbing my back.

I tried to express that I’d thought I was having a heart attack, my heart had been pounding, I had started sweating, the last word he had said to me was “Cancer,” and then he had taken a phone call. He chuckled some more. In all actuality, I probably had had an anxiety attack of some sort. How fragile and feminine of me. We talked about treatment options, which was basically him telling me to schedule something with the receptionist out front and not to eat or drink after midnight the night before surgery. You know, all of those rules you follow to keep your mogwai from turning into a gremlin.

I am sure readers will wonder why I kept going to this same doctor, and the truth is, I don’t know. He was in an upscale medical center, and he had a good reputation. I had originally gone to another doctor in the same practice who had gone on indefinite leave to take care of his terminally ill child. In defense of male gynecologists, that previous doctor was possibly the best doctor I’ve ever been to, of any kind, and I think I stayed loyal to the same practice, hoping he would come back. When a female gynecologist joined this practice, I switched over to her, but she was a mother of four and started keeping fewer and fewer hours, leaving me to the less attentive doctor. I am sure there are good and bad gynecologists of both sexes, but I was ready to try something new, and I’m not alone. In surveys, 80% of women say they would prefer a female gynecologist when possible, and given my treatment by most male gynecologists, I would have to concur.

The doctor who took a phone call after showing me how close I was to “CANCER” was then two hours late to my surgery. I had been hooked up to an IV drip since arriving at the hospital and had to keep running to the bathroom, wheeling my IV rack with me, because the additional hydration made me have to urinate every few minutes. I felt like a child in a made-for-TV movie about a pediatric oncology ward. I came to understand the need for the slide-proof grips on the bottoms of hospital socks. When my doctor finally arrived, he announced cavalierly that he had had to “catch a baby.” Ah! The profit margins on those little bundles of joy! I wanted to shake him and yell, “Let’s pretend my tumors are babies! I had to have ultrasounds and everything, too!” but I restrained myself. At the time, I believed him, that he really was delayed because somewhere, someone needed to come into the world at the same time I had scheduled a surgery, but I have since heard stories of doctors showing up late for surgeries in their tennis garb. I’m trying not to be that pessimistic about the whole system.

One of the next times I saw him (This all runs together in my memory because I had two surgeries two weeks apart. The recovery room nurses at the hospital actually said, “You again!” when I woke up from the second surgery.), I overheard him on his cell phone while I waited for my appointment. He was saying (presumably to another doctor), “Oh, I know. Women are always afraid of that procedure. It’s nothing.” I wondered why he became a gynecologist if women were so silly and needed constant reassurance from their male doctors. Maybe he needed to see himself in that role of rescuer or dashing doctor and had taken the job. Maybe because he was Jewish, he had to become a doctor and didn’t know what else to specialize in and someone made him be a gynecologist. We had had plenty of Jewish professor/Jewish doctor talk during the chatty moments of our encounters. We had gone to graduate and medical school across town from each other. My graduate school outranked his medical school. We liked to joke about things like this. I guess what I’m saying is that I don’t think he was a bad person, but he needed to change his thinking about women to be a good doctor. All I know is that I’m glad I moved away, and I no longer have to deal with his condescension and that overhearing his conversation with another male doctor confirmed Rita Rudner’s shtick for me, when she says that going to a male gynecologist is like going to a mechanic who has never owned a car.

Since moving to my current place of residence, I’ve been going to the Public Health Department for all of my (non)reproductive health needs. Until recently, I had no complaints. Everyone was female, everyone was open-minded, no one was pressuring me to reproduce, and my birth control was free of charge. This is something I’ve always had strong feelings about. If we, as a society, pay for other people’s children (which is fair—I agree with public education and free school lunches and breakfasts), shouldn’t we pay for people not to have children as well? It seems cost-effective to me. But the state of Oregon has changed the insurance provider for all educators, and the new insurance might not pay Public Health for my birth control. I might have to pay. Both Public Health and I are waiting for a definite answer on this. When the nurse at the front desk explained this to me, I was shocked, “But don’t they understand that paying for my birth control is so much cheaper than paying for a baby?”

“You would think,” the nurse said. “Everything’s cheaper than a baby. You’d think the insurance companies would catch on.”

The last time I checked, it costs the average middle class family $174,000 to raise a child from birth to age 18, not including college. Given all of the profits that would translate into for all kinds of entities, maybe we should all be making sure that our birth control isn’t being replaced with something more sinister, like Pez.

--Shaindel Beers

6 comments:

A.S.K.-P. said...

All I can say is OH MY GOD! I can't believe some of the ignorant AND unprofessional people in this society! Thank you for sharing this.

Jerry the medical sales recruiter said...

Woman has always been neglected by the health care system.

Just understand that Obamacare will cost this nation thousands of jobs....many of those women's jobs, mostly high-paying ones.

In my industry, medical sales, we have already lost 10,000 female medical sales representatives in anticipation of reform. Learn more about the impact of reform on the medical device sales industry at http://www.gorillamedicalsales.com

Cadenza said...

Thank you for sharing this poignant story. Currently, I'm rifling through a stack of medical bills sent to me after an unexpected trip to the ER. Catastrophic care doesn't truly cover catastrophes and I'm fit and in good health.

Part of the bloat in health care is the 33% administrative costs lopped on top of your medical bill. Consider it a mark-up.

But sending physicians on junkets, deluging them with trinkets and perks are also part of the bloat. Medical sales is more advertising and advertising costs big money, which ultimately, the consumer pays. Administrative costs in hospitals are more in line with the finance industry because they need to send out quarterly dividend checks to stock holders. Start looking into who is making a profit on your well being and you'll find a lot of needless waste.

Paula said...

Why should ANYONE make money on my health care?

Victoria said...

i feel terrible that you had to go through that. it just makes me much more appreciative of my gynecologist, who happens to be a man, but is someone who i'm totally at ease with. he's amazing, he always gets so excited when he has the chance to tell me about a new kind of birth control and explain exactly how it works. it takes a while, but i'm always happy to listen.

Sarah said...

Wow- All I can say is this is right on. I've never understood why insurance companies will pay for well-baby care but not birth control pills, why insurance company will cover VIAGRA and not in-fertility treatments for women. I have always sought out female doctors for everything possible- I find them to listen much more, to have better bed-side manners- to treat the whole person- mind, body, and spirit- and have much higher level of sensitivity. This is why I had a Certified Nurse midwife for my delivery and a Doula! My therapist is a female, my son's pediatrician is a female, my gyn is a female and so is my general m.d.! I hope I can keep them all when I go to private insurance since I'm self-employed and getting divorced! Yet another "problem" with our health care system. I'm dependent on my soon-to-be-ex husband for affordable health care- yet want to be free from him financially. And I've heard that scary word "pre-cancerous cells" in my early 20's and had the same insensitive treatment at a public health care place by a man. Luckily I found a sensitive woman doctor for the surgery! We all survive- with the help of sisterhood and good brothers too.