Trust is undoubtedly an important part of the practice of medicine. In order to receive treatment or participate in preventative care, patients must have some degree of trust in their physician and believe that they have the skills required to improve or sustain their health. But trust is a two-way street, and it's not uncommon for doctors to simply not believe people — women in particular — when we say we're in pain.
But why does this happen? Why is it so hard for some doctors to believe women? Is there anything we can do about it? We spoke with experts to find out how to navigate these situations and why it has such an impact on not just our physical well-being, but our mental health as well.
Why does this happen?
Like any complex question, there is no easy, straightforward answer. Every medical professional is different and brings with them varying experiences and training that could impact how they view and treat patients. To start with, it helps to remember that doctors are people too, Shadeen Francis, a marriage and family therapist that specializes in sex therapy and social justice, tells SheKnows.
“While they are armed with medical knowledge, even the most learned practitioner is still limited by the boundaries of scientific discovery and the extent of their own understanding,” she explains. “Doctors are trained to follow a decision-tree model of diagnosis that rules in or out potential diagnoses based on symptom presentation. When tests results are negative or symptoms don’t match up to a typical presentation, doctors may conclude the absence of a clear physiological explanation means the patient is overreacting, withholding information or lying.”
Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells SheKnows that doctors may not believe their patients when they say they're in pain for a variety of reasons, including detecting that the patient is attempting to fool the doctor about being in pain. This can be exacerbated if the patient has been trying to obtain multiple prescriptions from different sources for the same condition in a short period of time, he adds.
Other red flags for doctors, according to Mikhael, include contractions in the patient's medical history, a lack of findings on testing and imaging studies or previous diagnoses from other physicians or an "exaggeration of the symptoms to get attention," like saying that on a scale of one to 10, their pain level is 15.
Another reason doctors may not be able to accurately diagnose patients is because of the ongoing trend of office visits becoming shorter and more hurried coupled with large amounts of paperwork, Francis points out. "This can limit a doctor’s capacity to listen deeply, think creatively and empathize," she adds.
Finally, when discussing doctors not taking patients' pain seriously, Francis reminds us that we have to remember that medicine exists within our larger social system that has an unequal distribution of power. "The voices of folks with less systemic privilege — e.g., people of color, women, folks with disabilities, noncitizens, etc. — are routinely silenced, ignored or discredited," she explains. "This leaves little room for patients to advocate for themselves and get the care that they need."
How does this affect your mental health?
For a lot of people, seeing a doctor is a feat in itself, between getting an appointment and then finding a way to pay for it — not to mention the fact that the appointment itself can be anxiety-inducing for some. Then, after all that, if a doctor does not believe you when you say you're in pain, that can be a blow for your mental health.
"Not being believed adds an additional barrier to care and healing," Francis explains. "It is added emotional labor to advocate for yourself in the face of skepticism, and this can be really difficult."
She notes that a doctor's disbelief can have a similar impact as gaslighting, making you question your own self-knowledge — especially if this has happened on multiple occasions. Furthermore, a doctor’s response or lack thereof can also create feelings of depression, anxiety, hopelessness, embarrassment or shame, Francis says, adding that "all of these can worsen an existing condition by compounding mental pain with physiological pain."
How can you get a doctor to take your pain seriously?
Ideally, medical diagnoses would be obvious and straightforward, but, unfortunately, that's usually not the case, and sometimes we have to act as our own advocate. Fortunately, there are several strategies for getting your point across clearly and effectively.
Find the right doctor
Of course, this is easier said than done, and not everyone has the option of seeing another physician if one doesn't work out. But if and when at all possible, seek out a doctor who believes you and is on the same page about your health care.
“It is important for patients to find doctors who they feel they can trust and talk to them about the symptoms their experiencing,” Dr. Kenton Fibel, a family medicine physician specializing in sports medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, California, tells SheKnows. “This is crucial to a healthy doctor-patient relationship. If a patient does not feel that their current doctor is taking their symptoms seriously or acknowledging their pain, they may want to seek a second opinion or find a physician that they feel communicates better with them.”
Be specific about your symptoms
The more effective you are at communicating your pain and health experiences with your doctor, the more likely you are to get an accurate diagnosis. For instance, Mikhael recommends being as clear and specific about your medical history and current pain as possible. He also suggests asking the doctor for help rather than dictating what you think your treatment plan should look like.
Along the same lines, Francis says we should "tell the story" of our symptoms, giving precise information about when the incident that is causing your pain happened, how it feels, how long you’ve been feeling it and what you’ve done about it thus far.
"Our brains are responsive to stories, and providing information in this way can help get [us] out [of] the asked-and-answered exchanges that are often default in a medical exam," she says. "Coming in with short notes about your symptoms and what you want to say about them can help you remain clear and focused and keep you from forgetting to share something significant."
Tell your doctor if you don't feel heard
It may not always be easy to speak up for yourself, but it may be necessary.
"It will take some courage, but as you don’t feel heard, it would be worth expressing that to your doctor," Francis says. "In the doctor-patient relationship, doctors have the social power that comes from having a prestigious title; they are seen as the experts. Nevertheless, letting them know that you don’t feel like you’re being taken seriously, that they haven’t understood what you’re trying to say, that you don’t feel like they’re really hearing you is important."
Your pain, including your physical and mental well-being, is important. If you're not getting the care and assistance you need, speak up if you are able to do so because we all deserve to be believed.