Listen to Your Patient

Nada Khan

Do we listen to women? Do we really listen to what they are telling us? The research behind the Department of Health and Social Care’s recent Women’s Health Strategy for England suggests we don’t — ‘not being listened to’ is the common thread that underpins the responses informing the strategy. Women described how their symptoms were not taken seriously by healthcare professionals, and self-advocating to get the right management. I see parallels in other reports: the All Party Parliamentary Group on Endometriosis described women waiting an average of 8 years for their diagnosis despite 58% of women visiting their GP 10 times or more with symptoms. What women want is simple: they want to be listened to, believed, and taken seriously by their doctors, but their often convoluted diagnostic journeys among a range of conditions demonstrates how this does not always happen.

The research in this month’s Issue on women’s health underlines the importance of listening to women and building trust between doctors and their patients. Williams et al discuss help-seeking behaviours in women with symptoms of gynaecological cancers and note that a ‘lack of trust in the healthcare system can cause delay’. Women aged >50 years are a high-risk group for cervical cancer, and in their qualitative study, Bravington et al emphasise the importance of history taking and addressing women’s concerns as the key to successful screening.

Gender matters in health care. A team of researchers in the US looking at women experiencing a heart attack found that female patients were less likely to survive if treated by a male doctor. The negative effects of gender non-concordance in health can be attenuated in workplaces where there is a higher proportion of female doctors, so we should be ahead of the game here in UK general practice, where the latest General Medical Council workforce report shows that between 2012–2021, 57% of GPs were women. We’re well placed to learn from our colleagues and advocate alongside our patients to make sure they are heard. As the authors of the heart attack study note: ‘a significant number of life’s outcomes are not determined through self- advocacy … instead, they result, at least in part, from people who advocate for, and act on, a person’s behalf’.

William Osler (1849–1919) told us to ‘listen to your patient, he is telling you the diagnosis’. Historically, the kind of medical model Osler ascribed to was based on knowledge of men studying men. As Barbara Ehrenreich and Deirdre English pointed out in their book, For Her Own Good: 150 Years of the Expert’s Advice to Women, Osler represented the patriarchal aspirations and achievements of 19th century medicine, the vestiges of which still influence our practice today. I would hate to undermine the father of modern medicine, but I think I would prefer to change his famous aphorism to ‘listen to your patient, she is telling you her story’.

Issue highlights

Negative portrayals of GPs in the media have heightened since the COVID-19 pandemic. Mroz et al present an analysis of media depictions of remote consulting in UK general practice and report how the media is influencing the ‘war’ on general practice. Prospective online access to medical records remains a relevant issue despite recent delays in the rollout of the programme, and in an editorial, McMillan et al highlight an urgent need for research on the impact of online access on workload and patient outcomes. And finally, in Life and Times, McCartney et al present a framework for considering diagnoses as ‘delicate’, and accepting a level of uncertainty with patients.