Copperfield blasts a recent report saying that GPs need training in women’s reproductive health to end ‘medical misogyny’
For the avoidance of doubt, I want to make it 100% clear that I’m not a misogynist. I like women so much that I married one, I berate my two sons for neither of them having the selflessness to be a daughter, and of all the hormones available, I think oestrogen is my favourite.
That said, I’m going to come over all alpha-male in my description of the House of Commons Women and Equalities Committee (WEC) report, ‘Women’s reproductive health conditions’. Because it’s utter bullshit.
You only have to read one word of the report to realise this, and that word is ‘dismissed’. As in, ‘Women… are not being listened to and are dismissed far too readily’. No GP in history has ever actually ‘dismissed’ any patient about anything. It’s a word used almost exclusively by the Daily Mail to reinforce their readers’ prejudice against GPs and immediately flags that this report is a sanctimonious blame-dump.
Not convinced? OK, how about the idea of the annual appraisal process being ‘strengthened’ to ‘include a specific performance indicator on the diagnosis and treatment of women’s reproductive health conditions’. This, in one sentence, displays a complete misinterpretation of the issue. It is an ignorant, Pavlovian response to the issue, and a total misunderstanding of the nature and purpose of appraisal (I assumed they’ve confused it with QOF, but, no, they’ve suggested using that, too).
Look, people. Diagnosing certain conditions in female health, as in all other areas of medicine, can be tricky and iterative – especially in general practice, when pathologies are presented early in their evolution and often blend with multiple other issues. One of our many skills as GPs is diagnostically balancing precision and pragmatism, and it’s all too easy to misconstrue this – wilfully or not – as incompetence or delay, especially if you have a reductive view and a drum to bang.
To suggest this amounts to medical misogyny is insulting, inflammatory crap. I have a clutch of prostatic men dumped in the community with indwelling catheters and no discernible follow-up; I have men with intractable ED but no local andrology service because funding has been withdrawn; I have men who can’t get their vasectomy on the NHS because the slots have gone. Is this medical misandry or just another symptom of a buckling system?
Reports like this don’t improve care, they just further alienate those desperately trying to provide it, against the odds. The only group being unfairly discriminated against here is primary care. And hell hath no fury like a GP scorned.
Dr Tony Copperfield is a GP in Essex
Spot on TC. Politically motivated nonsense
Spot on!
As the GP workforce consists of a high percentage and increasing of female GPs who see the majority of women presenting with “women’s problems “ it must be our female colleagues who are misogynistic to their own gender.
It seems these MPs assume that it is male GPs dismissing women!
No fannying about, TC, re this “bollocks” report. You’re no pussy in your opinion. But you have made a couple of boobs – can you put your finger on them? You are right though – the authors of the report must be feeling like a right bunch of tits..
Spot on. Totally bullshit daily mail jargon. It says 1 in 3 women have these symptoms so it is part of our normal life we don’t need to over medicalise it but we do need to offer treatment options with informed consent like we always do. Nsaids, tranexamic acid and various contraceptives for menorhagia and dysmenorhea and similar for endometriosis. It isn’t rocket science there just aren’t that many magical treatments available. AS for endometriosis half the time gyne don’t want the referrals and diagnosis is unreliable-laparoscopy findings not reliably related to sx at all, and high risk procedure. I would argue we manage these patients extremely well. I explain that none of the treatments is a long term fix but just treats symptoms. I think we manage the patients better than gyne with less risks because I try and keep them away from surgical interventions as this is a pathway to chronic pain and worsening symptoms in my experience.
So with up to 3 million women with the condition, 70 specialist endometriosis centres in the uk and lets say GP referring 3 uncertain diagnosis patients for 1 definitive doagnosis,
That sum requires 100,000 appts at each specialist centre.
Our routine gynae waits are already over 1 year.
Gatekeepers try to manage the available resources provided ny government.
If MPs wish me to refer everyone, I am perfectly happy to do so, but i will get a letter very rapidly ordering me to stop or just rejecting my referrals outright
Gender inequality has existed for years. Life expectancy, suicides, cancers, cardiovascular disease, lack of screening. We all know who the weaker sex are.
Agree with Finola
There has been a puzzling aspect of the endometriosis debate recently – criticism of the length of time to diagnosis. But since management is cheaper, simpler – and probably safer – than diagnosis, it seems an odd criticism. Early stages of endometriosis management are the same as management of other causes of menstrual symptoms. Diagnosis generally requires surgery.
Surely “length of time to effective management” is the relevant metric, not “length of time to diagnosis”.
Careful, Tony… Denying “medical misogyny” might lead to accusations of medical gaslighting!
https://www.bmj.com/content/378/bmj.o1974
In fact, with my scientific hat on, I realise that there is actually no way no of knowing the proportion of women with endometriosis whose symptoms are well controlled.
Yes, you can study the proportion of women WITH A KNOWN DIAGNOSIS who have good symptom control. But obviously you will miss all those women whose (undiagnosed) endometriosis responded well to, say, the COCP. Even a research study could not ethically check a sample of women with well controlled symptoms and perform a laparoscopy on each to count how many in fact have endometriolsis.
So you can’t establish a research population of women with endometriosis, only of women with diagnosed endometriosis; which naturally only includes those women whose symptoms did not respond to initial symptomatic treatment.
Agree. Everyone is doing their best in a crumbling system with record gynaecology waits – how is that misogyny?
Medical gaslighting is a triggering phrase to me!
Nil to add to the above other than to highlight the use of the phrase “fobbed off” which is also Daily Mail speak, almost universally in respect of female patients dissatisfied with the non diagnosis of their polysymptomatology. So much so that when Dr No sniffs (not literally) such a patient they anticipate the accusation and flag the approach of the end of the consultation with “I hope you don’t feel I’m fibbing you off etc etc…”
Spot on. There is a distorted anti-male movement and view from the media. I have never had so much education regarding women’s health compared to men’s health. Most of the users of the services are actually women too. I am surprised no one called for a discount for men as they are hardly using any of the services they’ve paid for.
Beautifully said.
In a world where women have a much larger piece of the health care pie and have longer life expectancy that still isn’t enough. They need more to feel even more equal. Those feelings are paramount. Unrestrained want leads to more want. My prediction is that the gap between men and women’s life expectancy will widen.