What If Your Doctor Doesn't Believe You?

Survivors of domestic violence might not be able to share the fact that they’re living with an abusive partner when they visit a hospital or doctor’s office. It might not be safe for them to do so. The abuser might be standing right next to them. They might feel embarrassed or ashamed to bring it up. Or they may not even realize that what’s happening to them is domestic violence. 

For all these reasons, it’s even more important for medical professionals to ask about and recognize the signs of abuse, which could have an influence on a patient’s diagnosis. However, that’s not always the case. 

Research has shown that screening for intimate partner violence in a doctor’s office is not always routine, even though it should be. A study published in the Journal of the American Medical Association found that 79 percent of primary care physicians routinely screen injured patients, however routine screening was less common for new patient visits (10%), periodic checkups (9%) and prenatal care (11%).

Compounding the issue is that at times  patients don’t feel like their medical concerns are taken seriously by healthcare workers. And that could mean they’re not receiving the care they need. 

According to Duke Health, one in five women believes they have had  their symptoms ignored or dismissed by a healthcare professional, while another 17 percent say they feel they have been treated differently because of their gender—compared with 14 percent and six percent of men, respectively. Another 31 percent of women with chronic health issues said they felt they needed to prove their symptoms in order for a healthcare provider to take them seriously. 

Female Patients Can Be Written Off as Emotional

Dr. Puja Uppal is a board-certified family medicine physician based out of Michigan. She’s been practicing medicine for 13 years and says she’s seen firsthand how healthcare professionals can treat female-presenting patients differently.

“I’m not surprised that we still have not improved in seeing gender bias,” she says. “There is an implicit bias that maybe she’s just exaggerating. Maybe she’s just being ‘hysteric.’ A lot of times when we have a patient that’s very emotional in the clinic a lot of people don’t know how to relate or deal with that person.”

One of the reasons for this, says Uppal, is that medical and nursing students are trying not to show bias in training. 

“In training….a lot of physicians are nervous to look at the gender [on a chart] because they want to treat everyone equally. But as a result, they miss the very common things unique to that gender.” She says that training needs to adapt to be more gender-specific instead of less, not just in diagnosing patients, but also in how to communicate with them. 

“We need to stop saying, ‘She’s just too emotional. She just needs skills to deal with anxiety,’” says Uppal, noting that anxiety is often a by-product of many other conditions, such as a traumatic brain injury (TBI) which is common among domestic violence victims. While injuries like a broken bone or black eye have visible symptoms that are easier to identify, something like a TBI or concussion can present with more ambiguous signs.

“With concussions, you can have ocular issues, balance issues…it can make you feel anxious, have heightened anxiety. There can be short-term memory issues and difficulty concentrating. It affects work and your sleep, your ability to concentrate,” says Uppal. And if there’s a bleed within the brain that goes unnoticed, it can lead to death. 

Survivors themselves may not realize that being strangled by an abusive partner can lead to a TBI. Many survivors who are strangled and quickly regain consciousness consider themselves “OK” afterward. But the fact is that a loss of consciousness for any period of time can have severe negative effects and can increase in severity if not treated. If a doctor is not asking about this, it can be overlooked altogether. In one study of a group of women who had been strangled or hit on the head by an abusive partner, 58 percent tested positive for a TBI.  

Many more symptoms of abuse can present with symptoms that might be written off as something more minor. To learn more, read “Three Hidden Signs of Physical Abuse.”

What Do You Do If Your Doctor Doesn’t Believe You?

In your gut, you know something is wrong and your doctor isn’t listening. What do you do besides scream into the ether?

• Get another physician. Start by asking friends or family members for recommendations. Or, call your insurance company to see who else is in your network. It may mean traveling a bit further away, but this could be worth it in the long run. 
•  Explain your symptoms another way. Try to present your symptoms factually, clearly, quickly and without unnecessary minutiae. Sometimes symptoms can get lost in a list that’s too long or includes what the clinician feels are irrelevant details.
• Try blunt honesty. This could be your best bet. “Literally sit there and tell the physician that your gender is getting in the way,” says Uppal. Ask them for a referral to a specialist or another physician in the practice. 
• Ask what to do if the symptoms get worse. What if the symptoms aren’t just anxiety or related to PMS? What happens if they don’t go away or escalate in severity? 
• Ask what else the symptoms could be. Hopefully, it will open up a broader conversation that can, at the very least, highlight potential concerns that might have otherwise been overlooked.
• Ask about screenings. Be your own advocate. Use this chart to ask about scheduling screenings recommended for your age which could help catch something early.
• Consider disclosing abuse at home. As difficult as it may be, consider disclosing any abuse that’s going on at home. You can request that information be kept off your chart for safety reasons (though, of course, there is always a risk it could be recorded). Try to recall any physical assault no matter how minor. 

Uppal reminds us that speaking up is a sign of empowerment and that we should squash those feelings that we’re somehow a burden. 

“Yes, you may have been dismissed by previous physicians, but you are a smart person, you have a gut feeling and it should not be ignored.”

Also, consider reaching out to your local domestic violence hotline to work out a safety plan. Abuse almost always escalates and if there is physical abuse now, there are likely going to be more incidents in the future.