Latest / The STA Clinician Podcast / Ep.274 'Understanding Pain in 2026: Part 3 - The Gender Pain Gap' with Dr. Rachel Dewar-Haggart

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Ep.274 'Understanding Pain in 2026: Part 3 - The Gender Pain Gap' with Dr. Rachel Dewar-Haggart · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across healthcare.
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Known for the last five years as the Sports Therapy Association podcast.
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My name is Matt Phillips, creator of runchatlive.com. And as always,
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this episode is being recorded live on the Sports Therapy Association YouTube
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channel and Facebook page at eight o'clock UK time on a Tuesday.
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Although as we'll mention again later on, if you are joining us live next week
0:39
on February the 25th, it will be a Wednesday.
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Still at eight o'clock, but just so you know, next week, Wednesday life.
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Right. So we have reached part three of our focus this month of understanding pain in 2026.
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And the topic tonight in this episode is going to be the gender pain gap.
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As was stated in the advert for this research, sorry, for this episode,
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research does consistently show that women experience more MSK pain than men.
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They have it taken less seriously and are more likely to receive delayed or inadequate treatment.
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So to talk about this very shortly would be my special guest Dr.
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Rachel Dewar-Haggett, a postdoctoral qualitative researcher within the Medical
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Sociology and Health Experiences Research Group at the Nuffield Department of
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Primary Health Care Services, University of Oxford.
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Firstly, though, I would like to thank my guests from last week.
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And if you joined us last week, hopefully you're now watching it for your fourth
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time through, trying to work it out of what was going on.
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It was a fantastic episode. It was with Professor Dave Newell,
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Head of the Centre for Pain and Active Inference Research at Health Sciences
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University, and also Anna Maria Matsieri, who is currently a PhD student at
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Health Sciences University, and also, as many of you will know her,
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Director of the ST School.
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I mean, I say this all the time and I hate myself saying it,
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but it was an amazing episode, but definitely one which I would recommend you
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listen to a couple of times or just be connected and kind of zoned in with some
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coffee, if that's your medicine,
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just to really listen to it and pause it and have a little think.
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It's a fantastic overview of predictive processing, which is basically in layman's
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terms, when your brain guesses what's happening and outputs pain when it predicts danger.
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And also active inference, which is where the brain acts to conform or update
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those guesses, shaping how you move, feel, and interpret sensations.
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It really is, I'm not going to lie, I think it was challenging,
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but I think it joins the dots for a lot of you who are aware of the biopsychosocial,
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who are aware of Loma Mamosi and explain pain and are looking to take that next
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step forward to help put it all together and just evolve, just gently,
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which is what we like to do on the SDA podcast,
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just gently kind of evolve, move forwards and understand how much of that you
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need to tell your patient or client or how much it's just to help yourself be
2:55
more effective in clinic.
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So available as always on the Sports Therapy Association YouTube channel and
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all popular podcast apps.
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And as I mentioned earlier on, just to remind you that next week,
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it will be Wednesday, the 25th of February with special guest, Dr.
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Rachel Zofnis, pain scientist, international speaker, science writer with a
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new book, Tell Me Where It Hurts, coming out March the 26th.
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Right then, just going to check. People are definitely with us.
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If you have joined us for the first time live, then thanks very much.
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I am able to bring up your comments and share them on the screen.
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So for example, Nikki Mansfield, first to the door, is saying,
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evening all. Fingers crossed YouTube's playing nice tonight.
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Yeah, we did have, we did, and it was YouTube's technical problems.
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But there were some technical issues last night, last week.
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But I think, touch wood, it's all going perfectly now. So thank you people who
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have come through to join us live.
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A real opportunity to ask some questions about such a topic,
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which I hope is close to all of your hearts.
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Cecily Hislop is here saying, hello, is there anybody in here?
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Just nod if you're going to... Okay, nice reference to Pink Floyd there,
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Cecily, and to our problems last week. So I'm just going to move on.
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Gary Benson, founder of the SDA, is here as well. Good evening,
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all. Hope you're all keeping warm and staying healthy. Thanks,
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Gary. Good to see you here.
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Becky Carroll, haven't seen for a while. Great to see you, Becky.
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Evening, all. Long time, no see. Fantastic. Thank you for joining us,
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people. Really appreciate it.
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And like I say, if you listen to the podcast and you like the idea of joining
4:18
us live, then just come along next Wednesday, eight o'clock UK time.
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On either YouTube or on the Sports Serbian Association Facebook page.
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Right, I've left my guest down in the lobby for long enough.
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So sit back, get your pens and pads out.
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You're still using them to ask some questions as we start part three of Understanding
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Pain 2026, entitled The Gender Pain Gap with my special guest,
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Dr. Rachel Dewar Haggart.
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Hello, I'm good, thank you. Thank you so much for having me.
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Oh no, thank you for coming along.
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As always, I'm really grateful for you giving up your time and talking about
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a topic like this, which is, yeah, it's coming perfectly, I think.
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We've covered an introduction to understanding pain, we've looked at some amazing
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theoretical stuff last week, and now we're going to hit a topic which seems to,
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rise whenever we're looking at anything to do with healthcare and that is some
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kind of gender inequality.
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So I think it's a really important topic which we've touched before in lots
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of different capacities which I'm looking forward to. So thank you very much.
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Maybe we can start for listeners who aren't aware of you.
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Could you start by giving, I know it's tricky with your extended career,
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but maybe a little summary of what you do on a daily basis and how you're connected to this topic.
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Yeah, thank you. So I'm a psychologist by background and I have been a researcher
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for many years, mainly based kind of in primary care settings.
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But I think sort of throughout the course of my work, I think I'd like to describe
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myself as a bit of a lived experience researcher, really.
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So when I kind of have my own health experiences, I tend to get quite curious
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and want to find out a little bit more about the condition, how it might affect
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me, affects other people.
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And then with that sort of then stems my own kind of research ideas and passions.
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So I'm predominantly a qualitative researcher. So I naturally a very nosy person as well.
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So it's basically a real privilege for me to go out and speak to people with
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lived experiences of chronic conditions and looking at kind of how they manage
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those sort of long-term conditions within primary healthcare settings,
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whether they get supported self-management and things like that.
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And yeah, I have moved from looking into ME-CFS to having an interest in fibromyalgia,
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to then doing my doctoral thesis on long-term antidepressant use,
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and then have sort of segues into sort of interests and understanding around
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communication in healthcare settings and the patient-practitioner relationship.
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And following a diagnosis of endometriosis in 2022, that has led me on to sort of really,
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interested in kind of women's health, sort of gender equity,
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sort of the diagnostic journey of endometriosis.
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Some people might be aware it's incredibly long and incredibly complex.
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And really, that's where I am now. So I'm at Oxford working on a study that's
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looking at understanding experiences of people living with endometriosis,
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both from the patient perspective and also the healthcare sort of professional
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perspective from primary and secondary and cursory care.
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So I'm just really nosy and want to see whether people's experiences match mine, really.
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And I think that's sort of where it's generated my interest in sort of the gender,
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gap in health and research.
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Thank you very much. Yes, endometriosis, I say we're lucky enough. It's not lucky.
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We shouldn't have to be talking about the delayed diagnosis and the pain and
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terrible circumstances people find themselves in.
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But yeah, we've had a couple of episodes, if not probably three or four on that,
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because it's such a great example, of diagnostic overshadowing and the wrong
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questions or the questions not being asked and something that should be.
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Probably we'll mention again tonight when it when we kind of
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mentioned diagnostic overshadowing and that sort of stuff but yes so thank
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you very much for sharing that and thank you for being here
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maybe we could start by we're kind of
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assuming that everybody understands what gender pain gap was i was really happy
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actually to tell you the truth i don't know if you've seen the latest ipa proofing
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advert on tv you've seen it yes i think so there's i know that neurofen i'm
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sure other pain killers are available um neurofen i think they've had they've
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had a campaign recently about pain.
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The gender pain gap came up. I was watching last night. I just went, look at that.
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You're a friend copying the STA clinician podcast. That's good. That's good to see.
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But it's obviously something very topical and it's kind of, I was encouraged
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to see that it's actually on TV.
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But for people who aren't aware of what we're meaning by the gender pain gap,
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could you give us a definition and maybe when you first became aware of it?
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Yeah. Yeah, absolutely. Well, I think even just thinking about it in the context of the
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sort of the series that you've got this month I was trying to think about what
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pain is in itself and pain and having to
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explain it is already an incredibly complex as
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as you've been discussing is it's a really complex concept to think about but
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I think you can then bring into this into the sphere is sort of the issue around
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gender and that there are there are differences in kind of perceptions of pain
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between male and female,
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how people kind of discuss and present pain with clinicians.
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Prevalence of pain as well in terms of musculoskeletal conditions.
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There are seen to be disparities there.
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And essentially the level of kind of care that men and women receive relating
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to pain, there are disparities and there are potentially many explanations for
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it, which I'm sure we'll go into as the conversation goes on.
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But essentially, there is research to suggest that there is a gap in the level
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of understanding and care around pain for men and women.
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Very interesting. Yes, we will go into those different reasons in great detail.
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And I'm very much looking forward to it because it's such important information out there.
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And just remind people, if you have got questions or any experience you want
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to share, then that'd be great by using the comments. What about,
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let's start off with just the biology.
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Yeah, just the biology, I think. That's a good place to start and then move from there.
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But so is it a case where women do experience more MSK pain?
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And if so, why is that? What would be a reason for that? Yeah.
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So I'm going to caveat this by saying I am by no means a sort of biomedical
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person by any stretch, but I'll give you sort of my understanding of it is that
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there are differences from a kind of hormonal perspective.
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And I think one of the things that we sort of go, we're very quick to blame
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hormones for everything, but actually there is some truth to that.
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And I think one of the things that we need to consider when we're looking at
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pain is the menstrual cycle and the sort of the fluctuations in levels of progesterone
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and estrogen during the cycle and how that can affect things.
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So, you know, there's evidence that shows that progesterone can have an impact
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on sort of the tendons and the joints and the sort of the flux of it and thinking
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about things of hypermobile,
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Ehlers-Danlos and sort of connective tissue disorders like that.
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So that's sort of one of the things that we can think about.
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And then it's also thinking about the life course as well.
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And then moving on to, say, when you're becoming or sort of going into perimenopause
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or sort of postmenopause levels of estrogen can have an impact on bone density.
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And sort of, again, that will then allow for, you know, things like osteoporosis
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to be, you know, again, more prevalent in women due to these fluctuations in hormones.
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And there's also evidence to suggest that autoimmune responses and conditions
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are more common in women as well, which might give some explanation to sort
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of high prevalence of things like rheumatoid arthritis. Yeah.
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So straight away you're saying that and straight away i
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suppose we just just the fact that there's a bit of a problem here
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because historically research into pain and
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msk issues has been predominantly by
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men on men yeah absolutely so again
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sort of once i sort of get in this real interest in
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like the gender sort of differences and things like that it it sort
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of really shocked me that it's you know even in the
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sort of 1970s women were excluded from
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research because hormones again here we go
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let's blame them again i feel like we should have a pound for every
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time we blame the hormones i'll be i'll be rich but again
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it's it's thinking hormones and sort of fluctuations in
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hormones were seen as being too problematic to have in health
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research because it was too much of a confounding factor
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for inferences to be made about whether
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a drug treatment was working or things like that
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so women were excluded and also risk to say
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if women were pregnant so unborn babies I think you can think of the I can never
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say the word thalidomide I think I've got that right sort of sort of massive
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issues with that as well and sort of the risk of testing and sort of involving
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women in research but I think really it's only been sort of.
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I think it's only been in the past couple of decades, really,
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that there's been a sort of a need or sort of it's been made necessary that
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women are included in research.
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And even when research is being conducted, that it's aggregated by sex as well.
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So it's looking to see whether there are sex differences in trials of drug treatments
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or the way that illnesses are or sort of conditions are presenting themselves.
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So one of the big ones that sticks out is heart attack.
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Heart attack presents differently in women to men, and it's something that's
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not necessarily considered or thought about.
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So, you know, how can it be treated if a woman is going in with pain or not
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understanding what it is?
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If they're in A&E and they're not presenting with the typical symptoms of a
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heart attack that has been shown in men, then, you know, treatment decisions
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and potentially the outcome for women could be, you know, quite dramatically,
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dramatically different.
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So I certainly think research is getting better and women are being included in research more.
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But then you can add this additional layer now of the fact that a lot of women
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that are included in research are white ethnic background.
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High socioeconomic status, health literacy as well.
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So more women are in research, but again,
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we're not thinking about these wider determinants of health and actually looking
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to see whether what we're looking at in terms of what can be of benefit for
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women are of benefit to all women, regardless of social status.
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That's really interesting. And I think we've already mentioned,
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but you yourself kind of oversee PhD students and that.
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And so are you noticing there's more female students who are coming up and stepping
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up and feeling the confidence to get involved and not be judged?
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Yeah, I like to think so. I mean, even reflecting back from when I started sort
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of my research journey about 15 years ago now, there was one professor in our
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department who was female.
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Certainly that's you know there are more professors
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and sort of leading researchers who are female in that
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field I think certainly I mean I
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work in a medical sociology department I think there
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are probably two men in our department so
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maybe sociology is the place to be there's there's I don't know probably something
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that could be said for that but I certainly think there's a lot more interest
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in menopause research that seems to be coming through and the impact of perimenopause
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and sort of even post-menopause that's coming through.
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But I certainly think there's still an awful lot of work that needs to be done there.
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But hopefully with increasing awareness and similarly with endometriosis research,
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which is very much my area and sort of where I'm in, there is a growing kind
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of movement and interest in trying to improve women's health and maybe try and
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bridge the gap in gendered health. Good stuff.
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It's interesting i can't help say but what comes through my mind
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but and it'll probably come out wrong but i see so much
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criticism and of the woke generation and
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the younger generation and the snowflakes everyone's so sensitive and there's
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a lot of probably fueled by social media but i see it in my students that they
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that does seem to be less of the homophobia and the racism and all the ugly
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stuff which was just there and accepted in society when i was growing up even
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in kind of like the 80s and the 90s.
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And I see it amongst kind of 16, 17-year-olds now. And I hope.
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Because I like to find a bit of optimism where I can, that the generation we've
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got now are less judging and they're more just judging people by as being individuals
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and less labeling a category.
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So I don't know whether you see that as yourself in the university and stuff
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as well, but I get it at my end.
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And I feel quite positive about it. I think there's obviously problems with
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current generations, but I think there's a little bit of a silver lining.
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Maybe, with this more awareness and acceptance.
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Do you see that a little bit? Yeah, I think so.
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Again, I think within the realms of kind of research and particularly when it's
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looking around reproductive health conditions, I think there's still some difficulties there.
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So again, with the research that we've just been doing,
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we were really keen to speak to members of the trans community or people who,
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you know, were non-binary, didn't identify as their assigned sex at birth.
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And that was really tricky.
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And I think we were unfortunate in that we were trying to recruit people during
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a time when the Supreme Court were making their rulings as to what defines a
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woman, which made it difficult.
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And I think it's trying to sort of break down those barriers.
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But I think even thinking about it from a gendered perspective,
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I was, again, I've been thinking about this.
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I still think that education in schools is a starting point for understanding
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of kind of women's health conditions and understanding of pain.
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And I mean, I know I'm a little bit far out of being at school from now on,
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but from what I've heard from people that I've spoken with.
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Sort of education around periods and periods pain and sort of menstrual taboos
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and sort of educating around that, the boys and the girls still have separate
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learnings about it and actually don't have that opportunity to have those conversations.
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And, you know, I've been speaking with people that have been going,
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I've been on the floor in the toilets in my school crying because I'm in so much pain.
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And, you know, I can't go in or I can't leave a classroom to say that I'm in
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pain and go somewhere and it's you know there is some of that gender thing and
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that kind of you know the assumptions that boys might not understand what's
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going on but it's also happening within within communities of girls as well
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and within families and I think that's because.
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Starting from a young age there's this assumption that
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periods are painful and this pain is normal
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when they go through to pregnancy childbirth is
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painful you're expected to experience pain menopause
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hormones going all over the place hot flushes feeling confused probably aching
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joints that as we said this risk of osteoporosis this is normal it's all part
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of being a woman and i think having this kind of normalization of pain within
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our kind of within our own community of women and
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sort of speaking to people about it then potentially stops us acknowledging
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other pain that might not necessarily be related to our menstrual cycles, but then thinking,
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oh, I'm feeling a bit unwell under the weather.
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You know, I'm experiencing aching joints, I'm feeling a bit fluey,
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not great, and going, oh, actually, this is probably just normal.
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It's part of being a woman because, you know, excruciating period pain is normal
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and being part of a woman.
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So, I think we've almost, from a young age, we've kind of ingrained ourselves
20:13
into understanding that or accepting that any level of pain is normal.
20:17
And then also, we don't necessarily discuss pain amongst ourselves.
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And how on earth do you quantify pain? I know that you get pain scores,
20:25
but what one person feels is excruciatingly painful might not be the same for someone else.
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And I think that's why I then sort of think about how do you describe pain? It's so complex.
20:36
I struggle to describe it. So don't ask me that question.
20:43
Scribble out my next question for
20:44
you. Yeah, so much really interesting reflection and information there.
20:50
We've already kind of alluded to the fact that yes, hormones are one of the
20:55
reasons why there's a lot of differences in MSK pain and the incidence and prevalence and that.
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But we've also kind of alluded to the fact that it's not everything.
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And I think there is a danger now that it typically happens, isn't it?
21:07
As we start, therapists now start realizing that yes,
21:11
menopause can be linked very much to differences in presentations of
21:14
tendinopathies and all sorts of things but there's a
21:16
danger now that yeah I understand women they've got totally different
21:19
hormones and that's kind of the end of it when really it's only kind of half
21:23
the story of that isn't it yeah absolutely and again I've been kind of reflecting
21:28
on my own experiences a little bit so I have always struggled with feeling slightly
21:34
under the weather and not quite right myself I
21:37
had glandular fever when I was 17 years old,
21:40
which was dismissed by the GP as being a little bit stressed,
21:45
which again is something that's quite common in women.
21:47
A lot of the symptoms that we
21:49
present with are kind of somatic or could be perceived as being somatic.
21:53
So you're probably a bit stressed. You're a bit anxious.
21:56
You're doing too much. Try and rest a little bit more.
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And I'm going, well, actually, I've got glandular fever. I'm really quite unwell.
22:03
So I kept pushing and pushing and pushing and from
22:06
there on in I think maybe some form of post-viral fatigue not
22:10
entirely sure which again sort of thinking is it ME
22:13
is it CFS I don't know few years
22:16
down the line I kept on just feeling constantly like aching and in pain and
22:21
I had sort of sort of sensitivity to touch and sort of a lot of symptoms that
22:26
are very characteristic of the fibromyalgia diagnosis and I was very fortunate
22:30
to have a GP that listened to me was very empathetic and understanding.
22:34
I had a fairly quick referral to a rheumatologist who then subsequently diagnosed me with fibromyalgia.
22:41
But what I think, again, is really interesting is that nowhere at this point
22:46
was I asked about my menstrual cycle and whether my pain was constant,
22:51
whether it fluctuated, whether there were particular times where my pain was
22:55
worse, where my pain was, and sort of taking this kind of whole holistic view.
22:59
And I know that we say we can't blame hormones for everything.
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But that wasn't really considered in amongst everything. And
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I'm remembering back to the note that the rheumatologist wrote back to the GP.
23:12
And at the bottom, it says, I have advised Rachel that she might want to try
23:16
not to, you know, try to sort of stop doing as much as she is because I was doing my PhD at the time.
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I was about to get married and, you know, all sorts of everything,
23:25
you know, working as well.
23:26
It's all too much going on. So she might want to try doing a little bit less.
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I'm thinking, OK, you've given me a diagnosis of fibromyalgia,
23:34
which is fairly rubbish in itself.
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And you know having to learn to deal with that you're telling
23:39
me i'm doing too much but actually you've not asked me
23:42
about kind of other components of my sort
23:45
of myself and my being which could
23:48
be my menstrual cycle so which actually then turned out
23:50
to be endometriosis much later so it's it's sort of trying to think holistically
23:56
about the kind of how how all of the pieces of the puzzle fit together to be
24:01
able to sort of reach that decision and i think these things then also do contribute
24:06
to diagnostic delay as well,
24:08
because you're going to see loads of different people who are giving lots of
24:11
different reasons for things.
24:12
I think IBS is another really common thing that women will be diagnosed with
24:16
if they're complaining of kind of pelvic pain and.
24:19
Sort of painful bowel movements things like that oh it's probably
24:22
ibs let's look at your diet and again
24:25
it's sort of it's not looking holistically at people sorry
24:29
i've deviated from your question matt it's a
24:33
perfect example and i wanted to go back to when you mentioned i think you said
24:35
you were 17 or something like that and unfortunately it's a story we've heard
24:39
so many times on the podcast so it's not like an n equals one it seems to be
24:43
a regular thing when people do have i mean it's so good that people like yourself
24:47
are able to come on podcasts and talk about these things because everyone else
24:51
suddenly goes, oh, it's not just me then.
24:52
And we realize that it's, you know, but yeah, that sounds like it's a typical
24:56
thing where you're 17 and they just say, you're stressed. It'll be exams. You're a teenager.
25:00
And it is, like I said, the beginning is diagnostic overshadowing, isn't it?
25:03
And had you been a bloke who had gone in saying, oh no, I'm not feeling very
25:06
good after my rugby game.
25:07
And I'm like, well, let's get this, do some blood analysis and let's check this.
25:11
And how long is we going on for? Yeah. Yeah.
25:14
So it's there. It's a shame. There is, yeah. And again, I was sort of reading
25:18
up on there being some research where, you know, I think it was medical students
25:22
were looking at sort of video scenarios of both a man and a woman presenting
25:27
to A&E with symptoms of pain,
25:29
sort of musculoskeletal pain, and presenting pretty much exactly the same way.
25:34
The only difference was their gender.
25:35
And it was seen that the women were more likely to be exaggerating their pain.
25:39
Again I think studies have
25:42
shown that when men and women present to
25:45
A&E with pain men are more likely to be
25:48
seen more quickly more likely to be given sort of stronger pain relief to help
25:52
with their symptoms more quickly women are more likely to be left for longer
25:56
to be waiting to see someone and also be more likely to be prescribed anxiety
26:00
medication as well so again there's these sort of unconscious biases and and
26:05
disparities on on sort of how pain is perceived by clinicians sometimes.
26:09
Do you know whether these, and I've researched or I've seen kind of papers come
26:14
to these conclusions as well, the only thing I'm not quite sure that I just
26:16
thought of as, do you know whether the response, for example,
26:20
from the team at A&E, who, by
26:21
the way, we know, do an incredible job and really push back. Absolutely.
26:24
Does it make a difference if the team there are predominantly more men or women
26:28
or a mixture, or is it kind of culturally a bias which is found across the genders?
26:33
That's a really interesting question that i don't necessarily
26:36
know the answer to but i think again thinking
26:40
back to kind of the research that
26:42
i'm doing in terms of primary care and primary care perceptions of things there's
26:46
a lot of stuff in the literature at the moment of kind of the gender of the
26:50
gp and how seriously people are taken when presenting with problems in particular
26:55
again i know i'm referring to menstrual pain but i think it can be kind of considered.
27:00
It's pain in general, I guess.
27:02
But there's always been this assumption that because I have period pain and
27:07
because it's all quite sensitive areas and difficult things to talk about,
27:11
speaking to a nice lady GP means that they will get me and they will be able
27:14
to communicate and understand where I'm coming from.
27:17
They can be more empathic compared to male GPs.
27:21
Whereas actually, I've done quite a few interviews with people that have said,
27:24
actually, I much prefer speaking to a male GP because they'll be able to take
27:28
a slightly more objective kind of understanding of how I feel about or how I'm
27:32
explaining my pain so again I don't know whether there's kind of clinicians
27:37
and you know whether there are disparities in that at all but again.
27:42
I've spoken with I'm doing interviews with healthcare professionals at the moment
27:47
and I've spoken with one male GP and he sort of says I get it I tell them from
27:52
the outset go I completely understand that you are in pain.
27:55
I also appreciate that I am male, but I'm here to listen to your story and for
28:00
you to tell me what's going on.
28:01
And I think it's communicating that kind of validation of their concerns and
28:06
saying, tell me your story, the kind of,
28:09
hopefully removes that sense of that unconscious sort of assumption I suppose
28:14
that you know a male GP or a female GP are going to to sort of be helpful and
28:19
I think that also lends itself to.
28:22
Again one of my colleagues is a female
28:25
GP and she says her you know her appointment
28:28
times are all she sees are people presenting with
28:31
gynecological or reproductive health problems because
28:35
I'm the nice lady GP who understands how things are
28:37
and that she says takes away from the kind of
28:40
maintenance of the training and the knowledge acquisition
28:43
for the male GPs to be able to practice those skills to be able to communicate
28:47
with females presenting with pain etc and I think I think there's a lot of potential
28:55
to blame the the gender of the GP for the reason why patients have this feeling of being dismissed.
29:02
I don't necessarily feel that it's like the crux or one of the key factors as
29:07
to why diagnostic sort of diagnosis takes so long.
29:10
Good answer. I like it. Yes. Sarah Clark, thank you very much for your comments.
29:14
Sarah says, I've been really looking forward to this episode with Rachel.
29:17
I have a huge interest in medical gaslighting and diagnostic overshadowing,
29:21
far too common, unfortunately.
29:23
Yeah it is it is and that's i
29:26
think i'm going to give you a difficult question now rachel apologize in advance
29:30
oh just following up with sarah clark sorry sarah clark follows up within my
29:34
experience it depends on which any department you go to yeah it's got to be
29:38
a product of training and experience and just yeah living through experience
29:42
doesn't it will vary a lot,
29:46
my question i'll come to you in a second becky if be so polite i'm sorry i've
29:50
just seen becky but my question for you is what can we do okay right you've
29:54
got 20 i'm pleased to say we've got about,
29:57
2800 downloads now a month which is great they're all listening to you now or
30:00
not now but they will be over the next month what can we do as part of the health
30:05
care system okay a lot of our listeners are soft tissue therapists maybe massage
30:09
therapists sports therapists we get physios now health professions as well but
30:12
what's a little thing that we can all do to try and make a difference.
30:17
I told you it's a toughie. It is a toughie. And this is why I will not become the future for health.
30:25
More money, more time, more investment. But that aside, I think it's a difficult
30:32
one because, again, I think there's a lot of narrative in research and stuff
30:36
that there is an awful lot of this.
30:38
I completely agree with what Sarah was saying. There is gaslighting.
30:42
There is dismissal. There is normalization of symptoms. But I think the one
30:47
thing that people really value when they go to speak to someone about their
30:53
problems is being able to have a space to talk about it.
30:56
And again, I know I'm speaking from kind of my research experience.
31:00
I am very fortunate and I have no agenda when I speak to my participants.
31:04
I just want to find out everything from them. And I will say to them,
31:08
so to start with, tell me about your experiences.
31:10
And I have had narratives from people ranging from about three minutes long
31:14
to about an hour and a half long where I've literally not said a word because
31:17
it's the first time that someone is able to go,
31:20
I can sit there and I can talk to people about what's going on for me without an agenda.
31:25
And I think it's one of those tricky things that if the system allowed it,
31:31
continuity of care would be so fantastic because...
31:35
Having to relay the same story again and again and again, because you're seeing
31:40
different healthcare professionals, note-taking is not necessarily consistent in the system.
31:47
I think that contributes to this feeling of not being listened to because you're
31:51
having to start again from the story, go, well, I saw this GP two months ago.
31:56
I'm now coming back. I've still got the same problems. Things are getting worse.
31:59
I'm going to have to tell my story again, etc. etc i certainly
32:03
think from a physio perspective more pelvic health physios
32:06
please can we just have nhs pelvic physiotherapy
32:10
i think this is one of the things that from the
32:13
patients that or people with endometriosis that i've spoken to and even a couple
32:17
of kind of pelvic health physios and people working in either multidisciplinary
32:21
teams or tertiary care settings are sort of talking about how valuable physiotherapists
32:28
are and sort of looking at Again,
32:31
looking at the body as a whole and trying to find sort of approaches to sort
32:35
of managing pain conditions for women's health, I think is really important.
32:38
So more of you guys keep coming along and get involved in the NHS.
32:43
But I think ultimately, giving someone the space to talk and really validating these things.
32:49
And I think asking about pain throughout the whole of their life course and
32:55
their experiences about and throughout the kind of the monthly cycle as well.
32:58
And sort of acknowledging that pain.
33:01
Varies and it's not the same and again i
33:04
was thinking about this you're probably more likely to go to a health
33:07
care appointment when your pain's not that bad because you're able
33:10
to get to have an appointment whereas you
33:13
know if you're in absolute agony you're probably not even going to be able to
33:16
get out of bed so people might not necessarily see you
33:19
at your worst so it's exploring that as well
33:22
very long and convoluted answer but that's wonderful
33:25
very good more physios more more soft tissue like
33:28
all of this kind of stuff absolutely it's really needed i
33:31
think that's great the continuity is is a problem which i guess needs
33:35
to be worked on internally but yeah i like the fact we've had we've had the
33:38
good fortune of having quite a few pelvic health specialists male and female
33:42
i remember for example bill taylor who has just made a plea for massage therapists
33:49
to contact him or to contact their local pelvic health.
33:54
Specialist because they have so
33:57
many patients who they want to be able to refer to massage
34:00
therapists and hands-on therapists who are on the same page who will recognize
34:04
red flags or be on the same page in terms of narratives because they don't want
34:08
to do it themselves you know they and they don't want to make someone travel
34:11
200 miles which they have done for that specialist treatment when they've got
34:14
a you know a well-known or an appropriate massage therapist around the corner.
34:19
So yeah, you're kind of echoing pleas that we made before, because there's no
34:24
coincidence that a lot of pelvic health, people who are suffering pelvic health
34:27
pain will benefit so much from massage therapy and that time just to relax,
34:32
unwind, and maybe just have someone who will listen to them, like you say.
34:36
Yeah, absolutely. And the other thing you said really struck a note as well, because I think.
34:41
I think sometimes this gender bias comes out of obviously the unknown and not knowing.
34:46
And then there's a fear of asking a question, looking stupid.
34:48
But the only way you learn about, I think the only way you learn really without
34:51
getting too hippie is by asking people questions.
34:55
And then suddenly you'll hear a story, which you go, I never knew that.
34:59
I never realized it felt like that for you.
35:01
And then that's how you get rid of maybe your bias because you know.
35:05
Yeah, absolutely. I think the people that I've been speaking with,
35:08
you know, not one story has been the same. And I sit there and I go, I think I know it all.
35:13
And then someone else will come in with something and go, oh, my goodness me.
35:17
Like, you know, just completely hadn't even anticipated or thought of that.
35:22
And that's just from a small sample of like 40-ish people that I've spoken with
35:26
and to think that, you know, there is far more to it.
35:29
And I think the other thing as well, that from a patient perspective that people
35:34
value is if clinicians don't know the answer, tell us that we don't know the answer.
35:39
I think that, you know, it's sort of, I think it's about that kind of shared
35:43
decision making, information gathering, trying to work out a solution.
35:47
And rather than just sort of saying, well, you know, what can I do for you?
35:52
I don't know how I can help you go.
35:54
I don't understand why you're experiencing pain. I can understand that this
35:58
is really distressing for you. This sounds like it's really difficult.
36:02
How can we, you know, how can we look at trying to find things that may help?
36:08
I think, again, in primary care,
36:10
contraception, hormonal contraceptive seems to be one of the answers.
36:15
To me, I feel that that's sometimes sticking a sticking plaster over an amputated
36:19
leg because there is so much more to it.
36:21
I know we said that hormones are responsible, but again, it's considering the
36:26
impact on quality of life and sort of thinking of strategies.
36:29
Again this supported self-management how can we
36:32
kind of empower people and enable people to go
36:35
out and try sort of simple stretching exercises yoga
36:40
massage you are absolutely right some you know
36:42
people that I've spoken with go you know what I've my sort
36:46
of treat to myself is to go for a massage once a month and I feel
36:48
fantastic afterwards because it's that you know that kind
36:51
of release of you know pain and things like
36:54
that so yeah ultimately there is
36:57
there is nothing wrong with saying if you don't understand why
37:00
someone's experiencing pain to tell them
37:03
that say I don't understand what it is but let's try and unpick those
37:06
pieces together and work towards a solution that we can
37:09
try and improve your quality of life as best we
37:12
can and also I think I've done
37:15
some work looking at communicating realistic optimism in
37:18
in settings as well and it's not promising the world saying
37:21
I'm going to cure you of all your pain it's acknowledging that
37:23
pain is there it is it most more
37:27
than likely is going to be a chronic pain condition how can
37:30
we manage it how can we help how can we keep you in the
37:33
system and have that continuity of care yeah that's
37:36
really good really important points yeah just not being embarrassed about not
37:41
knowing the answer and realizing that the person in front of you has probably
37:44
got the answer you just got to invite them and provide the same space and then
37:47
like you say is is it's totally gone now the second thing you said.
37:51
It's going to come out with something so profound then.
37:53
What was the second one you just literally said just now? Oh, yeah. No.
37:59
It tied in with the fact because I was reading something the other day about
38:01
communication and how sometimes...
38:05
Oh, yes, that was right. But they're not fixing. It gave me this fixing reflex.
38:09
Sometimes I was reading a case study of, it was to do with alcoholism and that.
38:14
And it was a case study. I mean, this particular case study was one,
38:17
but it was a good example of how it was just from a clinician who was trying
38:22
to help somebody who was an alcoholic.
38:24
And they came and literally in the half hour consultation, they said,
38:28
they literally said, not agrobatim, but they said, look, the cure to this, I wish I had the cure.
38:33
I'd be a very rich person, but I'm not. but i can guarantee i'm going to be
38:36
with you and i'm going to walk this journey with you and give you everything
38:39
that i can do so together we can find i mean classic kind of person-centered care.
38:44
And literally i think in this particular case which is why it
38:47
kind of made the news was they came in
38:50
the next week and the person hadn't had a drink and it was like
38:53
they didn't have to come up with a solution all they
38:56
did was say i'm with you you're not by yourself and the person explained and
38:59
it was kind of a transcript of the dialogue just saying you're the
39:02
first person my life hasn't said you know tried to come up with
39:04
a solution which made no sense to me well you said you was going to be with me
39:07
and i suddenly felt supported and i haven't had the drinks since i last saw you
39:09
what do you do now it's just so powerful yeah although
39:13
it's an equals one it was still just a classic example of just
39:15
what really our role should be and that you
39:19
know i've got some pretty good information i can help you out some stuff but i'm going
39:22
to be with you i'm not going to do things to you you know absolutely and i think
39:26
that's i think there's been some discussions and in previous podcasts about
39:29
this kind of placebo and and how you know this communication and sort of that
39:33
empathy and things like that is a natural kind of placebo and can improve the way things are.
39:39
And I think, again, one of the things that I've noticed from kind of my own
39:43
personal experiences and kind of looking at people who are living with long-term
39:47
pain conditions, things like fibromyalgia, and also, again, like endometriosis,
39:53
chronic pelvic pain, things like that, there is so much time spent looking for
39:57
a diagnosis and seeking this diagnosis that once the diagnosis is there,
40:01
it's almost like everyone can sit there and go, okay, we've done our job now.
40:03
We know what's wrong with you.
40:05
But actually, it's the, and this is the big thing that we're finding,
40:09
it's the so what question.
40:10
And it's going, actually, there is so much more now that needs to be done.
40:14
We now know what the sort of the condition is or what's going on.
40:19
Let's try to find ways to manage it. Let's get you onto a referral pathway to
40:24
somewhere. Let's try and get you speaking to this person.
40:26
And again, reflecting back on what Sarah has said on the sort of the dependence
40:31
on which A&E you go to and disparities in care.
40:33
I've been speaking to some people who work up in scotland and
40:37
their their care centers it's like a disney
40:40
world it's amazing they've got dieticians they've
40:43
got physiotherapists they've got all sorts
40:46
whereas other places you know you're lucky if you
40:48
get to see a gynecologist who's kind of got the
40:51
expertise to be able to help you or sort of has an
40:54
understanding that chronic pelvic pain is is
40:57
you know something that can be an umbrella term for
41:00
conditions like endometriosis and should be put on similar pathways
41:04
and I think there's just such disparities in that
41:07
and I think a lot of women can sometimes be
41:10
left in this kind of silo of just going oh I've
41:13
got I've got a label for something they've got they've got what's called this
41:17
rumple stilt skin effect where they've got a label so they feel that intense
41:21
relief but then it's going well now what do I do how do I cope with it and who
41:24
do I speak to where do I go because a GP can only do so much gynecologists or,
41:31
you know, the consultants.
41:33
You know, rheumatologists might be difficult to sort of be kept on the books
41:37
with or you get discharged back to the GP and then you have to start the process all over again.
41:41
So there's definitely something missing.
41:45
Yeah, I doubt it.
41:46
Becky, I think we've kind of answered your question. It's difficult to be specific,
41:50
but Becky Carroll has asked, do you know if trainee GPs now get at least some
41:55
basic training in female health or is it still very much an add-on if that GP decides to do so?
42:00
Is it area-specific?
42:03
Again, it's not something that I'm massively aware of.
42:07
Again, anecdotally, regarding endometriosis, I've heard that it gets brought
42:12
up in maybe an hour's kind of lecture session and going,
42:15
this is what it is but here you go I think
42:18
I think it's one of those tricky things as well again
42:21
thinking of my own experience of of kind of fibromyalgia I was very lucky or
42:26
I am very lucky in the sense that I can sort of read papers and read under you
42:30
know get understanding of things and I knew that fibromyalgia was a diagnosis
42:35
by exclusion so I knew that I had to go through all the blood tests I knew how
42:39
to go all of these things and kind of try and.
42:41
Tease that out. And again, I was fortunate in that I had an appointment with
42:44
a GP who knew what fibromyalgia was.
42:47
But again, there are some people that, you know, I think there's this whole
42:51
thing of advocacy as well and patients having to bring in their ideas of what
42:55
their diagnosis might be to the GP because they're trying to,
42:59
again, they're presenting themselves for the first time. They might not have seen a GP before.
43:02
They've got seven and a half minutes to try and say what's going on,
43:06
what the problem is, what they're hoping for, and then coming to some form
43:09
of shared decision and it's trying to put
43:12
things out on the table and I think if you've got that level
43:15
of advocacy if you can be health literate enough to health
43:18
literate enough to talk about those things then great but then if you go into
43:21
a consult and you're just like I'm in pain you can't describe what that pain
43:26
feels like and then a GP doesn't necessarily again like you were talking about
43:30
earlier know the right questions to ask that can start a whole sort of cycle of difficulties.
43:36
But I think, yeah, going back to Becky's question, as far as I'm aware, it's covered.
43:42
But I think unless you kind of go into obs and gyne training as part of your
43:46
medical degree and then sort of learn through it from it there,
43:49
you know, go on to a specialty, as a specialty, sorry, then it's relatively limited.
43:56
As far as I'm aware, I might be wrong.
43:58
Thank you. Just to read out a few comments. Thanks for leaving the comments,
44:02
people who've Do I just live?
44:03
Cecily Hisslopper said, my GP practice has been great dealing with my menopause
44:07
and HRT, but when I had southern onset MSK pain, lots of other assessments were
44:11
done, but I felt dismissed and had no answer to my,
44:14
symptoms so yeah it's tricky isn't it but i think in like we've already said
44:19
it depends from practice to practice unfortunately the continuity isn't there
44:23
across the system which is.
44:25
Something a work in progress maybe becky has come back
44:28
and said hormone treatment i find it bonkers the gps are
44:31
quick to prescribe birth control to young girls and yet seem
44:33
to be less receptive to prescribing hrt to perimenopausal
44:37
and menopausal women yeah absolutely
44:41
and i think there's this again with
44:44
the work that that we're doing and sort of I think menopause is
44:47
only really just coming into the sort of the forefront of research
44:50
which again is just completely mind-blowing but
44:54
I think again it's considering how HRT can
44:58
have such an impact on things like MSK pain
45:01
and then the blood testing and where things are going and it seems to
45:04
be quite a lot of like trial and error and see how things go and
45:08
sort of absolutely and I again I
45:11
completely agree it's very quick to prescribe birth control to
45:14
young girls because it's almost a bit like this is the way that we can
45:17
kind of deal with the pain take a pill here you
45:20
go and then be left on these pills for years whilst
45:23
continuing and not actually acknowledging that there might be some underlying
45:26
causes as to what's you know what could be causing pain in the future but yeah
45:31
I think there needs to be a lot more work done in menopause research again from
45:36
from my own background endometriosis and menopause research, there's literally...
45:42
Sort of a handful of papers there's very very little
45:45
and knowing how to manage it and whether whether people
45:48
you know whether healthcare professionals ask about
45:51
you know do you have any underlying reproductive conditions any
45:55
hormone difficulties that you've had before considering hrt and
45:57
menopause and then everything else that goes along with it thank you yeah thanks
46:02
for the question great question um on what you were mentioning earlier on with
46:05
some people can't convey can't describe the pain everything has an interesting
46:09
comment here from sarah again And this was picked up in our month on neurodivergence as well,
46:15
with how people who are neurodivergent can struggle describing their pain or
46:18
describing it in ways which aren't the same as maybe a neurotypical doctor or GP has got.
46:23
Sarah says, my autistic participants with EDS speak of difficulty with describing
46:27
timeline of a symptom onset to their, and trouble describing the severity of
46:31
pain if they visit the doctor when the pain flare has settled.
46:34
That's essentially what you were saying, wasn't it? this.
46:37
Yeah, absolutely. And I think, again, it's just the, I think it is,
46:40
you've reminded me, referring back to the Nurofen care thing,
46:44
and I think they've put together a package now of like a document that patients
46:49
can download to take to their doctor's appointment.
46:50
And it's got a whole list of different words of how people can describe pain.
46:54
So I think it's like tugging, pulling, stabbing, squeezing, twisting,
46:59
et cetera, of how to describe it.
47:01
But I think, again, pain is so complex and so variable within people and across
47:06
people but it you know again if.
47:09
I don't I really struggle to to be able to describe the context of pain and
47:14
again I think it's got on my my rheumatology report for my fibro Rachel reports
47:18
feeling like a 90 year old woman because that was the only way that I could
47:22
describe it not that I know how a 90 year old woman feels but it's just this kind of,
47:27
And again, it's these flu-like symptoms, which to me actually demonstrates quite
47:31
a lot of pain that people might be experiencing.
47:34
But again, how do you communicate it? And yeah, I need to look back at that
47:38
neurofen thing now, the different symptoms.
47:41
I think like Dr. Bronnie Lennox-Thompson was saying in the first episode,
47:45
sometimes we focus so much on the pain and is it a one to 10?
47:49
When really sometimes questions like, what can you do? What can't you do?
47:52
What do you want to be able to do? What do you miss? if I could wear
47:55
a magic wand what would you be doing those sort of questions can help
47:59
me sometimes the patient more they're just trying to fixate
48:02
on you know what's causing this pain and how severe is
48:04
it it's just again just trying to yeah yeah yeah
48:08
it's interesting um great great questions people thank you so much everyone
48:11
who's joined us live and and giving us those questions um really good I wanted
48:15
to mention one thing which we talked I think a little bit off air when we were
48:18
talking about this and and I saw it in some research as well and I think you
48:22
mentioned it as well when you said that it's good that women are more involved in research,
48:27
but a lot of the time they're from a certain socioeconomic kind of part of the community.
48:31
But also as well, you said that often that the where they're from ethically
48:35
might be a thing as problem might be different as well.
48:37
So we're still not getting a good representation from all different kind of circles of life.
48:42
And I think I've read as well in the research that sometimes the underestimation
48:47
of women's pain can particularly be with women of color, which I found was really interesting.
48:51
I know You've had some thoughts and experience on that. So could you expand on that a little bit?
48:56
Yeah, it's, again, it's a really interesting concept.
49:02
I don't know why.
49:04
It exists, but there is certainly this sort of perception that women of colour
49:10
have much higher pain thresholds and are much less sort of in need of analgesia
49:16
to help manage their pain.
49:17
Again, I don't know where it's come from. There is this sort of concept or idea
49:23
of Beebe or Begum syndrome. I don't know if that term in itself can be seen as quite derogatory.
49:29
I know that some of the participants that I've spoken with use that terminology
49:32
and sort of say that, you know, again, I think it's based on a woman of colour's
49:36
experience of going into a medical setting and being completely dismissed of their pain symptoms.
49:41
I think particularly, again, I think there's this, there are some cultural kind
49:47
of sort of cultural understandings within their communities that,
49:51
you know, we don't talk about pain, menstrual pain is taboo.
49:54
I know, again, it's, there are, there's evidence to show that women from a black,
50:01
African black community are more likely to have
50:04
fibroids so pain might present slightly differently but I don't I don't know
50:07
where this kind of this bias has come from is it because they're not involved
50:13
in research and sort of don't report and you know don't engage in that research
50:17
I think one of the horrifying things as well there was a lot of sort of initial.
50:22
Research into kind of gynecology women's health things like that were actually
50:26
practiced on women of color i think the contraceptive pill was first trialed
50:30
on i think it was puerto rican women,
50:33
again without with very sort of little sort of
50:36
ethical considerations around it if you
50:40
haven't read it or if you don't know of it at all the secret life of
50:42
henrietta lax if you've ever heard of henrietta lax absolutely
50:46
brilliant but but again looking at the fact that her cells
50:50
have essentially changed the sort of the world of
50:53
cancer and there was no no ethics for
50:55
her cells being harvested her family you
50:58
know there was no ethical um consideration or realization
51:01
of it but i think there might be these sort of ongoing unconscious
51:05
sort of racial biases that you know
51:07
that there's this understanding that you know i think there was one suggestion
51:13
once that there is a higher threshold or sort of higher pain thresholds because
51:18
of the color of their skin indicated that it was thicker and more resistant
51:23
to i don't know some absolute rubbish but um yeah.
51:28
But it's so useful to mention and yeah i'm so glad you reminded me of that i
51:33
remember reading about i've never read the actual book but i remember reading
51:35
about it just yeah just being wow this is such a
51:38
example that people need to know about and a name that needs to be
51:41
kind of shared in history as well just to turn the tables
51:44
right but yeah we'll put that link to that in the in the show notes but yeah
51:48
it all ties in with just kind of values which were there in the past in Victorian
51:52
times and there's no point of standing there slagging them all off and criticizing
51:56
them we just got to look at ourselves and realize that we've got their genes
51:59
and we've kind of all got our biases inside
52:02
and all it's because we don't understand or mix or know something so
52:05
even again we just need to ask questions and not see it as
52:08
a threat there's nothing wrong with not knowing what the person in
52:10
front of you is is being involved in if they
52:13
look different or smell different or kind of talk differently or
52:16
whatever it is is different about them just ask what
52:19
was that like you know and then suddenly you'll see hopefully those
52:23
biases disappear because suddenly you won't have that fear it's so
52:26
important if you're in healthcare so yeah very interesting
52:29
why where are we 8 55 five let me
52:33
just check we've kind of talked about
52:36
how we can get rid of all gender bias in health care it's quite simple we'll
52:40
put a state steps one to three in the show notes if you want to join in that
52:43
just get rid of it but it's i think it's useful for people not to kind of just
52:48
to realize that we have all just got biases it's part it's a human trait i think tristan attenborough.
52:54
Spoke about it really nicely at the conference and just recognizing you're not
52:57
hating yourself We've all got certain biases and we might feel guilty saying
53:00
them in public, but it's don't beat yourself up about it. Just recognize it and move on from it.
53:05
You know, that's, I think that refers to this as well.
53:08
Yeah um great right well look we've
53:11
reached the end of the hour i'm hoping that listeners definitely
53:14
people who join us live i'm hoping that you've got a bit
53:17
more understanding of the gender pain gap um and and
53:20
hopefully how you can start raising awareness amongst colleagues as
53:23
well as yourselves to try and help reduce it just to
53:26
say i think there was a there was a comment much earlier on from
53:29
nikki mansfield about my paper on long-term antidepressant use
53:33
and whether it's publicly available there is one paper that
53:36
has been published that is not my entire
53:39
thesis and I'm very happy to have that paper shared in
53:42
the in the notes I think one of the things that might
53:45
be worth noting in that is that we had to or for
53:48
my research I did exclude so I did a survey as part
53:51
of it and I did exclude people who were prescribed amitriptyline for
53:55
pain rather than as antidepressant because the dosages are
53:58
slightly different but I think I think you're absolutely right
54:01
in terms of kind of again long-term antidepressant
54:04
use that kind of feeling of pain and whether again again in
54:07
women sort of somatic symptoms it's sort of identified as
54:11
being you know somatic symptoms oh it might be
54:13
that you're a bit stressed a bit anxious have some antidepressants see how you
54:16
go but um i'm very happy to share that paper and
54:19
i could also put a link to my thesis but it's 400 pages long
54:22
so it might not be one that you want oh no nikki and becky.
54:25
And other people certainly be all over it yeah but the sounds
54:28
i think sarah will be dipping into a breakfast morning read
54:31
as well enjoy if you can't sleep at night it's a perfect i mean if you if you
54:36
didn't have pain then you will have pain after reading it and also you've been
54:40
involved in in watching over a lot of other like you say other other phd researchers
54:45
and guiding them anything in particular anybody you want to give a shout out to or was that good.
54:52
No well i don't know particularly,
54:54
Well, I think some of the research that I was doing before I moved to Oxford
55:00
and Southampton was looking at sort of developing a communication package for
55:05
clinical empathy and realistic optimism for primary care clinicians.
55:09
Paper soon to be published. My paper component of it soon to be written and
55:14
then hopefully published, as is the joys of research.
55:17
Papers always need to be written. but as part of that I'm
55:20
now supervising a student who is developing an add-on module to that about communicating
55:24
around menstrual symptoms so that might be one of interest and I'm hopefully
55:29
about to start supervising a PhD candidate that is looking at neurodivergence
55:35
and perimenopause so that should be an interesting one too.
55:38
Okay I just know that a lot of people in here all over
55:40
that so that's yeah great I'm
55:46
gonna have to lasso you and get you back in to talk all about that at some point
55:49
if people do want to follow you and keep up to date with what you are do you
55:55
do you manage to use social media at all to update people on what you want or
55:58
is it not I'm very rubbish at using LinkedIn I tend to kind of promote my husband's
56:02
work but I might start trying to use it for myself a little bit more,
56:06
but I think otherwise my profile on my Oxford web page profile,
56:11
again, very happy for the link to be shared, ping me an email and I'm very,
56:15
very happy to have a chat over a cup of tea.
56:19
Or other drinks.
56:22
Okay, so we'll make sure those leads go into the show notes.
56:25
That'd be great. If you want to follow you and hear what you're up to, that's fantastic.
56:28
Yeah, a lot of talk. Right then, everybody. Thank you so much for joining us.
56:32
Just a little reminder of what we've got coming up.
56:35
So next week in part four, the last part of the month, this is why I just get
56:38
a little bit of depression sinks in, thinking, ah, I've got to shift the topic
56:41
now. I've got it after the neurodivergence month, and now I'm going to get it with pain.
56:45
But we will have some, we have got some fantastic stuff coming up in March,
56:48
which I will share with you. I'm very excited.
56:50
But before we get turned to March, we are going to have Dr.
56:54
Rachel Zofnus with us next Wednesday
56:56
in part four, who's been on the show before, was absolutely smash.
57:00
Pain scientist, international speaker, science writer, and she has a new book,
57:04
Tell Me Where It Hurts, which I've had the joy of reading, a pre-release copy.
57:08
And yeah, it's going to be a classic kind of book for particularly patients
57:11
and for you guys to brush up on what's going
57:14
on and and how to understand pain in 2026 so
57:17
um rachel is going to be here rachel's oftenest um next
57:21
wednesday february the 25th if you do want to join us live if
57:24
you listen to the podcast you might want to join us live and ask questions directly
57:27
to rachel and yeah on the sports association youtube channel or the facebook
57:31
page i take make a note of both of those links i think tonight facebook has
57:35
gone down for some reason it's not us it's just facebook and youtube just don't
57:39
like third party software going live on their platforms which is kind of a business thing.
57:43
But yeah, make sure you've got both handy in case one does go down.
57:47
But as far as tonight's gone, I think we've still got people here, which is great.
57:50
And we're still going out live. So thank you so much to my special guest tonight,
57:54
Dr. Rachel Dura-Haggett. Thank you so much.
57:57
Thank you. And a shout out to your lesser half, James, who if people are recognizing
58:01
the surname, James Dura-Haggett was part of our Neo-Divergent Month in part
58:06
two, I think, talking about access or barriers it was. So there is a link there, obviously. Thank you.
58:12
And I think he had a little comment here. I don't know whether he wants me to
58:15
share this on the screen or not. I know.
58:18
Posterity to go onto YouTube and be there forever. I avoided it first time round,
58:23
but let's shuffle it up here.
58:29
Apparently, StrongPathCIC says, Dr. Rachel, do you have a hug?
58:31
It looks like a total babe.
58:33
So yeah, I avoided that earlier on until I verified the link.
58:36
But there you go, James. You can now have that and look back at it and chortle away to yourself.
58:41
He's gonna love that all right people
58:45
thank you so much for joining us um really appreciate the people who join us
58:48
live we appreciate everyone listens to the podcast as well like i say it's gone
58:50
up this this month it's gone up about 700 a month
58:53
so really appreciate that obviously the messages are getting out there which
58:56
is all we do it for but if you do listen to the podcast and you like our content
58:59
which seems to be the case to please share it and the best way of doing that
59:03
is leaving a rating and a review so it appears higher in google it makes a massive
59:08
difference if you just go into your favorite podcast app, whether you listen
59:11
to it on, and just leave that rating.
59:12
Five is a great number for this particular example. Five stars will do fine.
59:16
Don't waste too much time thinking about it.
59:17
And if you could put some good words down on that, makes it appear even more
59:21
in Google when people put in, for example, gender pain or gender inequality will be there.
59:25
And the great word of our guests, like Dr. Rachel Deerhaggart, will be there.
59:28
And this episode will be available to them rather than something else,
59:31
which might be not quite as good.
59:34
Yeah, that's what I'm suggesting. So yeah, do please do that.
59:36
If you listen to the podcast, we'll be back. Wednesday. If you can join us live,
59:40
then remember it is a Wednesday.
59:42
But until then, as always, take care of yourselves and each other,
59:46
and we'll see you again soon.