Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / It’s Not Hysteria: How women’s health gets overlooked

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It’s Not Hysteria: How women’s health gets overlooked · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:01
Speaker 1: This is parent data. I'm Emily Oster. When I was twelve,
0:06
Speaker 1: my mother got me a book about puberty and she
0:09
Speaker 1: left it on the breakfast room table, so I checked
0:12
Speaker 1: it out. I like books, and there was some good
0:15
Speaker 1: information about periods and boobs and pubic hair. But when
0:20
Speaker 1: I got to the part where they told you to
0:22
Speaker 1: take out a hand mirror and look at your vagina,
0:25
Speaker 1: I was like, no way, I'm closing this book and
0:27
Speaker 1: I'm never doing to do that.
0:28
Speaker 2: Ever, I would consider myself lucky though that.
0:34
Speaker 1: My research life eventually brought me back to the vagina.
0:38
Speaker 1: When I was in graduate school, a friend and I
0:39
Speaker 1: wrote a paper about menstrual cups, and we got the
0:43
Speaker 1: chance to teach a bunch of adolescent girls how to
0:45
Speaker 1: use the cups and how to therefore better understand.
0:49
Speaker 2: Their own vaginas.
0:51
Speaker 1: In the process, I got more comfortable with the idea
0:54
Speaker 1: of a vagina and with how cool it was, to
0:57
Speaker 1: the point even of giving seminars to all male colleagues
1:01
Speaker 1: in which I explained with props how you use a
1:04
Speaker 1: menstr cup, and then yes, I did pass the menstrul
1:07
Speaker 1: cup around.
1:12
Speaker 2: Not everyone is so lucky.
1:14
Speaker 1: We don't all get to learn about vaginas in school,
1:18
Speaker 1: or from our families, or from our research, and this
1:21
Speaker 1: is to our detriment. And today we're trying to make
1:24
Speaker 1: some progress on that. My guest doctor, Karen Tang.
1:28
Speaker 2: Is here to teach. Karen is a.
1:31
Speaker 1: Minimally invasive gynecological surgeon think disorders like andrewmetriosis and polycystic
1:37
Speaker 1: ovarian syndrome.
1:38
Speaker 2: And she's also tearing up social media with her women's
1:41
Speaker 2: health education.
1:43
Speaker 1: She has a book, It's Not Hysteria Everything you need
1:47
Speaker 1: to know about your reproductive health but we're never told,
1:50
Speaker 1: and it's exactly what it sounds like, a user manual
1:53
Speaker 1: for everyone with a female reproductive system. You can imagine
1:57
Speaker 1: that when you only have fifteen minutes at any given
1:59
Speaker 1: guy pnecological appointment, knowledge is power. In this conversation, we
2:05
Speaker 1: talk about how to talk to your doctor and how
2:08
Speaker 1: to make the most of your time with them, the
2:10
Speaker 1: lack of data on women's health, why Karen feels strongly
2:14
Speaker 1: about reclaiming the word hysteria when it comes to health
2:18
Speaker 1: for women, and what it means to study women's issues
2:22
Speaker 1: and lady pain as opposed to you know, real pain.
2:27
Speaker 1: As you'll hear, this is a fun conversation, but don't
2:31
Speaker 1: let the tone distract you.
2:32
Speaker 2: It's also a really important one.
2:34
Speaker 1: Women's health is health, and women's health is public health,
2:38
Speaker 1: and doing something about women's pain should be a priority
2:41
Speaker 1: for everyone. After the break, doctor Karen Tang, Doctor Karen Tank,
2:56
Speaker 1: thank you so much for joining me.
2:58
Speaker 2: I'm so excited to be here. Thank you for having me.
3:01
Speaker 1: Can you start by just introducing yourself a little bit?
3:05
Speaker 2: Yeah, sure.
3:05
Speaker 3: So I'm a gynecologist and my day job is a
3:09
Speaker 3: minimally invasive gynecologic surgeon, which means I specialize in things
3:12
Speaker 3: like nimetriosis and fibroids and pelvic pain. And along the
3:17
Speaker 3: way kind of accidentally wandered onto social media, where I
3:21
Speaker 3: started doing educational videos as one does, as one you know,
3:25
Speaker 3: accidentally starts on social media, but there's such a need
3:29
Speaker 3: for you know, reliable women's health education. The videos became
3:33
Speaker 3: pretty popular, and that led down the line to the book.
3:36
Speaker 3: So the books called It's Not Hysteria, Everything you Need
3:39
Speaker 3: to Know about Your Reproductive Health, partheesy about what We're
3:42
Speaker 3: never told, So basically a guide to pretty much everything
3:47
Speaker 3: in gynecology from the basics of you know, periods and
3:50
Speaker 3: how you know, pregnancy happens with chapters on individual topics
3:56
Speaker 3: like nimetriosis and fibroids and pcos perimenopause, menopause which.
3:59
Speaker 2: Is Hue joint, now birth control, abortion, So pretty much.
4:03
Speaker 3: Everything that someone could possibly have had a question about
4:07
Speaker 3: had an issue with. I think all of us with
4:09
Speaker 3: a vagina or uters at some point has had some
4:11
Speaker 3: sort of issue in this book, you know. So I
4:15
Speaker 3: wanted a guide that pretty much from the you know,
4:18
Speaker 3: teen years through you know, all of your life, there's
4:22
Speaker 3: some value that you can get from this. And basically
4:26
Speaker 3: just having seen people struggling to find this information in
4:30
Speaker 3: a reliable way led to all of these things.
4:33
Speaker 2: So all these educational.
4:34
Speaker 3: Resources that I throw out there, just as you do,
4:36
Speaker 3: just to give the world this information that is lacking.
4:40
Speaker 1: So your book is fantastic. But what's interesting about it
4:44
Speaker 1: is it's very It starts very basic, so you know,
4:51
Speaker 1: there's a lot of quite detailed stuff in it, but
4:53
Speaker 1: the beginning of this book is is more or less
4:55
Speaker 1: a chapter that's like, here's where your vagina is, here's
4:59
Speaker 1: what is you know, here are all the parts. And
5:04
Speaker 1: I actually found it quite useful, and I can imagine
5:08
Speaker 1: many people finding it useful. But I'm curious what you
5:11
Speaker 1: saw out in the world that made you think this
5:13
Speaker 1: was necessary, because I think that many people could have
5:16
Speaker 1: said people need a primer on endometriosis.
5:19
Speaker 2: That's not well understood, pee costs not well understood. Like
5:21
Speaker 2: these things.
5:22
Speaker 1: There are a set of things where it's easy to
5:23
Speaker 1: imagine being a person in practice and saying, my patients
5:27
Speaker 1: are coming in and they don't really understand this, you know,
5:29
Speaker 1: reasonably detailed, somewhat rare thing that's happening. But to say,
5:34
Speaker 1: I'm seeing something in my work that makes me think
5:37
Speaker 1: people need to know where's the uterus? What is it
5:42
Speaker 1: that you saw that you saw that need Yeah, so much.
5:45
Speaker 3: I mean both in my practice and then also obviously
5:48
Speaker 3: on social media there's a whole genre on TikTok of
5:52
Speaker 3: people interviewing the person on the street. It's usually a
5:55
Speaker 3: man who just has no idea what is going on
5:59
Speaker 3: with like female and atom, like how tampons work. And
6:02
Speaker 3: it's not just men, it's you know, obviously, everyone has
6:05
Speaker 3: some moment in their life where they don't know what
6:07
Speaker 3: the parts of the body are, you know, how pregnancy works,
6:11
Speaker 3: like how a tampon gets inserted where it goes.
6:14
Speaker 2: So I noticed that.
6:16
Speaker 3: Obviously, you know, whenever we are talking to patients in
6:18
Speaker 3: the office in theory, you should be explaining these things
6:21
Speaker 3: to make sure that at the end of the appointment
6:24
Speaker 3: they understand. You know, if you're talking about a surgery,
6:26
Speaker 3: a medication, any sort of medical treatment, that the person
6:31
Speaker 3: would be like, yeah, no, I totally get that. But
6:33
Speaker 3: I have seen enough patients who had seen other doctors,
6:36
Speaker 3: you know, not to disparage their doctor, but just I
6:38
Speaker 3: noticed this where they would have a surgery and they're like,
6:41
Speaker 3: I don't even know what part of the body they
6:43
Speaker 3: took out. So this would happen, you know, with hysterectomy.
6:45
Speaker 3: So I'm like, did they take out your ovaries or
6:47
Speaker 3: you like, I don't know. I don't know if they
6:49
Speaker 3: took out my ovaries, I don't know. A lot of
6:50
Speaker 3: times they didn't even know what it was for. Like
6:52
Speaker 3: the doctor told me I needed it. I was bleeding
6:54
Speaker 3: a lot. I was like, did you have fibriids? Did
6:56
Speaker 3: you have you know, adnomiosis, Like I don't know. And
6:59
Speaker 3: so it's just so frustrating to see people kind of
7:01
Speaker 3: not have that agency over their own body, and you know,
7:05
Speaker 3: in the course of doing the social media videos, you
7:07
Speaker 3: would also see comments like I actually just got one today.
7:10
Speaker 3: I have a video that went pretty viral about you
7:12
Speaker 3: know what a hysterectomy looks like. So I showed like
7:15
Speaker 3: a super sped up version of like, here's your uterus,
7:18
Speaker 3: you know, here are.
7:18
Speaker 2: The blood vessels, here's your rectum.
7:20
Speaker 3: And somebody said, well, why do you need to cut
7:23
Speaker 3: a hole to take you know, like in the vagina,
7:25
Speaker 3: Like can't you just take it out through the hole
7:27
Speaker 3: that the period blood comes out of? And I realized
7:29
Speaker 3: that she thought that there was literally a hole in
7:31
Speaker 3: your abdomen that the blood was just sort of falling
7:34
Speaker 3: out of. I was like, oh, no, there's you know,
7:35
Speaker 3: the vaginant, there's no hole there. It's the cervix, that's
7:38
Speaker 3: the opening in your uterus, and the blood comes through there,
7:41
Speaker 3: through the vagina. And so, you know, like I said,
7:43
Speaker 3: I never assume I talk about in the book, My
7:48
Speaker 3: husband is not medical, but he has a PhD in ethics,
7:52
Speaker 3: and so every semester for a while he was teaching
7:54
Speaker 3: a sexual ethics course, and he realized, you know, you
7:57
Speaker 3: can't talk about ethics if people don't understand how things function.
8:01
Speaker 3: So he would like give it, literally like an eighth
8:03
Speaker 3: grade level quiz on you know, what are the female
8:07
Speaker 3: parts and what are the male parts? And no one knew,
8:09
Speaker 3: like he would do it before and after and like
8:11
Speaker 3: literally no one Like these are again, legal adults who
8:15
Speaker 3: could become parents at any second, and had nobody had
8:18
Speaker 3: any idea like vast efforts like fallopian tube any of
8:21
Speaker 3: this stuff. And so I would come in and give
8:24
Speaker 3: a little guest lecture on birth control, and there was
8:27
Speaker 3: always some question like how does this work? Like people
8:29
Speaker 3: would ask, can you get pregnant with oral sex? So
8:32
Speaker 3: you would think, like these are sort of like really
8:33
Speaker 3: basic things, but a lot of people were not having
8:36
Speaker 3: this information. So you know the title of the book,
8:38
Speaker 3: it's it's it's kind of in a joking way, but
8:40
Speaker 3: it's kind of true. It's like you should have had
8:42
Speaker 3: this information about your body how it works. But most people,
8:46
Speaker 3: I think, kind of get to adulthood and we're not
8:48
Speaker 3: told about these things. And so and I was saying,
8:51
Speaker 3: you know, if you were to take me and I
8:52
Speaker 3: would need like an eyeball surgery or like you know,
8:55
Speaker 3: a foot surgery, I couldn't name for you, right, now
8:57
Speaker 3: the bones in the foot, like I couldn't tell you,
9:00
Speaker 3: like you know, like draw you a picture of like
9:02
Speaker 3: you know, like the retina and the cornea and the
9:04
Speaker 3: lens and all that stuff.
9:06
Speaker 1: You know.
9:06
Speaker 3: So I don't assume that everyone knows this stuff about
9:09
Speaker 3: the female reproductive organs, which is important because it causes
9:12
Speaker 3: all sorts of problems and you need to.
9:14
Speaker 2: Yeah, I think part of what's very very nice about.
9:17
Speaker 1: This approach is when you are in that environment with
9:21
Speaker 1: a doctor, it is actually quite difficult to ask the
9:25
Speaker 1: full range of questions that people have. Like one is
9:28
Speaker 1: because there's not enough time, but the other is because
9:31
Speaker 1: like if i'm if I feel like I'm like nine
9:33
Speaker 1: steps behind where you are, Like I can't even get
9:37
Speaker 1: to the right question to engage in the fifteen minutes
9:41
Speaker 1: that we that we have. And so I think this
9:43
Speaker 1: is often how I think about some of some of
9:45
Speaker 1: my work around pregnancy is like I'm not gonna I'm
9:48
Speaker 1: not your obstetrician, Like I want you to have enough
9:51
Speaker 1: information about something like prenail testing that you can come
9:54
Speaker 1: in and be like, Okay, I understand, here are the
9:56
Speaker 1: things that we're talking about, Like we're closer to being
10:00
Speaker 1: able to have the conversation. And I think if I
10:03
Speaker 1: don't understand that you how the Philippian tubes work, or
10:06
Speaker 1: you know, how they connect to the ovaries or don't
10:08
Speaker 1: connect to the ovaries, and it's it's very difficult to
10:11
Speaker 1: get to explaining all the other things that you would
10:14
Speaker 1: need because and at that point, people shut down and
10:17
Speaker 1: they get they get afraid.
10:18
Speaker 2: Basically, they get scared.
10:20
Speaker 1: And uncomfortable and like, you know what, don't don't even
10:22
Speaker 1: tell me, Just take out whatever is that if you
10:24
Speaker 1: want to take something out, take it out, and like
10:25
Speaker 1: I don't, I can't just want to understand.
10:28
Speaker 2: I just want to leave.
10:29
Speaker 1: Like I'm not comfortable in this situation. I want to
10:31
Speaker 1: get out of here. And that of course is not
10:34
Speaker 1: a great place to be for decision making.
10:37
Speaker 3: Yeah, and that's exactly right. You know, we always tell
10:39
Speaker 3: people on social media, you know, we're not going to
10:40
Speaker 3: diagnose you, like we can't in a book, in a
10:43
Speaker 3: video tell you exactly what's happening with your body.
10:45
Speaker 2: But we can give you those tools.
10:47
Speaker 3: And that language to understand so that you can make
10:49
Speaker 3: the most of those you know, short minutes. And I'm
10:52
Speaker 3: talking the book about too, you know, it's problematic that
10:55
Speaker 3: people get fifteen minutes with their gynecologists. They've been waiting
10:58
Speaker 3: months and months, and then there's no time to actually
11:01
Speaker 3: cover all the questions that they have, and that leads
11:03
Speaker 3: to a lot of these you know, like miss missed
11:06
Speaker 3: diagnoses and like people really suffering for a long time.
11:09
Speaker 3: So yeah, that's the whole idea, just like you said,
11:11
Speaker 3: is just give people those tools. Kind of catch everybody
11:14
Speaker 3: up so that you can, you know, have that language
11:17
Speaker 3: hit the ground. I tell people you're hitting the ground running,
11:19
Speaker 3: You're not like just trying to catch up and being
11:21
Speaker 3: like hold up, can you just get me just explain
11:23
Speaker 3: like what the parts are so which is so important.
11:27
Speaker 2: So yeah, and you give people a little bit.
11:28
Speaker 1: You do a little bit of scripting in the book,
11:30
Speaker 1: which I love around you know, if you're going to
11:32
Speaker 1: have this conversation, what are the things, what are the
11:34
Speaker 1: sort of core questions you might ask for the core
11:36
Speaker 1: things you might want to make sure that you surface
11:39
Speaker 1: with your doctor, which I think is the other is
11:41
Speaker 1: another piece of where people get stuck. Sort of many
11:45
Speaker 1: questions that I have or things that I think I
11:46
Speaker 1: should share going around in my head, but then when
11:48
Speaker 1: faced with the moment, I'm like, I love like I'm
11:53
Speaker 1: not saying.
11:53
Speaker 2: That's about other people. I'm saying specifically this about me.
11:57
Speaker 2: What was my personal story exactly?
12:00
Speaker 3: But it's true, you know it is. And it's also
12:02
Speaker 3: you know, people are feeling anxious. You know, it's not
12:05
Speaker 3: the most it's like on the dentist, like no one's
12:07
Speaker 3: like ultra comfortable.
12:08
Speaker 2: But just to kind of go in there with.
12:10
Speaker 3: Some preparation, and you know, framework I tell people, you know,
12:13
Speaker 3: like take notes, like shot down your answers these questions,
12:16
Speaker 3: or you know, write down the things that you would
12:19
Speaker 3: you know, want to prioritize with your time.
12:22
Speaker 2: Again just to kind of help you organize yourself.
12:23
Speaker 1: So the book, the title in the title youth word hysteria.
12:29
Speaker 1: It's not hysteria. And I love the word hysteria because
12:32
Speaker 1: the first part of the book is all about the
12:35
Speaker 1: like history of sort of that word and this idea
12:38
Speaker 1: of what is the matter with women? But I'm curious
12:42
Speaker 1: why hysteria? Why do you love hysteria?
12:46
Speaker 2: Is that's a great name.
12:47
Speaker 3: It used to It actually started with a very like
12:50
Speaker 3: kind of like just very straightforward name was like pain,
12:53
Speaker 3: period's pain, empower man.
12:54
Speaker 2: It was very illiterative. I thought it was fun.
12:57
Speaker 3: And then just with the team, we were talking through
12:58
Speaker 3: like is there kind of like a catch your title
13:00
Speaker 3: we can come up with? And I can't remember, you know,
13:01
Speaker 3: somebody came up with it's not hysteria, and I was like,
13:03
Speaker 3: oh my god.
13:04
Speaker 2: I had like this like.
13:05
Speaker 3: Excited moment because it really captures so much. You know,
13:08
Speaker 3: obviously historically, like the word hysteria comes from the word
13:12
Speaker 3: for uterus in Greek. That's why it's the same, you
13:14
Speaker 3: know as hysterectomy hysteria. So you know, back like thousands
13:19
Speaker 3: of years ago, they thought that your problems with your
13:22
Speaker 3: health were because your uterus was malfunctioning. And then you
13:25
Speaker 3: get to like Freud, and hysteria becomes like this, like
13:28
Speaker 3: you know, anxiety manifested as your physical problems, and now
13:33
Speaker 3: it's all sort of a combination. Where if a woman's
13:35
Speaker 3: complaining about a lot of physical symptoms, pain, hormonal issues,
13:39
Speaker 3: et cetera, and there's just so many of them, a
13:42
Speaker 3: lot of times it gets assumed, well, you know, there
13:44
Speaker 3: can't be one medical problem that covers all of those things,
13:47
Speaker 3: so it must be just like a lot of anxiety,
13:49
Speaker 3: or someone's like a hypochondriac or they're overreacting. So you know,
13:53
Speaker 3: there's all of this sort of like the legacy of
13:55
Speaker 3: how women have been seen and how women's bodies have
13:58
Speaker 3: been treated, in addition to how a lot of people
14:00
Speaker 3: currently feel like they're like, well, I kind of feel
14:03
Speaker 3: like they're telling me I'm crazy because you know, I'm
14:05
Speaker 3: trying to get help in not getting a whole lot
14:07
Speaker 3: of answers. And again I tell people, it's not to
14:10
Speaker 3: blame I'm a gynecologist, I'm in the medical system. But
14:13
Speaker 3: the system is flawed. You know. Obviously, your whole platform
14:17
Speaker 3: is about like research and having data, and there's so
14:19
Speaker 3: little data on women's health for various reasons where we
14:22
Speaker 3: can talk about that. But you know, so in the
14:25
Speaker 3: absence of what super scientific algorithms like there are for
14:29
Speaker 3: management of like diabetes and heart attacks and cancers that
14:33
Speaker 3: you get sort of the management becomes very like this
14:37
Speaker 3: expert says this, and this person says this, and it
14:40
Speaker 3: depends on the luck of the draw which doctor you're
14:42
Speaker 3: sitting in front of. So it's obviously a source of
14:44
Speaker 3: great frustration, but I wanted to with the books say
14:46
Speaker 3: that you know, there are actual medical conditions that explain
14:50
Speaker 3: a lot of these quote unquote mysterious and like, you know, anxious,
14:54
Speaker 3: Like how do you how to say that? Like you know,
14:55
Speaker 3: like you think that it's from all this anxiety, but
14:58
Speaker 3: it's actually a pcos or it's actually enemy perimenopause. So
15:02
Speaker 3: just trying to tease out some of the mythology that
15:07
Speaker 3: has been kind of thrust upon women and women's health
15:11
Speaker 3: for all of human history. Not too much of a
15:14
Speaker 3: heavy lift, but yeah, yeah, yeah.
15:16
Speaker 2: Not too much of a heavy No. It's well, it's
15:18
Speaker 2: you know, simple, like three hundred and fifty three pages, right,
15:21
Speaker 2: except we are next at all.
15:23
Speaker 1: It's totally great done now. So I want to ask
15:25
Speaker 1: this question about data on women's health because you know,
15:27
Speaker 1: I like data, and I like to tell people things
15:30
Speaker 1: from data, and I like studies. And when we come
15:34
Speaker 1: to many of these things in women's health, we are
15:36
Speaker 1: lacking data.
15:38
Speaker 2: We're lacking data sometimes.
15:40
Speaker 1: Very basic things like what's the incidence of this problem?
15:45
Speaker 1: And we're almost always lacking data on the kind of
15:49
Speaker 1: what are the paths to treatment and which of them
15:54
Speaker 1: should we think about doing? You know, so I think
15:57
Speaker 1: the you know, diabetes is a good is it good contrast,
16:00
Speaker 1: whereas you know, if you come in, there's a very
16:02
Speaker 1: specific way we're going to diagnose this, and then there's
16:05
Speaker 1: a very specific set of almost like decision trees around
16:09
Speaker 1: you know, Okay, you're gonna do this and this, and
16:12
Speaker 1: even if you come in with a more vague set
16:13
Speaker 1: of symptoms like I'm having you know, I'm tired, my
16:16
Speaker 1: weight is fluctuating, you know, and it's it's clear, it's
16:19
Speaker 1: that it's like, Okay, we're going to test you for this,
16:21
Speaker 1: We're going to diagnose you in this way. We're going
16:22
Speaker 1: to have these different like trees of ways that we're
16:24
Speaker 1: gonna we're going to treat you. That feels missing in
16:28
Speaker 1: these women's health areas, And I have some theories about why,
16:33
Speaker 1: but I'm curious what your theory is about.
16:35
Speaker 2: Oh, I have some theories.
16:36
Speaker 1: I mean, it's the patriarchy is obvious, but could you
16:39
Speaker 1: be more specific?
16:40
Speaker 3: Yeah, So it all comes down to what people consider
16:43
Speaker 3: real medicine and real important things. So for instance, just
16:49
Speaker 3: the concept of what is a respectable you know, like
16:55
Speaker 3: a topic for research for funding. It all comes down
16:58
Speaker 3: to money too, is that you know, if is not
17:00
Speaker 3: enough funding, no one can do the research so like
17:03
Speaker 3: I kind of listed off a couple of things, like
17:04
Speaker 3: cancer so much funding. People are like, of course cancer
17:07
Speaker 3: is bad. We want lots and lots of you know,
17:09
Speaker 3: information and treatment options, which of course is important. But
17:12
Speaker 3: you know, somebody who has I always bring it back
17:15
Speaker 3: to enemy triosis because that's my specialty. But it can
17:18
Speaker 3: cause enormous suffering, like people can literally miss like entire
17:21
Speaker 3: weeks out of every month from their life, from their work,
17:24
Speaker 3: their ability to function. It can cause infertility and cause
17:27
Speaker 3: you know, just a horrible you know, diarrhea all the time,
17:31
Speaker 3: so like absolutely horrific quality of life impact. And it
17:35
Speaker 3: can almost act like a cancer, and that it can
17:37
Speaker 3: invade other organs, like it can invade into your rectum
17:39
Speaker 3: and your bladder and your diaphragm and your lungs, but
17:43
Speaker 3: it's somehow not treated as seriously. So it's like, well
17:46
Speaker 3: but that's just like lady pain stuff, Like it's just
17:48
Speaker 3: pain as opposed to cancer, which is like, oh, cancer
17:51
Speaker 3: is real, Like that's a serious medical problem. So you
17:54
Speaker 3: get all the funding, you get all the attention, and
17:56
Speaker 3: then you have more data, like you said, to guide treatment.
18:01
Speaker 3: So literally if you can kind of picture you mention
18:03
Speaker 3: heart attack, stroke, cancers. There's literally a decision tree. There
18:08
Speaker 3: is a data driven decision tree about in these situations
18:11
Speaker 3: like this is like the optimal like evidence based approach,
18:15
Speaker 3: but for women's house, so much of it there's not
18:16
Speaker 3: we don't even know what causes them, so there's so
18:19
Speaker 3: little data. We don't even know what causes enemetriosi's, pcos fibroids,
18:22
Speaker 3: so there's no way to prevent them. We can kind
18:26
Speaker 3: of like try and address them and you know, surgically
18:28
Speaker 3: cut out in ametriosis or fibroids when they show up,
18:31
Speaker 3: but then they grow right back because we can't keep
18:33
Speaker 3: them from coming back because we don't know where they
18:34
Speaker 3: come from, and so you know, we're sort of playing
18:37
Speaker 3: catchup and then let alone.
18:39
Speaker 2: The treatment tree.
18:40
Speaker 3: It's sort of a little bit of I call it
18:41
Speaker 3: the throw the spaghetti at the wall and see what
18:43
Speaker 3: sticks approach, where we kind of say, well, here's a
18:47
Speaker 3: bunch of different options, here's the pluses and minuses, and
18:49
Speaker 3: sort of you choose. If this one doesn't work, then
18:52
Speaker 3: you try a different thing. That's how a lot of
18:53
Speaker 3: people choose, Like birth controls, we strategize a little bit
18:56
Speaker 3: based on what's in the birth control and the person's preference.
18:59
Speaker 3: But there's a little bit of this like let's just
19:01
Speaker 3: see what happens, Like we don't do that with diabetes
19:04
Speaker 3: medicine or heart attacks, like like let's just try and
19:06
Speaker 3: see if it works, and then if it.
19:07
Speaker 2: Doesn't, we'll try a different thing.
19:09
Speaker 3: So, like I said, it really kind of comes down
19:11
Speaker 3: to what people consider like an important target for research.
19:15
Speaker 3: And it all goes back to so when I was
19:19
Speaker 3: in medical school and training, and every person in Oba
19:21
Speaker 3: Juan has probably had this moment where if you were
19:24
Speaker 3: a good student and you told someone a mentor professor
19:28
Speaker 3: that you were going into Obijuan, they'd.
19:29
Speaker 2: Be like, oh, why you could? You could do something real,
19:32
Speaker 2: Like you.
19:33
Speaker 3: You're a metology right, you could be a plastic surgeon
19:36
Speaker 3: or an orthopedic surgeon. So when I said I was
19:38
Speaker 3: I was interested in surgical a surgical field, people like, really,
19:42
Speaker 3: gynecology is not really a surgical field. I'm like, we
19:44
Speaker 3: are taking out organs like it's a real surgical field.
19:47
Speaker 3: But again there's that sense of disrespect. It's like, well,
19:49
Speaker 3: it's just like lady organs, it's not real organs like
19:52
Speaker 3: bones or the brain.
19:54
Speaker 2: Or the heart. You know, it's just lady stuff.
19:57
Speaker 3: So you know, just that that that bias that is
20:00
Speaker 3: already there.
20:02
Speaker 2: You know, it's just lady stuff.
20:03
Speaker 3: If the woman can't tolerate the symptoms, not that it's
20:06
Speaker 3: like we need to come up with an answer for her,
20:08
Speaker 3: it's that she just needs to kind of deal with
20:10
Speaker 3: it better. That just pervades the whole system and then
20:14
Speaker 3: you don't get the data and then it all spirals
20:16
Speaker 3: from there.
20:18
Speaker 1: The example of this that I always think about in
20:19
Speaker 1: the pregnancy context is hyperamesis, where it's you know, it's
20:25
Speaker 1: like extreme nage and vomiting of pregnancy, and we basically
20:30
Speaker 1: have no very little idea about why that affects on
20:34
Speaker 1: people and not others and what exactly is going on.
20:37
Speaker 1: Within the last couple of years, there's actually been a
20:40
Speaker 1: fairly substantial advance in our understanding of at least some
20:46
Speaker 1: of what might be going on, using basically family stuff
20:50
Speaker 1: to think about genetic mutations that are linked to this
20:53
Speaker 1: behavior or not behavior to this condition rather and the
20:58
Speaker 1: two things that sort of always strike me from that
21:00
Speaker 1: or one the reason that this got studied is because
21:04
Speaker 1: the researcher had hyperreathmesis that was it she basically she
21:08
Speaker 1: had this and she was like, oh my god, it's horrible.
21:10
Speaker 1: This is horrible, Like I'm going to research this, but
21:12
Speaker 1: we should not rely on researchers having condition right to
21:17
Speaker 1: learn about them.
21:17
Speaker 2: That's a terrible It's the same thing with enemy triosis.
21:20
Speaker 3: Like one woman I think at mit, it was just
21:22
Speaker 3: like this is ft what and then so how do
21:24
Speaker 3: we So.
21:25
Speaker 2: She basically dedicated her career to it.
21:28
Speaker 3: I thought you were going to say because of Kate Middleton,
21:30
Speaker 3: because I thought because you know, so I think.
21:32
Speaker 2: It got real.
21:33
Speaker 1: Yes, it got more attention there, but I think that
21:36
Speaker 1: then I don't know, but that wasn't that attention wasn't research.
21:40
Speaker 1: But then people like when this came out, you know,
21:42
Speaker 1: and what this is is an academic and really super interesting,
21:45
Speaker 1: important academic breakthrough around this genetic link. But it isn't
21:50
Speaker 1: It isn't a treatment, you know, it's it's not a
21:52
Speaker 1: treatment at all. And but people were like the number
21:56
Speaker 1: of things that people are like okay, but like what's
21:58
Speaker 1: the treatment, Like where's And it was sort of like
22:00
Speaker 1: the distance between this and actually developing something is very
22:03
Speaker 1: big and requires a bunch of money.
22:06
Speaker 3: Yeah, we're like we're just getting like the very tiny
22:08
Speaker 3: starting looks like a little starting element. Yeah, of like
22:11
Speaker 3: let's find out what causes it and then we can
22:14
Speaker 3: then maybe we can we can help.
22:15
Speaker 1: Yeah, more parent data, including why women's pain isn't taken
22:27
Speaker 1: as seriously as normal pain, how to arm yourself with
22:32
Speaker 1: knowledge against panic headlines, and how to talk so your
22:34
Speaker 1: doctor will listen after the break? Do you write a
22:54
Speaker 1: lot in the book about pain as a sort of
22:59
Speaker 1: symptom that is uh, that is dismissed. And I wondered
23:03
Speaker 1: if we could talk about the iu D case because
23:05
Speaker 1: that's come up so much recently for people the kind
23:08
Speaker 1: of view that IUD insertion is something that is very
23:13
Speaker 1: painful but is not talked about. And I'm not even
23:17
Speaker 1: sure I have a very specific question here, but I'd
23:20
Speaker 1: be curious how you how you've sort of reacted to
23:23
Speaker 1: that whole discussion.
23:25
Speaker 3: Yeah, So it's interesting kind of like personally and then
23:28
Speaker 3: also professionally, I will divide the two because professionally, like
23:32
Speaker 3: I said, I'm a pain specialist, and I did agree,
23:35
Speaker 3: I kind of feel like in general as a field,
23:38
Speaker 3: like we were not trained well in terms of how
23:40
Speaker 3: to address these things with patients, like what they might
23:44
Speaker 3: feel like, what the options are, and to be frank like,
23:48
Speaker 3: a lot of the options are not great. So part
23:51
Speaker 3: of the reason that we don't routinely do say local
23:53
Speaker 3: anesthetic on everybody, like with injections, is because it's as
23:57
Speaker 3: more painful than the IUD. So to give the injections
24:00
Speaker 3: of localistic with the needle, like you have to do
24:02
Speaker 3: at least three shots, which is a sizable needle, and
24:05
Speaker 3: it hurts. So a lot of gynecologists and this is
24:08
Speaker 3: the way it was presented to me. It was like, well,
24:10
Speaker 3: why would you do like three shots and then wait
24:12
Speaker 3: and then do the IUD. You could just do the
24:14
Speaker 3: IED and it's quicker. So on TikTok, it was about
24:19
Speaker 3: three years ago now that this sort of blew up
24:21
Speaker 3: on TikTok about pain and people were explaining like how
24:24
Speaker 3: horrible their experiences were. And I think it's also a
24:28
Speaker 3: little bit of the bias and who was telling their stories,
24:30
Speaker 3: because I think every gynecologist like, well, we've been placing
24:33
Speaker 3: these for years and most people do just fine, Like
24:35
Speaker 3: you do ibuprofen, or you place them after childbirth, and
24:38
Speaker 3: it's much less painful after you have a vaginal delivery
24:40
Speaker 3: than if you are seventeen you never had a baby before.
24:43
Speaker 2: So the.
24:47
Speaker 3: Sense on TikTok that everybody was, you know, being tortured,
24:50
Speaker 3: was also based on like who was making these videos,
24:53
Speaker 3: Like obviously it's just like the Yelp reviews. It's like
24:55
Speaker 3: nobody's going to be like it was fine, Like you know,
24:58
Speaker 3: it's either like you.
24:59
Speaker 2: Loved it, I hate it.
25:00
Speaker 1: I will say I had this like I had like
25:03
Speaker 1: I want to hear the second part of your reaction,
25:05
Speaker 1: but I had the same sort of first part, which
25:06
Speaker 1: was like like professionally, I really want to understand this better,
25:09
Speaker 1: but personally like I had this after my kids, like
25:12
Speaker 1: it was fun.
25:13
Speaker 2: I had three.
25:14
Speaker 1: I felt nothing and so I wasn't like a recreational activity,
25:18
Speaker 1: but I did not. I would not have described that
25:20
Speaker 1: as especially uncomfortable. Oh wait, Karen, hang on a second,
25:25
Speaker 1: my producer tomorrow is making faces tomorrow.
25:28
Speaker 2: Do you want to add something?
25:30
Speaker 1: Uh?
25:31
Speaker 4: Yeah, quick question though, just to be clear, did both
25:35
Speaker 4: of you first get Aud's after you'd already given birth?
25:38
Speaker 2: Yeah? Yeah, so I didn't have one before having kids.
25:40
Speaker 1: So I mean neither I had mine. I've had I
25:42
Speaker 1: have two. I mean, I'm on my second at one
25:45
Speaker 1: after each kid. Did you have one before?
25:48
Speaker 4: Oh my god, I had a few actually, Like it
25:53
Speaker 4: was really awful. Oh no, it's And it's funny because
25:56
Speaker 4: when I went back for my six week postpartum appointment
25:59
Speaker 4: and I got you know, and and they were.
26:01
Speaker 3: Like done, and I was like, oh, it's like nothing,
26:03
Speaker 3: It's like you're kidding me. Like that's what I'm saying,
26:06
Speaker 3: is that, like, you know, it's very different. If you're
26:08
Speaker 3: like postpartum, you had vagual delivery and like the cervix
26:10
Speaker 3: is like super open, then yeah, if you've ever yeah.
26:14
Speaker 4: It's night and day different. It's shocking. Yeah, okay, sorry,
26:18
Speaker 4: sorry to make it personal. I just needed to ask
26:20
Speaker 4: that they are awesome though.
26:23
Speaker 1: Yeah, I thank you tomorrow. I really appreciate this perspective.
26:29
Speaker 3: So I think this is you know, and and again
26:30
Speaker 3: this is pain is so individual. The circumstances are so specific.
26:34
Speaker 3: So like I said, if you had just had a baby,
26:35
Speaker 3: it's very different than you know.
26:37
Speaker 1: Cervix is already services exactly flapping around.
26:41
Speaker 2: Yeah, I just get whatever up there. It's fine, exactly.
26:44
Speaker 3: And I personally have always if someone hasn't, you know,
26:46
Speaker 3: had it delivered before and their service sem closed. I
26:48
Speaker 3: would give them medication to help open their cervix, I
26:50
Speaker 3: give them i'd be profu and I pre treat them before.
26:52
Speaker 3: So you know, we I was, you know, doing all
26:55
Speaker 3: that stuff, and in general, my patients did great and
26:57
Speaker 3: didn't seem like it was this epidemic of pain. I so, again,
27:03
Speaker 3: this is not to do with like the actual science,
27:05
Speaker 3: but this is just sort of the phenomenon of you know,
27:08
Speaker 3: like when these topics kind of go viral and things
27:12
Speaker 3: are happening and everyone's getting very kind of caught up
27:14
Speaker 3: in it. I made a video, except at the time
27:16
Speaker 3: they weren't just.
27:17
Speaker 2: Talking about iud's.
27:17
Speaker 3: They were talking about everything like colposcopy, which is biopsies
27:21
Speaker 3: to check for abnormal pap smears. And then somebody was
27:24
Speaker 3: made a video showing a tenaculum, which is an instrument
27:26
Speaker 3: that's used sometimes during an IUD insertion, but it's not
27:30
Speaker 3: the only thing it's used for. We use it for
27:31
Speaker 3: other things, and they were just like, look at this,
27:33
Speaker 3: it looks like it's torturing people. And you know, so
27:36
Speaker 3: again I'm trying to from a scientific perspective as a
27:38
Speaker 3: pain expert. I was like, oh, actually, there are studies
27:41
Speaker 3: that show that local anesthetic doesn't actually help with those
27:44
Speaker 3: like you know, it actually feels about the same because
27:46
Speaker 3: again you're using the needle. Somebody took a clip of
27:49
Speaker 3: me out of context from that video and said I
27:51
Speaker 3: was saying that IUDs don't hurt, and it went crazy viral.
27:54
Speaker 3: People were sharing all those like this doctor hates people
27:57
Speaker 3: and they think that I d's don't turt. I'm like,
27:59
Speaker 3: I never even said the word IU. There's no IUD
28:01
Speaker 3: in the video. I was not talking about IUDs. But
28:03
Speaker 3: it just got kind of got caught up in this
28:05
Speaker 3: like this this swirl of anger. And obviously, with some distance,
28:09
Speaker 3: I now see obviously like people were angry, like they
28:12
Speaker 3: had a bad experience, they felt like they weren't being
28:14
Speaker 3: listened to, and of course they were upset. But I
28:17
Speaker 3: sort of became a turk, you know, everyone's anger mistakenly,
28:20
Speaker 3: and and you know, three years later, I still get
28:21
Speaker 3: occasional DMS like you're the lady who said I d's
28:24
Speaker 3: aren't hurt.
28:24
Speaker 2: You know, like, how dare you? And I'm like, oh
28:26
Speaker 2: my gosh, I never said that.
28:28
Speaker 3: But you know, now they were on the other side,
28:31
Speaker 3: what is a good thing that came out of all
28:33
Speaker 3: this is prompting people to talk about is to say
28:37
Speaker 3: women deserve to know what their options are and the
28:39
Speaker 3: pluses and minuses.
28:41
Speaker 2: A lot of people now are using like.
28:42
Speaker 3: Nitrous oxide, which is not a pain medication, you know,
28:45
Speaker 3: like like laughing gas for the dentist. It actually doesn't
28:49
Speaker 3: really help with pain, but it makes the whole experience
28:51
Speaker 3: less uncomfortable, so people do prefer it, meaning that they
28:55
Speaker 3: feel more comfortable. They don't feel as you know, like
28:58
Speaker 3: the experiences as anxiety provoking or you know, just negative.
29:02
Speaker 3: So it's something I'm looking into. A lot of ginocologists
29:04
Speaker 3: have looked into this, and we're also kind of being
29:07
Speaker 3: creative with different ways to give local anaesthetics. So a
29:10
Speaker 3: lot of us have started putting it into the uterus
29:12
Speaker 3: instead of with a needle, like with a gel or
29:14
Speaker 3: a liquid with a little syringe to kind of put
29:16
Speaker 3: it through the cervix into the earth. So again it
29:19
Speaker 3: prompted some sort of innovation. People are still doing studies
29:23
Speaker 3: on this, so it's it's sort of at the level
29:25
Speaker 3: of like, well, we tried some stuff and some people
29:27
Speaker 3: did really well with it, but again it sort of
29:31
Speaker 3: was kind of stagnant. There were really no options, Like
29:34
Speaker 3: we were like, there's not amazing options, so we're kind
29:36
Speaker 3: of going to just ignore it. So it has been
29:40
Speaker 3: positive in terms of prompting a movement forward in some way.
29:44
Speaker 3: So I do think that that's really helpful because you know,
29:46
Speaker 3: I and a lot of other gynecologists have changed things
29:48
Speaker 3: like let's try you know, like putting it in a
29:51
Speaker 3: different way so you don't have the pain of the
29:53
Speaker 3: needle and maybe it helps numb the uters a little
29:55
Speaker 3: bit from the inside. And so it is I think
29:58
Speaker 3: it's a good conversation to have, but we have to
30:00
Speaker 3: be careful because a lot of times, like I said that,
30:02
Speaker 3: there are so many things the uproar about, like metallic
30:06
Speaker 3: compounds and tampons.
30:08
Speaker 2: Did you see that? Oh did I see that?
30:10
Speaker 1: Yes, I came across my desk.
30:12
Speaker 2: I assure you, yes, many of us made.
30:15
Speaker 3: Videos or posts responding to that, because yes, it's really
30:20
Speaker 3: not not great. Yeah, so we always warn't like, obviously
30:25
Speaker 3: the movement to have more data is good, but where
30:27
Speaker 3: it goes off the rails a little bit is that
30:29
Speaker 3: people are just like blow up. And this is truly
30:32
Speaker 3: where it's hysteria, where it's just like everyone is panicking
30:35
Speaker 3: based on something that's not even real. And so with
30:39
Speaker 3: the tampons thing, they basically like a researcher kind of
30:42
Speaker 3: just melted down some tampons like to like hundreds and
30:46
Speaker 3: hundreds of degree s frored height with like incredibly acidic
30:50
Speaker 3: basically nothing.
30:51
Speaker 1: That your vagina is super super hot, basically hot vagina.
30:56
Speaker 3: Yeah, you know, if it's like a cauldron of hot acid,
31:00
Speaker 3: then you know, but it's nothing like a body. And
31:03
Speaker 3: they were like, well, like a teeny amount of like
31:05
Speaker 3: lead came out. That's equivalent to what would be in
31:07
Speaker 3: like cereal, like with you know, foods that you eat.
31:10
Speaker 3: So but everyone panic. They were like, you're being poisoned.
31:13
Speaker 3: So the other danger of the other extreme for women's
31:16
Speaker 3: health is the tendency to over focus on bad So
31:19
Speaker 3: you know, both the lack of good data and also
31:21
Speaker 3: the over emphasis on bad stuff. So you know, we
31:24
Speaker 3: could talk forever about like Women's Health Initiative and hormone
31:27
Speaker 3: replacement therapy and how you know, like people kind of
31:31
Speaker 3: like really panicked and for twenty years like we're like,
31:34
Speaker 3: oh no, like hormoplace and therapy is gonna give you cancer,
31:36
Speaker 3: and it's horrible and no one should take it, Whereas
31:39
Speaker 3: like the reality is more of a nuance and you know,
31:42
Speaker 3: like less extreme, and we should be like individualizing our
31:46
Speaker 3: counseling so that we don't just like sweep away an
31:48
Speaker 3: entire category of medications for that can be very helpful.
31:52
Speaker 2: So yeah, I mean, the thing is like.
31:54
Speaker 1: For me sort of two big picture things, maybe a
31:57
Speaker 1: little bit out of that, but also out of the ID.
31:59
Speaker 1: So I mean, one is is that it seems like
32:02
Speaker 1: acknowledging the reality of this procedure, that it might be painful,
32:08
Speaker 1: that it might be more painful for some people than others, like,
32:11
Speaker 1: and that itself is of tremendous value. And some of
32:16
Speaker 1: the reaction I think people had the most extreme was
32:19
Speaker 1: my doctor told me this is no big deal, and
32:22
Speaker 1: I did not feel that, Like I it was very
32:25
Speaker 1: painful for me, and I feel dismissed. Whereas I think
32:28
Speaker 1: if we started by telling people, you know, you, given
32:31
Speaker 1: your circumstances, this could be painful, and here, you know,
32:34
Speaker 1: we recommend you take I agreement or just this is
32:36
Speaker 1: going to be painful might help a lot in terms
32:41
Speaker 1: of people feeling like feeling.
32:44
Speaker 2: Heard and understood.
32:45
Speaker 1: I think it's it's the gaslighting that is almost in
32:49
Speaker 1: some cases as bad as the experience.
32:52
Speaker 2: And the experience yeah for sure.
32:54
Speaker 3: Yeah, people feel like they're not like in control, like
32:56
Speaker 3: they're sort of like, well, you know, don't worry about it.
32:59
Speaker 3: And then if you like, oh my god, that was
33:00
Speaker 3: really painful, like, well, but it's okay. Yeah, like you said,
33:04
Speaker 3: it's all about.
33:05
Speaker 2: It comes maybe from a good place.
33:06
Speaker 1: You don't want to tell people like, look, this is
33:08
Speaker 1: going to be terrible, particularly because for some people it's
33:10
Speaker 1: not you know, you don't want.
33:11
Speaker 2: To scare people.
33:12
Speaker 1: But there's a balance there between you know, information and
33:16
Speaker 1: I don't know, between informing people.
33:18
Speaker 2: But there's a balance, yeah, exactly.
33:21
Speaker 1: And in the case of something like hormone replacement therapy,
33:23
Speaker 1: where again there's a sort of nuance, there's a balance.
33:25
Speaker 1: There's an individualization in information where I almost think we
33:30
Speaker 1: don't always trust patience enough to tell them, you know,
33:33
Speaker 1: here are the pluses and minuses like that, there are
33:36
Speaker 1: costs of you know, the IUG is a really really
33:39
Speaker 1: great way to not get pregnant for a long time,
33:41
Speaker 1: and people really like it and a lot of there's
33:44
Speaker 1: a lot of really great things. It has this potential downside, yeah,
33:48
Speaker 1: you know, and like this is your choice and we
33:51
Speaker 1: have to we can sort of talk about how we
33:52
Speaker 1: can make this downside better, but just to you understand,
33:55
Speaker 1: like it's not it's not free, but.
33:59
Speaker 3: That doesn't mean it's the whole the concept that they
34:01
Speaker 3: informed consent and that the reason that there are options
34:03
Speaker 3: is that there's not one perfect always you know, the
34:07
Speaker 3: best no risk, no side effects situation except for physical therapy.
34:12
Speaker 2: That's it. I always tell people physical therapy.
34:14
Speaker 3: Is the one good thing that never has any you know,
34:16
Speaker 3: real downside. But it's all about yeah, like you said,
34:19
Speaker 3: presenting like realistically, like what are the nuances of everything?
34:22
Speaker 1: And so I feel like my my most my most
34:25
Speaker 1: central like saying is just there's no secret option sy
34:29
Speaker 1: y I use like all the time for you know,
34:32
Speaker 1: like just for medical procedures, for things about my kids.
34:35
Speaker 1: You know. So what do you what advice would you
34:40
Speaker 1: give people in talking to their doctor, because I think
34:43
Speaker 1: part of the book is about, you know, when you're
34:46
Speaker 1: experiencing symtymptoms, maybe symptoms that you don't totally understand, how
34:51
Speaker 1: do I come into my doctor in a place where
34:55
Speaker 1: I can get the answers that I need. So I'm
34:58
Speaker 1: just curious if you could talk a little bit through
34:59
Speaker 1: how you see JET people have those conversations.
35:01
Speaker 3: Yeah, so sort of two kind of big areas. So
35:05
Speaker 3: one is how to kind of prepare going in to
35:08
Speaker 3: make the most of your time with the doctor. And
35:11
Speaker 3: then there's the what do you do if you're trying
35:13
Speaker 3: your best and your doctors is not listening, you're not
35:15
Speaker 3: getting answers. So in the first place, that's where the
35:18
Speaker 3: whole preparation comes in. You know, reading the book or
35:20
Speaker 3: like you know, just reading from any reliable source of
35:23
Speaker 3: good information, so you can kind of come into that
35:25
Speaker 3: ready to ask specific questions. And again this is where
35:29
Speaker 3: we say, obviously the book can't diagnose you with PCOS,
35:32
Speaker 3: but you can say, you know, I have symptoms of
35:34
Speaker 3: acne facial here, my periods are a regular, I've had
35:36
Speaker 3: troublegate losing weight. I know that those are symptoms of PCOS.
35:41
Speaker 3: Can you tell me about this, what you know could
35:43
Speaker 3: we do for evaluation? Here are my concerns about fertility,
35:46
Speaker 3: about regulating my periods, and that just sort of like
35:49
Speaker 3: that that just kind of jumps you ahead those several
35:52
Speaker 3: minutes of them trying to kind of figure out what's
35:54
Speaker 3: going on with you, what are your concerns, what are
35:57
Speaker 3: your priorities? So kind of having that you for yourself
36:00
Speaker 3: and what are your priorities is really big because sometimes
36:04
Speaker 3: you know, the doctor may latch onto something that you're like, well, actually,
36:07
Speaker 3: I'm mostly concerned about this. You can kind of guide
36:11
Speaker 3: the conversation during your available time to the things that
36:14
Speaker 3: are most important to you to make sure those get addressed.
36:16
Speaker 3: So that's sort of just like the approaching just generally,
36:18
Speaker 3: how do you prep like write things down, bring a
36:21
Speaker 3: friend or a partner or a colleague whoever to help
36:25
Speaker 3: if you get you know, caught up or you're anxious,
36:28
Speaker 3: you're not quite sure what to say, they can And
36:29
Speaker 3: I love this when people do this, Like I've had
36:31
Speaker 3: some really great partners to come and be like, actually,
36:33
Speaker 3: do you remember you wanted to make sure we asked
36:35
Speaker 3: about this.
36:36
Speaker 2: And she's like, oh yeah.
36:38
Speaker 3: So having somebody there to support you to maybe kind
36:41
Speaker 3: of jump in with questions or things if you you know,
36:44
Speaker 3: maybe forget to ask something that you know is really
36:46
Speaker 3: important to you. And you know, if you're going through
36:49
Speaker 3: a procedure or something like that, you need extra support.
36:51
Speaker 3: So you know, that's very helpful. You obviously are entitled
36:54
Speaker 3: to have somebody there with you if you need them.
36:56
Speaker 2: And then the what do you do.
36:58
Speaker 3: If you're trying and your doctor is telling you that
37:00
Speaker 3: that's normal, don't worry about it.
37:03
Speaker 2: You know there's nothing to do about that. That's just
37:05
Speaker 2: lady stuff, the gas lighting. Basically.
37:07
Speaker 3: Yeah, So I always tell people whenever you're seeing a doctor,
37:11
Speaker 3: there should always be a what's next like. There's never
37:13
Speaker 3: a like, there's no answers for you, there's no treatments
37:15
Speaker 3: for you, buy like. There should always be something so,
37:18
Speaker 3: be it testing, be it like trying something else. It
37:22
Speaker 3: could be if that doctor is not the one to
37:24
Speaker 3: help you with this, a referral to somebody who can.
37:27
Speaker 3: So I refer people all the time. I'm like, I
37:29
Speaker 3: think you need a pelvic physical therapist. I think you
37:31
Speaker 3: need a eurogynecologist, you need infertility specialists and reproductive and chronologist.
37:35
Speaker 3: There's always someone, you know. If I've reached the end
37:38
Speaker 3: of my ability to provide advice and care, I should
37:42
Speaker 3: be helping you figure out who the next person is
37:44
Speaker 3: who can give you that care. So if you are
37:47
Speaker 3: getting the brick wall, I call it just you can
37:50
Speaker 3: push back you'd be like, so, what do you think
37:51
Speaker 3: is happening? If they're just like, it's just normal and
37:54
Speaker 3: your pain or weird bleeding is just fine, you'd be like, well,
37:56
Speaker 3: tell me what do you think is actually going on?
37:59
Speaker 2: And what can we do next?
38:00
Speaker 3: So can we you know, if it's something like a
38:02
Speaker 3: physical symptom, like can we order imaging studies? Can we
38:05
Speaker 3: order some sort of testing. There's not always necessarily a
38:08
Speaker 3: need for testing, like say hormone testing in some situations,
38:11
Speaker 3: Like that's a little bit overutilized and it's not super
38:14
Speaker 3: helpful in some situations. So just to say, you know,
38:17
Speaker 3: have that conversation about what testing would they recommend and
38:20
Speaker 3: why or why not? And then again, if they are
38:24
Speaker 3: really not getting anywhere to say, can you refer me
38:27
Speaker 3: to someone else? Like is there a menopause specialist and
38:30
Speaker 3: enemytrisis or pain specialists? For until a specialist somebody that
38:33
Speaker 3: you can refer me to, so we can, you know,
38:37
Speaker 3: go down a path of evaluation and treatment. And if
38:40
Speaker 3: you're really getting absolutely nothing out of them, that's where
38:42
Speaker 3: you get your second opinions. You crowdsource, you know, that's
38:45
Speaker 3: one of the beauties of social media is that people
38:47
Speaker 3: especially with support groups have kind of bounded banded together
38:52
Speaker 3: to help people find doctors geographically. They make their own
38:55
Speaker 3: like kind of doctor lists for enemytriosis and you know,
38:59
Speaker 3: gender firming care, menopause, that sort of thing for menopause.
39:04
Speaker 3: There's some professional societies that have.
39:08
Speaker 2: Directories.
39:08
Speaker 3: So for menopause, the now they call it used to
39:11
Speaker 3: be North American Metopause Society, Now it's Menopause Society. UH
39:15
Speaker 3: has a directory for gender firming Care w p A
39:18
Speaker 3: t H, the World Professional Association of Transcender Health. And
39:22
Speaker 3: then UH, there's actually a for those This is a
39:25
Speaker 3: you know, a big deal around when Roe v. Wade fell,
39:28
Speaker 3: people who are trying to get sterilizations but were getting
39:30
Speaker 3: turned down because they were child free or they were unmarried.
39:33
Speaker 2: Uh, that was a huge problem.
39:36
Speaker 3: So there is actually a child free Reddit that maintains
39:38
Speaker 3: a massive surgeon list of both on collegists and urologists
39:41
Speaker 3: who are willing to do sterilizations if you're child free.
39:43
Speaker 3: So people have kind of like, you know, in the
39:46
Speaker 3: absence of let me just go to my local doctor
39:48
Speaker 3: and they're going to be the one who fixes it all. Like,
39:51
Speaker 3: people have kind of bound banded together to create these
39:54
Speaker 3: resources so that you know, people don't have to reinvent
39:57
Speaker 3: the wheel and struggle to find someone who is a
40:00
Speaker 3: secalists so or ask around in like local Facebook groups
40:03
Speaker 3: are something like people will say, oh, I had a
40:04
Speaker 3: great experience with so and so or you know, I
40:07
Speaker 3: this person really comes highly recommended. So you can reach
40:10
Speaker 3: out to your local community to try and find someone
40:12
Speaker 3: who'll be helping.
40:13
Speaker 1: And we'll put all of those things in the show
40:15
Speaker 1: notes if people are looking and want to and want
40:19
Speaker 1: the links.
40:20
Speaker 2: Yeah, I mean, I think when I when I think about.
40:22
Speaker 1: The kinds of reactions people have when they ask me
40:24
Speaker 1: about the relationships with their doctors, there's kind of like
40:26
Speaker 1: the doctors like you where it's like, Okay, this person
40:30
Speaker 1: is listening to me, and the like I.
40:32
Speaker 2: Love having this doctor.
40:33
Speaker 1: Then there's a sort of set of people in the
40:35
Speaker 1: in the middle where I think there's a lot of
40:37
Speaker 1: progress that can be made with asking, like asking the
40:40
Speaker 1: right questions, asking you know, in the sort of in
40:43
Speaker 1: the right way, being prepared in the right way, like
40:45
Speaker 1: maybe that's not where the conversation would start, but you
40:47
Speaker 1: can make the conversation go there. And then there are
40:49
Speaker 1: certainly people who say, like you know, I explain this,
40:51
Speaker 1: and I explain that. I explained it like this, I
40:52
Speaker 1: explained it is my doctor just kept being like completely
40:56
Speaker 1: ignoring me, and I felt and then I think that's
40:58
Speaker 1: where it's like it's probably time to find another person
41:03
Speaker 1: or a second opinion, like maybe this is not the
41:05
Speaker 1: right fit for you. And I do think it's actually
41:07
Speaker 1: quite it's quite hard to quit your doctor because there's
41:11
Speaker 1: you know, like it's like quitting the gym or I
41:13
Speaker 1: don't know, it's like it's just you know, there's a
41:15
Speaker 1: sort of trust there, and it's it is kind of
41:17
Speaker 1: feel a little bit like maybe it's me. And I
41:19
Speaker 1: think the frame i'd often get get give to people
41:21
Speaker 1: is like it's maybe it's you, maybe it's them.
41:24
Speaker 2: It's the fit.
41:25
Speaker 1: So like like this person may be an amazing doctor
41:27
Speaker 1: and like a perfect doctor for someone else, but if
41:30
Speaker 1: they're not the right doctor for you, then they're not
41:32
Speaker 1: the right doctor for you.
41:33
Speaker 2: And like that's no shade on them, it's no shade
41:35
Speaker 2: on you.
41:35
Speaker 1: Like you know, you just need to find someone who
41:39
Speaker 1: works for the things that you need for whatever is
41:41
Speaker 1: like the direction that you know is gonna the direction
41:44
Speaker 1: of care that's appropriate.
41:45
Speaker 2: For you exactly.
41:46
Speaker 3: And I've have a lot a lot of patients who
41:48
Speaker 3: love their general obguan for certain things like for prenatal care,
41:51
Speaker 3: for annual exams, but they just need to see a
41:54
Speaker 3: specialist for a particular problem. So you know, like your
41:57
Speaker 3: generalguan may not be an end ametrio systei chlog yep,
42:00
Speaker 3: they're not an enochronologist exactly. So plenty of people they're like,
42:04
Speaker 3: you know, I like my doctor for other stuff, but
42:06
Speaker 3: they're just kind of not doing great with this one thing.
42:09
Speaker 3: Then you can see a specialist for that and still
42:11
Speaker 3: stay with them for like you routine checkups, your pregnancies,
42:14
Speaker 3: et cetera. So again, it's about like finding those fits
42:16
Speaker 3: and finding the resources you need.
42:18
Speaker 1: For and also figuring out who is the right Like
42:21
Speaker 1: some my friend wrote to me the other day and
42:22
Speaker 1: they said, you know, can you, like, can you make
42:24
Speaker 1: a recommendation for my wife? She's having all these symptoms
42:26
Speaker 1: and like we need a really good OB. And I
42:28
Speaker 1: wrote back and I was like, the thing you're describing
42:31
Speaker 1: is you need a really good eddocrinologist, like you don't
42:33
Speaker 1: and OB is going to kind of have any idea
42:35
Speaker 1: what you're talking about, So like here, you know, here's
42:37
Speaker 1: an eddo chronologists. But I think it was even and
42:40
Speaker 1: then he was like, I'd never even heard of that job.
42:42
Speaker 1: So it's like, yeah, some of it is kind of
42:44
Speaker 1: figuring out, like.
42:45
Speaker 2: Is there some special system? Yeah?
42:47
Speaker 1: Is there a system that like I need to be
42:49
Speaker 1: I need?
42:50
Speaker 2: Yeah.
42:50
Speaker 3: It's interesting because we have a UK version. I almost
42:53
Speaker 3: felt like I was translating it from US to UK
42:57
Speaker 3: like medical system because they're with the NHS especially, it's
43:00
Speaker 3: such a strict like you have to see your GP
43:03
Speaker 3: before you even get to a gynecologist, and then like
43:06
Speaker 3: they may wait like a year and then see the
43:08
Speaker 3: guncolleges and not have a great experience and then have
43:10
Speaker 3: to get a second opinion, which takes a whole process.
43:11
Speaker 3: So in the US at least, we are fortunate to
43:14
Speaker 3: have a little bit of a simpler access to additional opinions,
43:18
Speaker 3: though obviously it's not like easy, but in other systems
43:21
Speaker 3: it's even more complicated. And but just wherever you are,
43:25
Speaker 3: you are entitled to have additional opinions, and the UK,
43:30
Speaker 3: like I said, they can fast track you if any
43:31
Speaker 3: of you listeners are in the UK. And then also
43:35
Speaker 3: important because people in rural areas may not have a
43:38
Speaker 3: whole lot of people to choose from, like they may
43:40
Speaker 3: you know, they may be one obgun in like a county,
43:44
Speaker 3: and so a lot of people now doing telemedicines like
43:47
Speaker 3: within the state. So if you don't have somebody within
43:49
Speaker 3: driving distance at least maybe you can try and access
43:52
Speaker 3: like remote telemedicine for a special consult or something. So
43:56
Speaker 3: so there are like some things that, thank goodness, like
43:59
Speaker 3: technology is mad a little bit easier.
44:01
Speaker 2: Like imagine what this was like before the Internet. It
44:04
Speaker 2: was just zoom.
44:05
Speaker 1: How did we ever have doctoring? How do you do
44:08
Speaker 1: any medicine dry for four hours? If you could to
44:11
Speaker 1: you know, find these for fifteen minutes. Yeahh Karen, thank
44:17
Speaker 1: you so much for being here.
44:18
Speaker 2: This was fabulous. I had a great conversation. Thank you
44:20
Speaker 2: so much.
44:21
Speaker 5: Pink like the clips of fund yar nay be Pink
44:26
Speaker 5: like the skin that sunder Big Bi, Pink fisty, pistin
44:33
Speaker 5: side great see pink pean for Risk.
44:38
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