00:00If you want to advocate for yourself, you first need to reframe that being persistent is not being demanding or difficult.
00:08You're advocating for your health, and so that is a simple clinical fact and a clinical need.
00:15And historically, women have been socialized to downplay pain, to accept vague reassurance, and to delay care.
00:26And all of that is a perfect storm to being mistreated, misdiagnosed, underdiagnosed, or overdiagnosed with the wrong thing.
00:33Someone can be overdiagnosed with something like IBS, where it's actually something like SIBO, you know, small intestinal bacterial overgrowth, or inflammatory bowel disease.
00:44And someone could be underdiagnosed with endometriosis, and in fact labeled as irritable bowel syndrome, or acid reflux, or something like that.
00:52So, you know, I think in terms of advocacy, one thing I would always advocate for is actually going to an appointment with someone else if you can.
01:02Because, number one, you have an independent adjudicator there that can limit any unconscious bias, that in the heat of the moment can help you to recall useful information, and can also advocate on your behalf as well.
01:17I think that's a really useful tool, because, again, it's not like a confrontation between patient and doctor, but it's always useful to have someone there, to be someone independent who's also on your side, on your court.
01:31And secondly, I would say to document things, and to really use specifics.
01:39So, instead of saying things like, you know, this has really been troubling me for a while, get really hyperspecific and data-driven.
01:47This has been impacting my sleep for six months, and I find it worse when this happens.
01:54It's improved by this, or I can't go to the gym because this is impacting this.
02:00And really getting hyperspecific and documenting how long, when it happens, you know, exacerbating factors, relieving factors.
02:09If you are data-driven, data is undeniable.
02:13You know, it's inevitable that if you go with data, that cannot be dismissed.
02:16Not that anything should be dismissed, but it really helps your case and also gives a burden of results to a doctor that they have to then look at that, analyze that, and then go down a certain route.
02:31And actually, asking for second opinions, being vocal, again, is not being rude or confrontational.
02:36If, for example, a doctor, a common response may be, oh, it could be stress, it could be anxiety, it could be this.
02:44Yeah, maybe it is in some cases.
02:46You know, the anecdote you told me, a doctor told you to walk more.
02:49That might sound dismissive, and you walked more, and it did help.
02:51So, yeah, in some cases, it may be psychological, but we shouldn't psychologize everything.
02:57So, a reframe could be, I appreciate that my symptoms could be related to stress, but I also wanted to explore other physical symptoms.
03:05What are some potential diagnoses that you're looking at, or what could certain blood tests reflect, or what are certain blood tests we could do to see if, you know, this can be ruled in or ruled out?
03:16What do you think about the utility of these scans?
03:19Can I get a referral to this specialist?
03:22What do you think about that?
03:23If they refuse that, you can ask, could you just maybe document that in my record that I have requested this referral?
03:30All of those things are not confrontational.
03:32They're not aggressive.
03:33They're just you advocating for yourself.
03:35At the end of the day, you're just trying to be heard.
03:38You're trying your symptoms to get out there, and if you need to use these reframes, which are very polite and just very matter-of-fact, then so be it.
03:46And, you know, there's a list of things that you could do, and these are the...
03:50When you come to the table with certain specific things, it triggers the doctor to go down a certain algorithm.
03:57And I can say this as being on both sides, being an advocate for my own health and family's health and being a doctor as well.
04:03If I say to a doctor, I've been experiencing this for six weeks every single day, that's going to trigger a different algorithm in my head as a doctor than if I said six days, for example, or didn't give a numerical value.
04:17Because is that acute?
04:18Is that chronic?
04:19So all of these things matter.
04:20Data matters.
04:21Okay.
04:27So all of these things matter.
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