In this episode, we tackle medical gaslighting with our wonderful guest Dr. Evelyn Mitchell
We’re back! We’re starting the week off strong by diving into something that is way too common for Uterinekind, medical gaslighting. We give you the important details on what it is, what you can do to combat it, and go into an expert interview on how to navigate your uterine health in a field dominated by medical gaslighting with this week’s amazing guest, Dr. Evelyn Mitchell. Dr. Evelyn Mitchell is the OB/GYN of your dreams. Grab a pen and paper for this information-packed chat as we go deeper into the right way to take control of your body and doctor appointments.
(For more about the team at the Dr. Mitchell, the Keck School of Medicine at USC and Verdugo Hills OBGYN, follow them on their Instagram: https://www.instagram.com/usc_verdugohillsobgyn/)
Gather around Uterinekind! Hello Uterus is teaming up with Beauty-Heroes to give back to you. We’re doing weekly giveaways for listeners over at our Instagram page @Uterinekind. This month’s Beauty-Heroes box is valued at $150 of truly clean beauty because you deserve it! Learn how to enter on our IG page and share with your friends!
Lastly, we end on a high note out of the UK! What’s on the 7 o'clock news tonight? Tune in for women’s health! We need this in the US as soon as possible!
Thanks for listening, learning, and being you. And join us back here every Tuesday for all things uterus, in service to you, uterinekind.
Carol:
It's in your head. Well, if you lost 15 pounds, your womb is inhospitable. We're told we're broken white coat, shoulders shrug. If doctors don't know what's wrong with me, maybe it is all in my head. And therein lies the destructive power of medical gas lighting. I'm Carol Johnson, and this is Helo Uterus.
Today we welcome a gynecologist we all wish was our gynecologist, Dr. Evelyn Mitchell. But first, Uterus in the news.
So MyFembree was approved. It feels like you kind of want to cheer because you're like, oh yeah, there's a medicine that's going to help my pain for my endometriosis, so it's going to help my fibroid pain. And then we're like, wait a second, can we focus on maybe funding research into treatments that aren't meds? And it's like, it's really hard. You want to be grateful for the medicine, right? But not if the attention and the money goes only to the medicine and the funding of pharmaceuticals, and it doesn't go to research and development of minimally invasive, technology enabled solutions for the root causes of these chronic conditions. You kind of want to cheer, but then at the same time you're like, I don't know, something about this seems a little sketchy. It's a once a day pill that you can take for a grand total of 24 months because of the side effects. And the safety data, which is only one year out, suggests that if you take it for longer, some of the side effects, like bone brittleness or early onset of osteoporosis, that they would not be reversible after a 24 month period of time. So I would imagine that the people who are going to take this, if they're educated about the side effects, you really got to know about the side effects. Okay, don't blow that off. So if you're educated about the side effects, I don't know how many people are going to be like, yes, I want that. But if you aren't able to function in any other way and there are complications around how your condition can be treated and this is your only option, then yay, I'm happy that you have that option. How much did it cost to develop this my fembri, which is essentially a symptom suppressor from what I can tell, please correct me if I'm wrong. It doesn't reverse any disease, it improves pain and bleeding. So how much did it cost to develop that? And is the same amount of money, time and attention, resources, etc. E put into developing root cause diagnostics and treatment things that get at the root cause rather than medicines that are on the market and doing good work for other conditions. And there's an AHA moment, it's like, wow, this could be good for this condition too. This isn't that a lucky coincidence. Now we can go through the process of getting it approved for this additional indication and we can extend the usage of this drug, right? It just seems like we're putting our attention in the wrong area. So that might be like, a good thing. MyFembree approval. And just watch out, ask a lot of questions and think about things like the fact that med schools don't require med students to master myamectomies and we have this treatment coming out and shouldn't we actually have access to minimally invasive treatments that do, in fact, get at the root cause of the condition rather than medicated symptoms? Okay, I'm going to get off my soapbox now. I am, however, going to learn a little bit about something similar to this. Having just heard about Ricky Lake, you guys probably are familiar with Ricky Lake, actress and talk show host. And now she makes documentaries and she's made some phenomenal documentaries, one of which is called The Business of Birth Control. And I haven't seen it. So it's my Monday movie night documentary. I will report back on this. I'm super curious. And before we roll into our main topic today, as if we needed more evidence of ignorance from elected officials, we've got another shining example. And I just thought I would share it with you because it's kids. Wow. How people get where they are, I just don't know. I walk around all the time working in uterine health thinking like, I'm not a doctor. I don't know enough. I don't go to med school. I can barely understand a study I've learned. I can hold my own a little bit. But then there's people like Dave Alvord, a Salt Lake City Council member, who says fetuses are not part of a mother's body because the umbilical cord and placenta do not connect directly to the woman. I'm going to give you a second just to digest that, just mullet around and think, wow, this is a person who sits on a city council for Salt Lake City and still does not know. I'm going to say he looks to be about 60, which means he's probably about 41 and doesn't yet know that fetuses are in fact connected to a mother's body and that the ubilical cord and placenta are actual organs that the mother's body develops in order to sustain a pregnancy. And you know what, Dave? Dude, you need a little bit of education. And PS, I mean, I got to tell you, we have taken a lot of hits lately. Uterine kind. You're going to now start minimizing our role in the sustaining of a pregnancy. I would like to have some tea with you. Okay. I don't know. I don't think we can take much more. I mean, we can because we're magic, but I don't think that we are going to take much more because you know what? We're done. We're done being gaslit, we're done being minimized, we're done being dismissed. And we're done listening to people like Dave who still doesn't understand the biology of the human system. Wow. I think we need a break. Angel after something like that. So we're going to take a quick break and when we come back, we're going to start to unwind Medical gas lighting.
Angel: Help bring an end to endometriosis by participating in the Rose Study. The study of menstrual blood may hold the key to the y of endo. From there, treatments are born. Participate in the rose study today. Visit Heliotros.com and click on the Rose Study blog for more information. Or simply google Rosetti for endometriosis. It's the first link. Please participate if you can. You could hold the key to the future for all uterine Kind. Thank you. Now, let's get back to the show.
Carol: There's a book out by person named Gary Wolfe called Personal Science learning to Observe. And it teaches you how to be a citizen scientist. And we're going to kick off with that. We're actually going to kind of shrink it down. So you can start being a citizen scientist after you hear this, and you probably are already doing it to some degree. If you can get your hands on this book, which I'm sure your library can get. Personal Science learning to Observe by Gary Wolf. It will inspire you to start to really pay attention to your body for the longest time. And by longest time, I mean until I was about 45 years old, maybe 40, maybe 40, I lived from my neck up. That was it. Maybe my throat up because I was talking on the radio and stuff, so I had to use my vocal cords. But essentially I lived from my throat up and I really didn't have a clue what was going on. For my shoulders down, I didn't have a clue. And I think that held me back in numerous ways, but it definitely held me back in the doctor's office, especially the gynecologist's office, because I wasn't connecting the dots on how my body was feeling. I wasn't paying attention to it, and I didn't even really know what to imagine in my body. And that was the first time around the age of 40, when I started to really, in a focused way, I started to meditate. And I remember listening to some training on meditation and they would say, okay, now go in and scan your body. And I'm, like, scan my body. Can I not do that? Can I skip that part? But what I ultimately learned was that the more I was able to picture my body, the inside of my body, that I would have a better relationship with those organs and with my body in general, that I would just feel stronger. I would feel more sort of in control, kind of tethered to the planet. You always hear people say, look, you got to get grounded, or I'm so grounded, or we need to be grounded. Well, it is a real thing. Like if you're living up in your head and you're not fully embodying your body, then you're not using all the tools that you have in order to navigate any circumstance in life, right, and also enjoy any part of life, right. If you're only in your head, then there's a lot you're not enjoying about life. The little signals and the little clues of which occur in other areas of the body. So learning to observe means remaining present, knowing your anatomy, paying attention to how you feel. And then when we move into a more clinical use of personal science, it's observing your symptoms and charting them, like really getting a handle on exactly what your symptoms are in a variety of categories and then charting them so that you can connect the dots, so that you can see how one symptom might impact another or be impacted by other symptoms. And we're going to hear later today in a conversation with our guests that connecting those dots. That is like one of the biggest gifts that you can give to your physician, because they can't do it for you. They would love to be able to do it for you, but they can't. So it's really important that you be the expert of your own body. And by being the expert of your own body, what you're doing is you are aggregating knowledge, you're aggregating data, you're bringing knowledge and data together. It is your data. You've observed it, you've charted it, meaning you've written it down, or you have somehow captured this information and you've had the chance to sit with that before you go into a doctor's appointment. And that's going to make you an expert of your body. And by going in to a doctor's appointment, having done that, having become the personal scientist of your own body, you will be more confident. And that's going to show it's going to be perceptible, especially to a person who's supposed to be trained to take cues from your whole being, right, as to your wellness. So you come in confident because you have the knowledge, you have the understanding of your body, you know what your symptoms are, you know how they're impacting you, and then you're able to direct the physician and direct the path for that consultation. So super important and a really, really good bit of learning advice that we can get from Gary Wolf. If you can get the book, awesome. But if you can't get the book, just keep saying to yourself, I want to be the scientist of my body. I want to be the one who has done the research on myself, who understands me more than anybody else. And I promise you that that is going to help you in your quest to get relief from any kind of health condition that you're dealing with. But it's also going to help you just in life. So the one way that it is going to help you again in medicine or in life is to spot medical gas lighting, which can be so subtle medical gaslighting and gaslighting in general can be super subtle. So as an intro to our conversation with Dr. Mitchell, our guest today, who's going to talk to us about medical gaslighting, let's just take a little top level look at it. It is so damaging. I shared with you before the one time a doctor asked me how my celiac was diagnosed. And from that point forward, I have, like, not wanted to go to a general medical physician. And it's been like, six years. I'll only go to a gynecologist. I don't want to go back. It's like, are you kidding me? I worked my tail off to figure this out, and then I'm going to get shamed for it. It is subtle, damaging. So you need to know what to look out for. And then here is the reason why I'm telling you this. You have permission to call it out and then to get up and walk out. And it can just be done very calmly and very matter of fact. I don't participate in gas lighting. I don't do that. I'm here because I'm experiencing a health condition, and I'm trying to get to the root cause of it so that I can understand the best treatment options for me, so that I can get well. But I'm not here to be gasoline or to not be listened to, in other words, and to have my symptoms dismissed and my experience dismissed. I'm not here for that. So if that's something that's important for you, then I should probably go and free you up. That's kind of how I would do it now, because all of your experiences inside my being and I want to kind of speak on all of your behalf. So it comes out more forceful than you probably might do in your own doctor's office. But, hey, if that's your personality, go for it. Put them in their place. It's not okay. What might this medical gas lighting look like? Your provider continuously interrupts you or doesn't allow you to elaborate, which is a real big problem when you consider that the knowledge that you have about your experience, that's literally the evidence and the doctor is the detective. Well, without any evidence, the doctor can't be a detective. There's no condition to diagnose, right? So you got to bring the evidence, and the doctor has to listen to it. They can't shut you up at that point by saying it's totally normal. I see this all the time. Doctor, I appreciate that you have seen patients that have similar experiences to mine, but it's very important to me that you hear my experience because I believe that there are some clues to what I am suffering with in my telling of this story. So let me tell you my story, and then together we can figure out what is evidence in there that can help you diagnose my condition. If they're not willing to listen to that, then you got to go, because that's a doctor who is not going to be the one that you want to partner with to get well. Other ways that you can spot medical gaslighting, they minimize your symptoms. An example of that might be period pain. They might say. Like. We heard a prior guest. Aria Vias. Discuss the bell curve. The infamous bell curve that made my head want to explode. Where her doctor. After she had gone to do a ton of research about endometriosis and was certain that she had something that was way outside of a regular period. Her doctor drew the bell curve and said. Well. Arya. Most people's periods are here and yours just happens to be here. Yeah. So what you want to make sure of is that they are not questioning your pain, your description of your bleeding, any of that, and normalizing it, because it's not normal. We know that now. We know it. Not everybody has heard this, but we know definitively that no amount of pain is normal for a period. You might have some discomfort a day or two before your period, the first day of your period, as your uterus is contracting to expel the endometrium, but period pain, no, there is no level that's okay. So if they question that, then you know that you're in a situation where you're being gasolt. Also, if they refuse to discuss your symptoms, that's where you get up, you say thank you. You don't even have to say thank you. Actually, I'm going to give you permission to not say thank you. You can get up and say, this consultation is not meeting my expectations. And quite honestly, I'm finding that I feel worse now than I did when I got here, and that's not the outcome I was looking for. And you go other things to look out for, not ordering any imaging or lab work to rule out or confirm a diagnosis and having your symptoms blamed on mental illness, especially if you're not given a referral or any screening for mental illness. It's fascinating that you see this all the time. It's like, are you seeing a therapist? Maybe you might have some issues there that could be contributing to the anxiety. Oh, really? You think it might be that? How about just a slight adjustment on that? Okay, we're going to look at it this way. The pain that I am feeling several days a month, the migraines that I have, the heavy bleeding with the passing of large clots and the inability to get out of bed five days a month, that is what's creating my anxiety, because it's making me feel like there's something wrong with me. But everyone else, you included, keeps telling me that there's nothing wrong. Right? We got to unwind it. It's so easy to fall for it. We're kind of conditioned in all aspects of life to just accept what I didn't know was gaslighting until ten years ago. I just thought that I didn't know a lot yeah. Well, at a certain point in time, somebody flips a switch in your world, and you realize, whoa, I'm not supposed to be treated like that. It's not normal, what I'm experiencing, even if five people with multiple degrees tell me it is. So medical gaslighting is real. Gas lighting in general, obviously real. And the thing about medical gaslighting, stating the obvious here, that's really bad is that your health and your mental health, your physical health and your mental health suffer. As a matter of fact, it can actually bleed over into a wide variety of sufferings. Your relationship could suffer as a result of medical gaslighting, right? So you go to a doctor. You know what your experience is? It's hell. You live in hell, right? You go to the doctor, and you're like, here's my experience. I live in hell. And they're like, oh, no, actually, you live on Elm Street, and it's totally normal. Then you go home to your partner, and you're like, I live in hell, and the doctor told me, I live on Elm Street. And your partner says, well, you should listen to your doctor. They know what's up. So you should feel relieved, right? They said that everything is okay. You should feel relieved. That is a nightmare scenario. A nightmare scenario that happens all the time. So my point in saying that is that medical gaslighting is, like any gas lighting, super destructive, and there's no boundaries to how it impacts you. It can be so destructive to your selfesteem, to the will, that you have to get better. It's bad, which is why I am so delighted. It's, like, amazing to say the word delighted after saying all that stuff. It's like a swinging pendulum. But I'm so delighted to have Dr. Evelyn Mitchell on, who I believe is our future. It is doctors like Dr. Mitchell that are the future of women and LGBTQ plus healthcare in this country and really around the world, because the world is getting smaller, and we're all starting to share our stories and starting to realize the good that's happening and the bad that's happening. And voices like Dr. Mitchell's are voices that we have to amplify. And I'm so grateful to bring her on this show because I also think that for me, it's my way of being able to take Dr. Mitchell, who's in Los Angeles and treats a patient population largely in Los Angeles, but I'm sure people travel to her as well. It's a way for us to bring a little bit of Dr. Mitchell into your world, and then you can take it to your community and talk to your friends and say, hey, you got to listen to how she describes the way we should be treated and to the things that we should expect and make change in our own community. Really good talk. Upcoming, we're going to take a quick break, and when we come back, we'll introduce you to Dr. Mitchell
Carol: Our guest this week echoes Gary Wolfe teachings in comments in a New York Times article, Feeling Dismissed How to Spot Medical Gaslighting and what to Do About It, published last week on July 29. Her name is Dr. Evelyn Mitchell. She's no b GYN with Keck Medicine of USC. And the Director of Diversity, Equity and Inclusion of Obstetrics and Gynecology at the Keck School of Medicine of USC. In that short description, Dr. Mitchell, as you are on call right now in between something and a possible C section, I just have to say that that sounds like five jobs, and you made time for us on a Sunday. So thank you for being here, and thank you just for being no, Carol, thank you for having this amazing podcast for patients to know how to advocate for themselves. And I hope we have a really good conversation today. Yeah, I love the little angel chimes that we just got there, because that means that what we're doing is really on point and necessary. Exactly. Yeah. So grateful for the attention that articles like the one that you were quoted in in The New York Times brings to issues like gaslighting. Would you share with us your opinion on the impact of provider bias and systemic racism in uterine healthcare?
Dr. Mitchell: For sure. So this is actually one of my passions. I've always been very interested in not only medicine and how to diagnose and treat conditions, but equally important, what is the patient experience? What our patients experiencing, and how can we optimize that? And so a lot of my research and a lot of my teaching and lectures are based on specifically implicit bias and how that impacts providers decision making, how that impacts patient healthcare disparities. Because as we're starting to see and I'll use an example of the unfortunate increased maternal morbidity mortality crisis that we're experiencing now in United States. As we all know, African American patients, american Indian, Alaskan Native patients are experiencing death during childbirth two to three times higher than, let's say, white patients. And a lot of our studies are showing in the past, oh, it's because of access to care, it's because of insurance, it's because of comorbidities. These patients are just more sick than others. Right. But now our studies are really starting to control all of these factors, and we still see these disparities. So there's something else happening. And among those things, we have to take into consideration systemic racism. We have to take into consideration on individual level provider bias. And how is that impacting disparities that we're seeing? They most definitely are in a lot of ways. And so a lot of teaching that I do at USC is focused on teaching providers about their bias and how we can mitigate that during our patient encounters.
Carol: How is that received? When you say teaching, are you talking about at the student level, or do you get to train old dogs, new tricks?
Dr. Mitchell: If I could speak. So old dogs new tricks. So how does that roll? Right? It rolls good sometimes and then sometimes. So I actually have a really nice privilege to be able to teach not only medical students and residents, but also faculty and staff. And so I am an implicit bias trainer for USC through a very nice organization. Gems gender Equity in Medicine and Science. And essentially we go around different departments around USC and we teach about Implicit Bias, we teach about microaggressions and essentially how to eliminate this in the workplace, not only for our patients, but for colleague interactions as well. And so I will say most of the time this is received very well. We've had tons of interest. It's a very high demand for myself and my partner that we do these trainings. But always we are teaching on a very controversial topic, right? This is essentially coming in and saying there are some things that we are not doing okay as doctors and we need to acknowledge that. And most providers take that well and are open, but unfortunately there are some providers who don't believe that this is a contributing factor. And we have to work through that, through a lot of literature, a lot of evidencebased, medicine, and also through patient experiences and stories. I think stories are powerful and numbers and statistics are great, but behind those numbers are real patient stories. And you just can't negate that. You can't overlook that. And I love to bring in patient stories and provider stories, my own stories, so that we can really see what is the reality here, what are people experiencing and how do we make this better? And I also bring in stories of how bias has impacted me as a physician, I'm not perfect. And even as an Implicit Bias trainer, we all have biases and we all have to constantly acknowledge that on a daily basis. And so even providing vulnerability myself and explaining some instances where I've seen bias and witness bias and myself perform bias and how that impacted patients, it's all a part of our lectures. And so it's really nice to go in and teach doctors how to do this better.
Carol: Yeah. How do you manage what internally for you when you look at this issue? Must seem like a giant mountain that you have to scale with no tools, even though you have tools. Just the idea that we're going to try to within gynecology change something that has been baked in. How do you keep yourself kind of focused on the task and know that you're going to make an impact even though you're one person?
Dr. Mitchell: Right, one person. Actually, we have all of our babies and here in our office, all of our babies and our families, that we're so blessed to be a part of their journey. And we have them here. And I have a message here that says stay strong. This is why we are all here. And so we constantly honestly, our patients keep us going here in our office. Unfortunately, we encounter patients every day who have traveled very long ways, have seen multiple doctors and come to us with their concerns and these concerns, unfortunately, that have been dismissed. Oh, I have pain. I've had pain for most of my life and I've just always been told, this is normal. We actually do the work up and it's actually not normal. Right. And so we have patients coming in all the time with these unfortunate stories about traumatic experiences that they've had with OBGYN and the pelvic exam and getting dismissed. And a lot of our patients are just grateful that we listen to them. We're always so surprised with this because that's our job, right? That's what we're supposed to do. But unfortunately, that's not happening everywhere. So our patients keep us going 100%. Yeah. And that's a great reminder to go that route of having posted in front of you just to keep you reminded of the sort of heart centered reason why you're doing something. It is a good daily lift up to see those notes.
Carol: And I love it that you even somebody who's been through the education and the training and obviously you have a multitude of responsibilities, you still rely on those little posted notes on your computer.
Dr. Mitchell: Oh, totally. I still rely on my patients who write letters to us and send us pictures of their babies or send us thank you notes after their surgeries. I have an email folder that's like, you go, girl. And when you're down, you go through that because I think it's really important to have self grace and lift yourself up because this is really hard to do. And we really celebrate the small successes too, if we are able to teach a doctor or teach a student one thing that day, let's count that. Let's be happy about that and proud of that and just take it a step at a time, honestly.
Carol: Yeah, it's important to acknowledge the little wins. So let's give patients some opportunity here too, because not everybody can have you as their gynecologist. It would be a gift if that were the case, but I know that you can impart some wisdom and help have an impact on their experience. So let's take a typical patient who's been told that horrible periods are normal, but the pain keeps getting worse and their life is upended and nobody is listening. And they've been through the birth control pills route and the pain meds route, but they're going to press on because they need relief and they book another appointment with a gynecologist. How do they establish upfront in a way that ends gaslighting before it starts, that they want a definitive diagnosis, for sure.
Dr. Mitchell: This is why I think research and this is why I think the internet and social media is just so important when we think about medical decision making. So as a patient, It's really important, number one, to acknowledge that you have a lot of power. You have the power in this situation, right? And it's really important for you to do your research do your research on which OB GYN is going to fit me right from the beginning. And so, you know, with social media, with whether you take an academic institution or faculty profiles or on the website, you want to do your research and understand, why am I picking this doctor? Right? Is it based on insurance access? Is it based on location? Is it based on my friend went to them and had a great experience. What are your pros and cons with seeing this doctor? It's really important that you have a good understanding of where your doctor trained, what is their background, what are their passions and their research that they're interested in, right? So if you see a doctor that is very interested in diversity, equity, and inclusion, and they are very passionate about pelvic pain, for example, right. You know that they're already going to be sensitive to the symptoms that you're bringing in. Right? And I will always echo this to patients. It's a myth that every doctor is the same. A doctor is a doctor. They got trained, right? That's absolutely not true. Yes, doctors are trained. Doctors are trained. But every doctor is very unique, right. And every doctor brings in really good things, and some doctors have things that need improvement, and that's okay to acknowledge, right? And that's okay to kind of question something like that interaction didn't really go as planned. It's not your fault. That's something that you have power and right to say and acknowledge. I think it's really important from the beginning you pick the doctor or a couple of doctors, because you may go to one, and you may want a second, a third or fourth opinion, and that's totally fine and warranted in a lot of cases. So I say, number one, do your research on the physicians that you want to go to, first of all.
Carol: Well, your number two is probably what I was going to comment about, the idea that a doctor doesn't come out of a manufacturing facility, and they bring with them their own personality and their own take on things. So was that your number two?
Dr. Mitchell: Exactly. So I would say a lot of people think, oh, doctors are robots, right? We are definitely not robots. We are human beings, just like you are a human being. And with us, we bring in our biases to work. We bring in privileges to work. We bring in our own experiences, whether it be good or bad with the medical system. And so it's really important that you find a physician that you feel can be vulnerable with you, that you feel will pay attention to your needs and be sensitive to a lot of the things that you're discussing. So that's really important to just expect that right. You should have a positive experience when you go to the doctor. You should leave your appointment feeling heard. You should leave with an action plan. Right. That is the baseline expectation that is foundation. And so if you're not leaving with that, then that's when you need to do your research and figure out, okay, I need to find someone that's fit for me. Right?
Carol: Yes. So in using this little hypothetical patient profile. She goes into that doctor. And if that doctor reiterates other advice. Such as birth control pills and wait and watch. And this is normal. And we'll see how it progresses. What does the healthy communication look like at that point in time coming from this position of the patient has power. But we don't really know that we have that power.
Dr. Mitchell: No, not at all. Right. So the next thing you want to do is when you pick a position that you feel is going to fit you the best, you want to come to the appointment prepared. So you want to make sure that you have a very nice journal documenting what exactly you're feeling. 90% of our diagnosis will come from your history, your story. So your story is really going to be very important for us to figure out what test am I going to order, what's on my differential, what ultimately our treatment options. Right. Your story is everything, and so it's really important that you come in. If you have pain, where is your pain? When does it occur? What does the pain feel like? Specifically? Is it sharp, stabbing, crampy? Comes and goes, constant? How bad is the pain? Have you noticed any triggers? Right. Have you noticed anything that makes it better? There's a lot in your story that is going to be really important. So it's really important for patients to keep a journal of exactly every symptom and a lot of good descriptors for those symptoms. So that's key number one. The second thing is you want to come in, and we have to be very realistic. Doctors may have 20 minutes for an appointment. They may book a new patient for 40 minutes. So you have limited time. It's really important that you pick one thing that you really want to focus on that appointment. Right. I will be honest and say if a patient comes in and bombarded with ten different complaints right. That's hard to really figure that out in 20-40 minutes. Increments. Especially when you want to do your best to make a relationship with that patient right. To make sure that they trust you. Right. So it's a lot of getting to know each other before diving into right. So come to your appointment with today. I'm experiencing these things today. My main priority is bleeding. I want to talk about my bleeding today. I want to zone in on that. That helps the doctor really zone in, puts a little pressure off right. And really allows them to focus 100% on that one symptom. That's really important to do. And then at your next appointment, for sure, next appointment, I want to talk about my pain next time, right? And then maybe at the next one, I want to figure out how do we put all this together and go over all my options, right? So it's really important to focus on one thing during one appointment at a time. That'll be really helpful. The other thing, come to your appointment with questions. There's so much on social media. There's so much on the Internet now. I will say the Internet can be really good for a lot of different conditions. You can read what other patients have experienced. You can read what are signs and symptoms, some common diagnostic testing. So the Internet can be really good information. The Internet can also be really bad information. Right. And so it's really important that you do your research and you come with questions. No question is a bad question. No question is a dumb question. So come with your list of questions, and if you don't have any, you do have one. You say, if you are me, what would you ask? If you are sitting here in my position, what would you ask right now? If that's the only question you ask, that's amazing. That would be fine.
Carol: Okay. Yeah. Great way to start to put them in your shoes. If they're not if they haven't already stepped into your shoes. Exactly. For whatever reason. Maybe they just came out of a horrible appointment. Or who knows? We all, as you said before, we're all human, right? So help them get into your shoes and then take that insight.
Dr. Mitchell: Exactly. Now, a lot of things that you want, you want to leave your appointment with an action plan. So you definitely want to ask your doctor what is on your differential? What do you think may be happening to me right now? And that could be one condition. Ideally, it would be two or three, just so that you know that they're thinking about other possibilities, right? So you always want to ask, what is on the differential right now? My bleeding, could it be due to fibroids? Could it be due to polyps? Could it be due to hormonal imbalances? What are all the possibilities that could be going on? Secondly, how are we going to figure this out? So what are some labs, what are some imaging that we're going to do to try to figure out what it is and what it's not? And then third, you really want to dive into treatment options. And I always think about it this way. You want to talk to your doctor about three main categories of treatment options. Number one, expectant, if I didn't want to do anything, what does that look like? What implications may that have for me in the future? So I don't want medication. I don't want surgery. I just want to proceed with observation. What does that look like? Because that's always an option. Always an option. And for some conditions, that may be warranted. Number two, what are my medical options? What are all of my medical options besides birth control pills? There's literally nine different things that we can do for a patient depending on what the patient is interested in. So you want to talk about all the medical options that are in the toolbox. Number three, what are my surgical options? And that includes major surgery, and that also includes minor, minimally invasive surgery. So those three topics, expectant medical, surgical. Those pretty much cover majority of the treatment options that a doctor should be discussing with you, depending on what condition was diagnosed.
Carol: I love how you put that. As I sit and listen to those words, the feeling that I got was that the patient is talking to the doctor in regular language. It's nothing super technical, but there were some keywords in there that you used that, to me, kind of put the doctor and the patient on the same level. It's kind of like when we're at work and we're in our area of expertise and we're talking to a colleague or we're talking to a boss about something, we're using a shared language that evens the playing field, and that's the way that you just spoke. So I hope everybody puts that on repeat and jots down notes and just plagiarized that language. It's like the one time when plagiarizing is good.
Dr. Mitchell: Oh, use all of it. And that's ultimately what this is. We want to establish shared decision making. I always tell my patients, you are the expert of your body. I happen to go to med school and know how to treat things. Let's work together and we can figure out what works best for you. That's the bottom line. Because otherwise you're in the dark.
Carol: Yes. That's kind of an interesting set up where both parties get left unsatisfied if the patient isn't able to communicate the experience in a detailed fashion. And the physician isn't really interested in listening to that detailed experience because they've heard it all before. Right. This is the 50th person this week that I've seen that's just telling me. And so then I feel like we end up in that never ending cycle of birth control pills. I know we want to make sure that whoever needs the C section can get it. So I'm going to rip through these questions just like from a patient's perspective. When we hear birth control pills, birth control pills. Birth control pills, we're hearing that in the context of this is where we're going to start, and we'll see how your symptoms respond to this, and then we can adjust from there. Right. And then I also hear maybe a lot of patients don't hear this, but I also hear we don't know enough about conditions like endo or fibroids. And we know that they're hormonally affected, but we don't know in what way. So if that's all accurate that I just said, then why is it that people prescribe birth control pills before actually definitively diagnosing a condition?
Dr. Mitchell: Birth control pills are easy. You prescribe it, you start taking it, you can stop them the next day. If you don't like it, you can keep going. They're not harmful. For most patients, it's an easy quick fix, honestly. So essentially, birth control will inhibit ovulation. It will inhibit the delivery of hormones from the brain to the ovaries. It basically puts things on pause. Let's put things on pause. Now, ideally, you would like to consider all of the options because there are other ways to do that besides birth control pills. There's the patch. manuvering depot shot. IUD next one on. There are so many things we can do right. Time constraints may prevent a provider from explaining all of those options. There's a lot of different reasons, but ideally, patients should be talked about all these options to figure out, okay, pills is one way, but what about these other options? What do you think about these? Right? Ideally, you would want to start treatment after we figure out what's happening. So after we do your lapse, after we do your ultrasound, after we do biopsies, and let's talk let's put all of this information together and let's talk about the treatment options. In general, birth control pills will cover a lot of the conditions that are responsible for things like pain and bleeding. So it's a quick fix. Some providers can get lazy and just depend on that, fixing things without really diving in and figuring out, yeah, it may work, but is this the ultimate long term solution for this patient that needs more exploration?
Carol: Yeah. So the quick fix, do you think that sometimes that physician is doing that because it is the only treatment that they personally can offer that patient? And I guess what I'm getting at is kind of what you alluded to before. Not all doctors do all things right.
Dr. Mitchell: Some providers may not place IUDs. Some providers don't have IUDs available to place. You have to get trained to place an excellent on, which is the implant and the arm. Some providers, some OBGYN don't even do surgery. So a lot of them can you say that again? Can you say that again? Because I think really, people really need to hear this 50 times. OBGYN, not all OBGYNs do surgery a lot. Unfortunately, a lot of OBS are being pushed into doing just OB practice. All you do is deliver babies. So the gym side is getting pushed to the side. And that's why we're getting a lot of the new fellowships, minimally invasive surgery. Those are for OB GYN to go and get extra fellowship trained on GYN surgery. I'm lucky in my practice, where we do a lot of gym surgery. We do ovarian cyst removals, hysterectomies, hysteroscopies. We do it all right. But that's also because we're part of an academic center where we also do those procedures and teach the procedures to residents and medical students. So we're constantly, whether we're teaching or doing, we're constantly in the or a lot. That is not happening in a lot of practices. And so if you're not in the or. You're not practicing your skill, that skill kind of goes on the wayside you're not comfortable doing hysterectomy. Some Obins are only doing one or two hysterectomies a year. That's not enough to keep up your skills. Right. So if you're not comfortable doing it yeah. You wouldn't even talk about it to patients sometimes.
Carol: right. It's not a hit on doctors because I don't know how one doctor could do as much as an OBGYN does. It's ridiculous. I mean, it's like everything they are asked to do everything. And now you have to consult attorneys and you have to have like a bail bondsman on standby. And the whole thing is just really intense in med school. Is it accurate that physicians that you can graduate and open a practice without being taught how to do a myoactomy? Which, Amyctomy, for those listening, is the removal of fibroids. So we know that that's a very common condition, especially for black women. It is not only common, but it's really debilitating. Is that true? That they don't have to know how to do it?
Dr. Mitchell: So I'm also assistant residency program director for our department, so that's job number six. But with that being said, I will also say that every residency program is different, too, in terms of what the residents are exposed to, specifically in terms of gyne surgery. Myctomies are not technically required for a resident to graduate. That is not a part of the numbers that we have to see minimal numbers to graduate. It is not hysterectomies are, hysteroscopies are, even abortions are, but my macromes technically are not. That being said, though, it is up to the department that we're passionate that every resident should know how to do a mimeectomy. Every resident should be very good at doing mimectomy. Right. And so depending on the program that you're in, we will push that. Right. Even though it's not required, you are still going to do a lot of my mechanisms because you need to know how to do that. When you go to private practice. That needs to be a part of your skill set. Is every program like that? I can't comment. So it is variable. It is variable, yeah.
Carol: I think that's one thing that actually kind of in closing my Holy Grail question, is it ludicrous to hope for the day when gynecologic care in the US. Is standardized? So that what I experience is what another person experiences. In that way, we can not only have better care, but we can also get to a point where the data is more reliable.
Dr. Mitchell: And that's the hard part. Women have consistently been disregarded in the medical system. Right. Research is definitely we are not priority in terms of research, research funding, research involvement. And those numbers go even lower. And we talk about women of color, women who belong to LGBTQ plus population, elderly women. You're not being researched. Your conditions are not priority, unfortunately, compared to other medical conditions. And that's why our data is limited. And that's a huge disparity and bridge that we need to fix. And that will come with time. But I think in the meantime, yeah, standardization would be great. When will that happen? We are still waiting. But in the meantime, I think it's important that patients are very vocal about what they're experiencing because a lot of patients come in and they think that their prior treatment and their prior experience was normal, and it's not. That's not normal and that shouldn't be happening. And that's why the final words in the article was, doctors need to be held accountable. That's a very bold statement that I made, but it's true. Doctors do need to be held accountable. We need to be very intentional about knowing the disparities that are present and eliminating them. We have to be very intentional about that. And hopefully the numbers will get better. It will take time. It will take a lot of training. A lot of older doctors have no idea what bias is. They don't have never heard what a microaggression is. What is that? Is that like a new minimally invasive treatment? Yeah. No, actually, it's majorly invasive. Right. And if you just stopped doing it, we'd be really happy. Right? And so a lot of this is we are literally reteaching doctors how to teach. And I'm so appreciative of the generation below me because they're so innovative. The students are coming in just unapologetic, like they know this is happening, this isn't right. We need to fix it. And they are very vocal. And so they're pushing doctors like me, older doctors than me, to do better. And I love that because that's not really typical in the medical field. You have to understand that medical training is unfortunately very toxic. You don't question your attendings. You don't question the doctor. The doctor knows it all. Is this very bad power dynamic in the medical system that we need to ultimately change? That will take time. But hopefully through podcasts like this, hopefully through patients being very vocal about their experiences and demanding for change. Right? And then on the flip side, doctors being open to that and being very intentional about making sure that their patients are treated with the highest equitable care. Right. Putting those two together, I think we will get there one day. And I'm positive in that. I am. I see changes all the time, and I love what I'm seeing. I love hearing patients have good experiences with us. I love to hear that. And I love for them to bring their friends so their friends can have positive experiences, right. And ultimately, through teaching, we will hopefully expand that to be all of the United States. But we shall see.
Carol: And that's why it's so great that you take the time to come on shows like ours and to make sure that what you know and see in your daily work is getting broadcast. Because otherwise patients and people, they won't know that it's okay to speak up. They won't know that their experience is abusive. And that's how you're absolutely right. Yeah. And that's how change doesn't happen. Right. It's like, oh, my gosh, if they all started talking, what the hell would we do? And that's what we're going to do. We're going to make it so that they can all start talking and we'll channel this information to the places that need to hear it. It has to change.
Dr. Mitchell: You're absolutely right. And I also want to make a plug. I am a doctor myself. I have privilege within that and I acknowledge that. I also want to make a plug to really take care and be very appreciative to your good doctors that are out there because unfortunately, there's a lot of doctor abuse that's occurring, right. Patients coming in. I've had a lot of patients refused to shake my hand because of what I look like. I've had patients refuse that I am the doctor, that I refuse that I'm the surgeon. I've had a lot of bad toxic macros discriminatory action based because ultimately we want doctors to represent the patient population. And that means that we are going to start to see doctors that are from underrepresented groups. Right. And that is our goal. With that being said, a lot of patients are very surprised that a woman, not only a woman, a woman of color is walking in and is a physician. And unfortunately, that comes with a lot of mistreatment on the physician side, too. So I do want to bring that up, that patients, unfortunately are experiencing these treatments, but also some physicians too. So on both sides, I hope that we both can respect each other and work together ultimately to make this all better for everyone. So I just wanted to make that plug too, because unfortunately that is happening too often, especially in COVID. COVID has resulted in a huge burnout for a lot of doctors and is not an excuse. It's definitely not. But hopefully I can send that message to the patients.
Carol: Yeah, it's an important one to have. And it's like the same symptom that we can see repeating in a variety of problematic areas. And it's the fact that we haven't taken the time to understand what it's like for the other person.
Dr. Mitchell: Right. Empathy. That's it. That is the word, empathy. Right?
Carol: Yeah. Just taking a moment to recognize that we're individuals and that first we're human. Right. First we're human. And also, I want to give a plug to the fact that the vast majority of everybody on this planet wants to do an excellent job at whatever they're showing up to do that day. 100%. We focus on in conversations like this, we focus on the things that have to be repaired. So we focus on a problem solution kind of conversation and it can be overwhelming, right? But this talk with you today, personally, I'm inspired because I know that the more stories that I bring out that are from people that are experiencing some aspect of uterine or uterine adjacent healthcare, these stories coming out will help spotlight problems and opportunities and epiphanies and it'll connect people. And I know that there's a person who's living in a state where they can't access you as a doctor, but your words will help inspire them to take more control over some aspect of their care plan. So we can do that. We can broadcast the good stories and we can focus on the problems and opportunities and just respect each other.
Dr. Mitchell: Love it. I love that 100%. And that's the bottom line, right? Seeing the world through each other's lenses and working together. So I'm so appreciative for this podcast. It's amazing.
Carol: Thank you. I wish we could clone you, but we're not going to do that. That's creepy. But I hope that you will come back at some point because I know you have more to offer and I'm just really glad that you are at tech and that you're doing what you're doing because it is crucial work that we need that is not just going to impact the way healthcare is experienced by people, but it impacts the way we actually experience life. We learn from these conversations specific to healthcare, but then we apply this information to other aspects of our life and just become more feeling beings, which is really awesome. So thank you so much, Dr. Mitchell. I am so glad that she agreed to come back on. That was a lot of actionable information that you can take and use and that you can just absorb. I think the thing that was really first of all, Dr. Mitchell's refreshing honesty, can we please just have a standing ovation for that? And also, how does somebody do six jobs like that? I want to know because just one job and I'm like, wow, I can't really get it all done. And then somebody like that shows up and you're just like, whoa, how many people are you? Just amazing. So amazing and so grateful that she's out there because we have hope. I'm really grateful that Dr. Mitchell agreed to come back on. I will not forget that. We're going to take her up on that and we're going to get to learn more from her. And also we're going to continue to bring people like Dr. Mitchell onto hello uterus, because we all benefit from listening to them and their stories, just like we benefit from listening to patient stories. That's super important too. So just really good all the way around and that is a perfect way to take a quick break before we end on a high note.
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Carol:
This is so cool. I'm going to laugh again because every time I do an ending on a high note and I go to start this segment and I'm like, this is so cool, then I immediately think of like, oh, but I'm going to have to say this, this is so cool. But the one bummer is we can't watch it in the United States yet, but we're going to figure out a way to make it happen. We are. We're calling Channel Five and we're going to I don't know, maybe we can have a watch party across the pond or something. Channel Five in the United Kingdom has done what we need and what we haven't isn't yet done in the United States. But we must do this. They took over Primus time, 07:00 p.m.. Their time, four nights of television on Channel Five major network in the UK for a special called Women's Health breaking the Taboos. And the way that they kicked it off is equally as impressive. They got the Metro to devote the front page of the newspaper to the fact that this documentary was being aired. So the Metro front page in the UK was all about this documentary. And then four nights in a row, the country gets bombarded with information that it needs to hear, needs to hear, must know stuff. It's already showing that it's made a positive impact. The channel is Geofenced, I think they call it, in the United States. We can't watch it. We're going to see if we can get some if we can do like a watch party, like a secret sessions in the US, we'll see if we can find somebody maybe to take the tapes. No, we're not going to commit any crimes. We're just going to beg that we can watch this special. Even if we can't. What I want to impart to you on this ending on a high note is that it's changing. It takes so long, right? When did Amy Schumer write her articles on endometriosis? Years ago. Right? It takes a long time, but it is changing. And as Dr. Mitchell said, these little wins, they're so important. They're just as impactful on a positive note as those little microaggressions are negatively impactful, right? So we know that a little microaggression can really set its claws into you and it can create a deep wound. On the flip side, positive progress, no matter what the country, is really important for our collective health and well being. It shows that we're convincing people to spend money on uterine health conversations and that's a real big move forward, a big show of progress. So yay to Channel Five. Yay to the UK. And here's hoping that we can get our hands on women's health, breaking the taboos and get a look at this documentary. In the meantime, in the blog post at Hello Uterus.com, I'm going to link to a variety of stories that have been written about this so that you can hear from the people that they cover in the documentary and you can learn about these wide variety of conditions that impact Uterine Kind. So, wow, what an episode. Thank you. Thank you to Dr. Mitchell. Thank you to the Keck School of Medicine and to the team there that helped facilitate Dr. Mitchell coming on our show. Thank you for sharing your experience with us, Dr. Mitchell. And thank you, angel, for producing this podcast and making sure that we can get this information out to people so that they can learn more about their bodies and avoid medical gas lighting at all costs. And thank you to the team at Uterine Kind. We're working on an app that is going to make it so easy for you to become a citizen scientist of your own body, for you to track and measure your symptoms. It is just a thrill to be able to build this and we're so excited to bring it to you soon, October. And thank you for listening. Thank you for being here. Thank you for seeking out the podcast. Thank you for sharing it and for telling your friends about it and helping us get the conversation going around these chronic uterine or uterine adjacent conditions that get ignored if we don't talk about them. So your support is really meaningful to us because we know that they need to be talked about. And the more people who listen and share and subscribe to the podcast, it really helps. So please do that. And a reminder that we are giving away a Beauty Heroes Beauty box a week. I don't have a drawing today because we were away last week and we were dark and I wasn't able to get the random drawing done. But we're going to give away four beauty boxes in August and then four again in September. So if you haven't entered, go to Uterinekind.com, share with us your email address. We will not sell it. We will not share it. We will not read it. We're not going to do anything with it. The only thing we're going to do is throw it in a random generator and we're going to randomly pick a person a week, every week, until we run out of people to win a beauty box from Beauty Heroes, which is super luxurious and clean care for your body. So check out Beauty Heroes.com and go to uterinekind.com and share your email with us so you can be entered to win one of our Beauty Heroes curated beauty boxes. That I'm telling you, it's really cool stuff, so definitely do it. And we're talking $150 worth of awesome skincare. But the cool thing is, nothing in it is toxic to you. Nothing. Am I clear? I think I've been clear. And we'll see you next week for another episode of Hello Uterus. So be cool, be well, and have a great week. Bye.
Angel: The Hello Uterus podcast is for informational use only. The content shared here is to not be used to diagnose or treat any medical condition. Please speak with the physician about your health condition and call 911 if it's an emergency. And thank you, Uterine kind for listening.