#015

Unpacking Gender Bias in Healthcare, and How Women Can Overcome It with Author Susan Salenger

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Unpacking Gender Bias in Healthcare, and How Women Can Overcome It with Author Susan Salenger

“Some doctors do respond differently to some women. I'm being careful because truly it's not a generalization. There is gender bias. I mean, it's still out there. There's no question about it.

As soon as women start talking about their feelings, and we all do that, it leads to a psychological diagnosis. There is no question that doctors see what they expect to see and sort of hear what they expect to hear, and that is partly because that's what they do but it's also partly because of how women talk to doctors. We're much more emotive than men are.”

-Susan Salenger, Author

Susan Salenger is the author of Sidelined: How Women Manage & Mismanage Their Health. While acknowledging the existence of gender bias, Susan writes a lot about helping women change this dynamic by showing them how to advocate for themselves, how to get past embarrassment, communication issues, shame and loneliness and proactively changing their approach to the healthcare system so they are less affected by gender bias.

This episode will give you an insider’s view into the latest links between gender and healthcare, gender differences in outcomes, approaches and attitudes towards self-care, second opinions and how women can change their approach to their doctors and the healthcare system.

Unpacking Gender Bias in Healthcare, and How Women Can Overcome It with Author Susan Salenger

Listen to the episode on Apple PodcastsSpotify, Deezer, Podcast Addict, Stitcher, Google Podcasts, Amazon Music, Alexa Flash Briefing, iHeart, Acast or on your favorite podcast platform. You can watch the interview on YouTube here.

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Quotes:

“I did interview women with all kinds of different diseases. What was so interesting to me was that they had several behaviors in common regardless of their particular disease.

The first thing I found, which did not surprise me at all, is that women put themselves last. There was this study done where they gave women a list of five items to prioritize, which would they care for first, and first we care for our children. Second, you'll love this, we care for our pets, then we care for our significant other and elderly family members. Last but not least, we care for ourselves.”

- Susan Salenger, Author

“I really learned was that women hesitate to get second opinions much more often than men do. I thought that was interesting because, really, the chapter in my book on second opinions is perhaps one of the most important chapters because it's so important to get a second opinion.

Women have been taught to play nice. We don't want to be rude, we don't want to hurt the doctor's feelings. All of that goes on, and so we just... I have so many women said to me, "Well, he was the professional. Who am I to question him?"

- Susan Salenger, Author

#015

Unpacking Gender Bias in Healthcare, and How Women Can Overcome It with Author Susan Salenger

Selected Link from the Episode:

Show Notes:

00:00:00 Intro

00:01:56 Sidelined: How Women Manage and Mismanage Their Health

00:02:38 What led Susan to write her book!

00:03:54 How doctors can treat men and women differently

00:05:08 Should you go to a male or female doctor?

00:06:38 Doctor age and gender bias

00:07:55 Book interview methodology and findings

00:10:49 Are women socialized to not challenge healthcare professionals?

00:11:58 Post-treatment regret

00:13:43 Healthcare advertising aimed at women

00:14:27 Anxiety, hesitancy and shame in the doctor’s office

00:17:12 Successful approaches to doctor’s visits – make a list!

00:19:03 Repeat back what you heard and write it down

00:20:58 Susan’s approach to focus groups and interviews

00:22:39 Loneliness and health

00:26:00 Women and clinical trails

00:28:10 Pushing back against a diagnosis of, “it’s all in your head.”

00:30:09 Advice for women in caretaking roles

00:32:25 Stress and healthcare

00:33.04 I manage to use the word “flummoxed.”

00:33:50 Pharmaceutical advertising and payment research

00:35:41 Show wrap

Full Show Transcript:

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Matt Feret (00:02):

Hello, everyone, this is Matt Feret, author of the Prepare for Medicare book series. Welcome to another episode of the Matt Feret show, where I interview insiders and experts to help light a path to a successful retirement.

Come say hello at www.themattferetshow.com for YouTube videos, show links, notes, websites referenced, quotable quotes and the complete show transcript. Thanks in advance for liking, following, subscribing and rating the show. Everywhere, you can listen and watch it. It really does help spread the word.

Gender bias is defined as some sort of intentional or unconscious prejudice that favors one gender over another. Multiple studies have highlighted gender bias in healthcare over the years, essentially how doctors treat women versus men, and the differences in approaches to healthcare and outcomes by gender.

My guest for this episode is author Susan Salenger, who recently published a book entitled Sidelined: How Women Manage & Mismanage Their Health. While acknowledging gender bias, Susan also writes a lot about helping women change this dynamic by showing them how to advocate for themselves, how to get past embarrassment, communication issues, shame and even loneliness, basically proactively changing their approach to the healthcare system so women are less affected by gender bias.

This episode will give you an insider's view into the latest links between gender and healthcare, gender differences in outcomes, approaches and attitudes towards self-care, second opinions, and how women can change their approach to their doctors and the healthcare system. Enjoy.

Susan, welcome to the show.

Susan Salenger (01:48):

Thanks, Matt. I appreciate you having me.

Matt Feret (01:52):

Tell everybody what you do and how long you've been doing it and how you help people.

Susan Salenger (01:56):

Okay, good question. Number one, I'm a writer and I just finished a new book, what was released in April, called Sidelined: How Women Manage & Mismanage Their Health. How long I've been doing that? It took me about 10 years to write, believe it or not. I mean, part-time obviously. Nevertheless, there's a lot of research and I interviewed a lot of women, and it took some time.

The book will help people, especially women, because it will help them navigate the relationship with their doctors and recognize some of the hurdles that, as women, we all have to overcome.

Matt Feret (02:33):

Talk about that a little bit more. Tell me why you decided to write a book about this.

Susan Salenger (02:38):

Well, I had a personal experience, an unfortunate personal experience many years ago where I agreed to some surgery that I knew I didn't need. I won't even bother with the details, but the point is I had the... It was exploratory surgery. I had the surgery. I was right, everything was fine, I didn't need it. I felt very ashamed and angry at myself for not listening to my gut. I really began to wonder. I mean, was I the only idiot in the room or do other women feel this way as well?

I just let it go. Several years later... In fact, many years later, I was taking some classes at college. I had retired and gone back to school and I met some other women who also agreed to surgeries that they didn't need. So then, that really tweaks my interest and I thought what's going on here? How do we, as women, make decisions and why are we all agreeing to stuff that we don't think we need, and why are doctors prescribing stuff that we may or may not need? All those questions occurred to me.

As I said, I interviewed a lot of women and found five or six things that we all had in common, and there were reasons that we agreed to this stuff even though we knew that we didn't need to.

Matt Feret (03:54):

Along the journey, did you find big disparities between the way doctors treated women versus men, or did you find that women were responding differently to doctors than men maybe? What's the difference in gender here?

Susan Salenger (04:13):

The answer to the question is all of the above. Some doctors do respond differently to some women. I'm being careful because truly it's not a generalization. There is gender bias. I mean, it's still out there. There's no question about it.

As soon as women start talking about their feelings, and we all do that and I can get to that later, it leads to a psychological diagnosis. There is no question that doctors see what they expect to see and sort of hear what they expect to hear, and that is partly because that's what they do but it's also partly because of how women talk to doctors. We're much more motive than men are.

As a man, when you go to the doctor, I assume you're pretty succinct. You tell him the facts and tell him or her what your symptoms are.

Matt Feret (05:06):

Just the facts, ma'am. Yeah, just the facts.

Susan Salenger (05:08):

Yeah, just the fact. Yeah. No, I am not that way, and maybe you can tell that already. When somebody says to me how are you, I want to know, well, how much time do you have? Because I spill out the whole story, and that can lead the doctor, not because of his or her fault, it just leads him down the wrong path. Sometimes the emotional symptoms or my feelings can take over my physical symptoms, which are why I went there in the first place. So, we have to be a little more focused when we talk to the doctor. That answers part of your question.

Also, men and women doctors do have different diagnostic styles or professional styles. A male doctor, like you, they're more business oriented. The visit is shorter than it is to a woman. A woman doctor is much more interested in building a relationship.

In fact, one of my favorite questions that I'm asked all the time is should I go to a man or a woman doctor? The answer is it doesn't matter. It depends on what you want. Because if you were on your lunch hour and you want to get in and get out, go to a male doctor. If you want to build a relationship, go to a female doctor. You want to pick the style that fits with your particular lifestyle and, of course, you want somebody that's competent. That's the main thing. There's lemons in every profession, so be careful. But now that I've said that, it really doesn't matter.

Matt Feret (06:38):

Do you see an age difference there with the male doctors and ages and female doctors and ages, or is this just what comes out of med school and what comes out of, I guess, the different approaches to medicine by gender?

Susan Salenger (06:53):

You know, I don't really know the answer to that. I think younger doctors have less gender bias. I did do a little bit of research, they have less gender bias than some of the older doctors.

I don't know about age bias. I mean, I'm going to be 80 next month. Well, I ran into it once. This is funny. I went to... It was not so funny. I went to my internist for a regular checkup and I brought him my book. I said, "Here," I said brightly, "I brought you a book I wrote." He looked at me and he looks at the book. "Well, when did you do this?" I mean, as if I had done it back in 1939 or something. I said, "Excuse me, I just finished it. It's brand new." He was startled. You know, that's the first time I've ever felt my age.

Matt Feret (07:45):

Yeah. No, that's-

Susan Salenger (07:46):

Now, can I have my book back, please?

Matt Feret (07:49):

I'm going to leave five in the lobby, but you can't have one. Is that what you told him?

Susan Salenger (07:52):

Exactly. Exactly.

Matt Feret (07:55):

All right, let's go into this a little bit more. You interviewed a lot of women for this book. What were some of the commonalities you already touched on earlier in our talk?

Susan Salenger (08:04):

Oh, I'd love to talk about that because what was so interesting is I did interview women with all kinds of different diseases. What was so interesting to me was that they had several behaviors in common regardless of their particular disease.

The first thing I found, which did not surprise me at all, is that women put themselves last. There was this study done where they gave women a list of five items to prioritize, which would they care for first, and first we care for our children. Second, you'll love this, we care for our pets, then we care for our significant other and elderly family members. Last but not least, we care for ourselves.

In fact, this is fun too. Not so fun, but there was a study done in Canada where women who thought they were having a heart attack just laid there in bed and did not wake their husbands or call the paramedics because one woman said, well, her husband worked so hard during the day that she knew he needed to sleep. I know I would never do that. Everybody in San Francisco would know that I was having an issue. But her response is typical. It's certainly... Let me say, I don't know if it's typical, but it's not atypical. It's more common than you realize. We really put ourselves last.

The other thing that I really learned was that women hesitate to get second opinions much more often than men do. I thought that was interesting because, really, the chapter in my book on second opinions is perhaps one of the most important chapter because it's so important to get a second opinion.

Women have been taught to play nice. We don't want to be rude, we don't want to hurt the doctor's feelings. All of that goes on, and so we just... I have so many women said to me, "Well, he was the professional. Who am I to question him?" My answer to any woman that thinks that is this is your body, and if you're prescribed a serious drug, or like myself an invasive procedure, you really want a second opinion. Again, that's because we see what we expect to see and doctors have different opinions.

Symptoms are so random and can be so similar. We all can have different diseases and share the same symptoms, so t's really tricky for a doctor to make an accurate diagnosis. It's not an easy thing to do. Most doctors will appreciate the opportunity to discuss their diagnosis with a colleague. I've never had a problem when I've asked for a second opinion, and I just think it's so important.

Matt Feret (10:49):

Why do you think there's a hesitancy based upon your interviews and your own experience? I mean-

Susan Salenger (10:55):

Well, again, I think we're socialized, as I said, to play nice. We don't want to hurt the doctor's feelings. I think the other reason is so many of us don't realize how many diseases are out there. There's about 20 to 40,000 diseases. If you go in and you say, "I have no energy, I'm exhausted. I have no appetite," those symptoms can fit probably all 20,000 of the diseases. So for the doctor, it's truly looking for a needle in a haystack. All he can do is make his best, most educated guess, but it's a guess. A doctor will be the first to tell you that.

So, I think that that's part of the reason we hesitate, is we tend to go in and think, "Oh, the doctor will tell me what I have and then I'll be fine and I'll live happily ever after." That's true if you have a broken leg and you go in and your leg hurts and they do an x-ray and they show a break. You don't have to go to med school to diagnose your pain. But it's usually not that simple.

Matt Feret (11:58):

There's a line in your book that you said, I'm going to quote it here, "I was confused by the conflict I saw between the energy and thoughtfulness women put into their own healthcare, and then the amount of regret they expressed to me about at least one major healthcare decision they had made," that's why you finally decided to sit down and write about it.

Susan Salenger (12:17):

Mm-hmm.

Matt Feret (12:18):

What is that confusion? Was your confusion solved by your interviews or was it confirmed?

Susan Salenger (12:26):

Both in a funny sort of way. Because women, we are proactive about our health. We make sure our tests are up to date, we get our checkups. We do whatever we need to do. But I found that when something was wrong, when you felt like you were having a heart attack or whatever it was, that's when the women hesitated.

I think, number one, that meant that if they were diagnosed, let's say with a heart attack, that probably meant that for a while, anyway, they wouldn't be able to do their duties, they wouldn't be able to take care of their children or they wouldn't be able to help their husbands or go to work. I think the conflict comes in when women have something specific that may take up some time, that they have to get well, they have to fill prescriptions, whatever it is. That's, I think, when the hesitation occurs. 0

I just went in for my physical. I knew I was fine. I went in, everything was fine except he made fun of my book, and then I left. But I think that was the difference I found because it was a real conflict. I mean, I couldn't understand. There's literature that talks about how proactive we are and there's literature that talks about how we don't always go to the doctor, so it was a hard balance.

Matt Feret (13:43):

I know you noted this in the book. You know this and you actually give examples of this out there, and anybody who's going to watch is going to immediately pick up on it. All of the healthcare advertising in this country from pharmaceuticals to insurance, it's all aimed at women. All of it.

Susan Salenger (14:00):

Right

Matt Feret (14:01):

Every single commercial is aimed at women. Yet, you found something here that, while the healthcare is aimed at it and they're very proactive in taking care of themselves, the vitamins, the exercise, and then they help others and their family members keep up with appointments. I mean, there's a lot of that going on, and even the healthcare of the family members in their lives, they usually take on that responsibility as you know it.

Susan Salenger (14:27):

Absolutely.

Matt Feret (14:27):

Yet, something happens when they walk into the doctors. Is it really that authority figure piece or is that emotion versus logic approach? What happens when they walk in the door, typically or what you found, to a doctor's office? What changes? And if something changes, how can people and women listening change that dynamic if they've gone through that?

Susan Salenger (14:53):

I think one of the things that changes is the anxiety. There's two things that happen, and I can speak for myself here as well. I get anxious when I go to the doctor, and I know a lot of the women that I talked with also do. What happens is, when you are anxious, you tend to talk about your anxiety. Perhaps you start talking about your feelings. At the same time... Wait, what do I want to say here?

In the women I interviewed, there was a tremendous amount of shame too about being ill, and I found that absolutely fascinating because I don't happen to feel that. That's not my personal emo on it. But so many of them felt ashamed and were embarrassed that they were ill.

I think, to answer your question, when they walk in the doctor's office, they're embarrassed so they hesitate to talk about all their symptoms. Fifty percent of women lie to their doctors, and 25% of that 50% don't even think that their lying is a problem. Not understanding that now that they've distorted what's happening, the doctors' chance of an accurate diagnosis are even less than they were in the first place. I was startled at the amount of shame that women feel about being ill. That took me aback.

In fact, what was particularly interesting as I put together a couple of... I talked to most women on a one-to-one and I put together a couple of focus groups because I wanted some geographical diversity. None of... Well, I shouldn't say none, but most of the women in each of, I had two focus groups, in each of the focus groups had never talked with anybody else about their symptoms or about their illness other than their doctor. Most of them said they were embarrassed, they were ashamed.

I heard how lonely they were. They were so delighted to be in the focus group because they were exchanging stories. I mean, I had hired a facilitator and she barely had to facilitate because they were really talking. So, I think that's one of the things that, really, you walk in the door, you're anxious, you're ashamed, you're embarrassed. That muddles you up.

Matt Feret (17:12):

So, what's your advice? How do you get over that, or how does someone work to get over that? A, recognize it and, B, work to blast through it.

Susan Salenger (17:20):

I think the first thing you do is recognize it, number one. But I think too there's some things you should do. I always use the word should very cautiously. You should make a list, go in with an agenda. A piece of paper, if you can. Don't have the list in your head. Write it out. What the list will do is it will help you focus and it also keeps the doctor on track. Most doctors will ask for a copy of my list so they know what it is I want to know.

Secondly, I think you need to really do your research. Say, the doctor says you have disease X. What you want to do is get the clinical name of your disease, have him or her spell it out for you, and go home and do your research. In fact, the second most important part of my book is the resource list at the back. I've done your research for you. All you have to do is go to the back of my book, look up what you need to look up and you're home free.

So, go in with an agenda, get the clinical name. Try to take somebody with you if you can because four ears are better than two. I'm one of those that get anxious, so anxious that sometimes, if I really think I've got something wrong, I can't always hear. The doctor will say one thing and I either won't hear it or I'll hear it. My hearing's fine. It's just right at that point in my life, it isn't.

Again, make a list, take somebody with you, do your research and don't, whatever you do, introduce a new problem or a new symptom as the doctor's just about ready to leave and half out the door because you won't get a full answer. That happens more times than you realize. That's my suggestion. Those are my suggestions and my advice.

Matt Feret (19:03):

Be prepared, bring a healthcare journal or a notebook and bring a friend to make sure that you've got your-

Susan Salenger (19:11):

I did leave something out. The other thing I do, and I think it's important, is I repeat back what I heard the doctor say. The reason I do that is, number one, because I get anxious, I want to make sure I heard correctly, but also it gives the doctor a chance to confirm or add on or delete some of the stuff I said. It gives us both a chance to make sure that we're being accurate, and that's also important.

Matt Feret (19:38):

Let's say we're going into, or I'm going in to a doctor's appointment and I get anxious and I forget. I do this all the time. I'll have my list and then I just won't cover it because you get the impression the doctor's busy and you want to rattle it off. So, what's your advice when you mess up an appointment? When you get out and the doctor goes, "Well, thanks. We'll see you in a year for your physical," and you're like, "Darn it."

Susan Salenger (20:07):

Yes. Well, I have two things to say. One, and I did forget to add this, prioritize your list. If you have a list of six things, at least you'll have them in order. If worse comes to worse and you screw up on five and six, you won't be as upset as if you screwed up on one or two. Then you have to email the doctor. Well, I don't know. Some doctors of mine doesn't have an email, but there's a patient chart and I can send messages; but I email her, I message or I phone back and I say, "Hey, I forgot this." I mean, that's all you can do. I don't know that there's an alternative, but you have to... Can you recommunicate? Is that a word?

Matt Feret (20:43):

I think it is.

Susan Salenger (20:46):

Yeah, good. See, it's clear.

Matt Feret (20:48):

Yeah, it is now.

Susan Salenger (20:49):

Yes. Right.

Matt Feret (20:49):

I know you mentioned this a little earlier, but I do want to hear a little bit more about this, the focus groups. You mentioned it took you 10 years to write this.

Susan Salenger (20:58):

Yeah.

Matt Feret (20:58):

So, you put together focus groups. Not a lot of people do that. So, where were they? Talk about how you put those together. You mentioned a little bit of the camaraderie. It sounds like it immediately happened. Talk a little bit about why you did that and what you learned.

Susan Salenger (21:14):

Well, I learned... Well, how I did it too, you also asked me that. It was easy. I threw money at the problem and hired a focus group person. They put the people together and they facilitated. I just took notes like crazy plus got a written report. That was easy. That part was easy.

What I learned, and it was so interesting to me, because when I talked to women on an individual basis and I went and met with them in their homes, it was much more intimate on a one-to-one. In fact, two or three of the 40 people I did interview said to me, "Well, I'll tell you because I'm never going to see you again anyway," and they were right. There was an intimacy and I got some wonderful information.

The focus groups were less intimate, but I was able to observe, number one, the loneliness and the invisibility. In fact, that's going to be my next book because it really struck me how invisible and how lonely these women felt. Part of it was because they hadn't talked to anybody else. By being so quiet, by being so embarrassed, they unfortunately denied themselves the support that they so desperately needed.

In the focus group, all of this desire for support came through. It was a phenomenal experience, frankly. I mean, I would do it again in a heartbeat.

Matt Feret (22:39):

You said that twice now, loneliness. It took me two times for me to pick up on it, so sorry for that, but let me hit it. Are you talking loneliness from single women, widows? Are you talking lonely even with families because they're simply not communicating their healthcare, or to anyone other than themselves, they're internalizing it? What do you mean lonely? Give me some examples. What do you mean?

Susan Salenger (23:04):

Okay, good question. Nobody's asked me that before and I like it. Loneliness, first of all, one thing about illness is you're socially isolated. When you're sick you don't go out, you're bedridden, you're in pain. In mean, whatever the hell it is. Loneliness in that sense is almost an automatic response to any illness because you don't see people, you don't have the energy. Maybe you don't want to see people, whatever.

What was the rest of your question? I'm sorry I lost the sentence.

Matt Feret (23:34):

Well, loneliness in terms of are we talking single women here? Widows?

Susan Salenger (23:38):

No.

Matt Feret (23:39):

Or are we talking lonely even within a broad family structure?

Susan Salenger (23:44):

Thank you because that's where I was going to go. I think the loneliness... Because a lot of the people I interviewed had chronic illnesses or autoimmune diseases, not because I chose that, it's just the way it worked out, with an autoimmune disease, in particular, you can look fine and be in miserable pain and nobody will know.

These women who are in pain or who are not feeling good and it doesn't show on the outside because they have on makeup or they're dressed, nobody recognizes just how poorly they're feeling. That's a different kind of loneliness. The first kind is because you lack people because you're sick. That's social isolation. This particular kind of illness that I'm talking about now is the invisibility. You're not recognized. Nobody understands. They say to you, "Oh, you'll get better," or "Stop whining. You look just fine," or "I had a cousin that had disease X and she got better. Why haven't you?"

For example, one woman I interviewed has lupus, which is an autoimmune disease that many, many women get and you can't see. Every time she pulls into a handicap parking space, somebody will yell at her and say, "You shouldn't do that. I'm going to call the police," or "You'll get a ticket. You have to leave that for people that are handicapped." That's the kind of loneliness I meant.

Matt Feret (25:07):

That's a societal-

Susan Salenger (25:09):

Yes.

Matt Feret (25:09):

That's almost a societal commentary right there.

Susan Salenger (25:13):

Yes, it is. Yes, it is. You really don't know who's sick and who isn't, and it might be nice to take people at their word. I mean, why would somebody tell you they're sick if they're not? That would be a peculiar response.

Matt Feret (25:25):

Did you notice any geographical differences between where you live and other portions of the country in terms of women advocating for themselves?

Susan Salenger (25:34):

No, I did not, partly was because I didn't research that piece of it. I didn't separate it out that way. That doesn't mean there weren't any, but it doesn't mean there were. I truly don't know. What struck me was the commonality of the behaviors. That was true whether they were black, white, Latin, west, east, north. It didn't matter. The behaviors were the same.

Matt Feret (26:00):

You mentioned or you talk a lot about the individual and what the individual can do to change their patterns and change their speech and change their doctor if they need to. What other things do clinicians, who might be listening, what might they want to think about? If there's a doctor or a dentist or a pharmacist listening in on this.

Susan Salenger (26:23):

Right. Right. I think... Again, my book is really about patients. However, of course, I have a partial answer. I think some of the issues are structural. I think, for example... I mean, I know, for example, that women's illnesses get a lot less research money than men's illnesses. Prostate cancer, for example, gets much more money than uterine cancer, ovarian cancer, cervical cancer, and those cancers are much more fatal than prostate. So, we need more money. That will automatically give women and their diseases the attention that perhaps they're lacking now.

The other thing that's the problem, and it's finally changing, is for years women were not included in clinical trials. We are now. It's much better than it was, but we're still living with that history. We know a lot less about women's bodies than we do about men's bodies because of all of the history.

The other reason, I think, that women have trouble getting the recognition that we deserve is we get a lot of autoimmune diseases. As I was saying, the chronic diseases, you can't always tell that somebody is sick. I heard story after story and I've read book after book about how women who are in terrible pain, it takes about five to seven years to get an autoimmune disease diagnosed. So many times, those women are given antidepressants, told to see a psychologist, a therapist. "It's in your head. Don't worry about it."

We still have remnants of the hysterical women from many, many years ago. That's changed. It's been modified, but we have an unfortunate history with medicine and it sometimes comes back to haunt us.

Matt Feret (28:10):

If I'm in this situation and I am told that, what's the correct response? How do you handle that in the doctor's office, or how do you handle that diagnosis of it's all in your head and it's not really in your body? What do you do?

Susan Salenger (28:28):

Well, before you get up and leave the room, which is what I would want to do, but don't do that. No, what you do is you say, "What else could this possibly be?" You can say either, "It may be all in my head," "I don't think so," or "I really don't think that's accurate." I think I'd say, "Well, what else could it possibly be?" or "Do you have somebody else perhaps you could refer me to that could take another look and let's see what they think?" I would not accept the diagnosis.

To be totally fair now to doctors, it isn't necessarily so that the doctor's brushing you up. It may be in your head, because we do suffer more from anxiety and depression than men do. So, it's not an off the wall statement, although it can feel that way. But I think the what else could this possibly be is an excellent question to ask. Frankly, I ask that whenever I do get a diagnosis because, again, there's a lot of diseases out there. If he says it's disease A, well, I'd like a disease B so that I can go home and look it up and see what I think.

Matt Feret (29:34):

If I'm a caregiver, and that word could mean a ton of things. Let's just say if I'm a caregiver for my parents or a loved one or a friend, or I'm not their caregiver but I'm involved in the decision-making process or trying to help out mom from afar, what are some of the advice you can give for caregivers or loved ones to watch out for in your parents or other loved ones' daily doctor visits or managing their chronic conditions?

Susan Salenger (30:09):

Well, I think, first of all, women do about 80% of the caretaking in the whole world. I mean, that's amazing. I don't have advice for what a caretaker should look for in their parents because I'm assuming there's a doctor involved and that the doctor would tell you what to look for.

Matt Feret (30:25):

Well, I meant in terms of being that person, being alongside that person making sure they're prompting them with the right questions or... That second set of ears that you mentioned earlier.

Susan Salenger (30:39):

Right. Well, I'm going to answer it two different ways. My first piece of advice, and there has been research on this, as the caretaker, take care of yourself. There have been so many studies where women, and this is one of the times women didn't go to the doctor, to refer back to your other questions, because women let their heart conditions go because they were so busy caretaking for some member of their family that, again, they didn't go to the doctor. So, the first thing you have to do is take care of yourself.

In fact, there was a study done where a dermatologist did a punch biopsy. They just did a punch thing in your skin and the people that were caretakers healed much more slowly than the people who weren't caretaking because the caretakers were stressed and not as in such good shape their self. So, my first piece of advice would be definitely to listen to your body and take care of yourself.

In fact, that's my advice about putting yourself last. Don't. Because you really can't take care of your family if you don't feel well yourself. And so, that certainly applies to caretakers.

What kinds of questions your parents should ask? Again, same thing, you would need a list and you would discuss before the doctor got there what was going on. You'd want to help them focus it and guide the agenda. As the caretaker, you also got answers to the questions that you thought needed to be asked.

Matt Feret (32:12):

You mentioned the word stress, and that was a couple minutes after you mentioned the words anxiety and depression.

Susan Salenger (32:17):

Yes. Yes.

Matt Feret (32:20):

Those three are all inter-related. Talk to me about that and what you found in the course of writing your book.

Susan Salenger (32:25):

There's a real connection. If you're stressed, it really affects so much of what you do, how you think, how you feel. We're all stressed. I mean, you can't go around thinking, "Well, I won't be stressed anymore." But you have to have different ways to deal with it and to find a support group if you're ill. That always helps you, whatever. There are suggestions in my book about how to deal with it because it depends on each person. I love those kinds of stories because they really bring home the points and they're fun.

Matt Feret (32:59):

They do. The book is called Sidelined.

Susan Salenger (33:02):

Right.

Matt Feret (33:02):

What questions-

Susan Salenger (33:04):

How-

Matt Feret (33:04):

Sorry, go ahead.

Susan Salenger (33:05):

I was just going to give you the rest of the title.

Matt Feret (33:06):

Oh, yeah.

Susan Salenger (33:07):

I thought you forgot it and I was helping you out.

Matt Feret (33:09):

No. No, no, I didn't. Go. Go, do it.

Susan Salenger (33:14):

It's just called Sidelined: How Women Manage and Mismanage Their Health.

Matt Feret (33:19):

Yes, that. And so, talk to me about... You already mentioned the next book, but talk to me about any questions... Gosh, I'm all flummoxed now. Hold on a second. Let me start this over. What questions did I not ask you that I should have about the book and about your research-

Susan Salenger (33:39):

Oh, that's [inaudible 00:33:40].

Matt Feret (33:40):

... and about women and their doctors?

Susan Salenger (33:44):

Let me think about that for a minute. Well, let me just talk... I guess we have a little time.

Matt Feret (33:50):

Oh, no.

Susan Salenger (33:50):

Well, good. One of the things I did want to discuss is the drug companies and the pharmaceutical industry because you were absolutely right when you said they're aimed at women. Again, I think I said that women make 80% of all the purchasing decisions on healthcare and the drug companies know that.

But New Zealand and the United States are the only two companies in the world, I want to repeat that, in the world, that allow drug companies to market to consumers, and there are billions of dollars spent on that. Billions. Those ads are incredible successful. I think a drug that is advertised to consumer sells nine times more than drugs that aren't. I think it's two-thirds of the people who see a drug ad on television takes some sort of action, either call their doctor and make an appointment or request the drug, whatever. So, it's enormously successful.

I think that, as consumers, we really need to be aware, particularly as women, that we are being targeted. They've even found that if you have an ad that has a kid in it, they are more successful because women take care of their children first. That goes back to the beginning of our talk. So, I think that that's important for women to know. We all want to rush for that magic pill. And, be careful. That's all I have to say.

There is a website called Dollars for Docs and you can look up how much your particular doctor and whether or not your particular doctor accepts lunch and gifts and all kinds of things from pharmaceutical companies. If you feel that you've been prescribed something that perhaps is not what you want to take, look up the drug. Go to Dollars for Docs and see what you can find out. That's my advice.

Matt Feret (35:41):

Susan, this has been great. Thank you very much for your time. Anything else that I didn't cover that you wanted to?

Susan Salenger (35:47):

No. I think that covers it. I should go. I would like to rifle through my notes and call you back, but I think it's fine. Thank you, I just so enjoyed talking to you. Your questions were terrific, really. I so appreciate it.

Matt Feret (36:03):

Thank you, Susan, I had a wonderful time spending some time with you.

Susan Salenger (36:07):

Thank you. See you soon.

Matt Feret (36:08):

My thanks to Susan Salenger for a great show. Make sure to check her book out at susansalinger.com or just hit the links on the Matt Feret Show website. Until next time. To your wealth, wisdom and wellness, I'm Matt Feret, and thanks for tuning in.

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