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First-of-its-kind inquiry launched into women’s pain


Michelle Wisbey


23/01/2024 4:07:36 PM

The investigation aims to overhaul Australia’s ‘old-fashioned attitudes towards women’, in a bid to improve healthcare and reduce stigma.

Female doctor using stethoscope on female patient.
Just one third of women said their clinicians listened to them and focused on their needs.

A scathing report has shed a light on the barriers women face when accessing healthcare, with many left feeling gaslit, not believed, and suffering in silence.
 
On Monday, the Victorian Government released its Women’s Health Survey Report, which quizzed 1700 women on their own health conditions and experiences.
 
The results highlighted a need for a significant and systemic overhaul of the country’s management of women’s health, with many respondents reporting being unsatisfied with their care and dismissed by their doctors.
 
Around 40% of women reported living with chronic pain, and one third said they have experienced insensitive and disrespectful practitioners.
 
In a bid to combat these issues, the State Government has launched a new Inquiry into Women’s Pain, with Victoria Premier Jacinta Allan saying women deserve to have their pain ‘believed and relieved’.
 
‘This won’t be a “mic drop moment” for the majority of Victoria’s population, because every woman has either experienced it for herself or knows someone who has,’ she said.
 
‘It’s time we stopped treating women’s health like some kind of niche issue.’
 
The inquiry will report on Victorian girls and women aged 12 years and over, investigating their lived experience of pain and how to improve their treatment and care in the future.
 
Its scope includes:

  • identifying barriers and enablers to accessing care, treatment, and services
  • describing the impact of the current service delivery system
  • identifying opportunities to improve care
  • considering models of care, service delivery frameworks, and workforce skills requiring change
  • improving the equity of access and efficacy to pain management.
Professor Danielle Mazza is Head of the Department of General Practice at Monash University and will be a part of the inquiry. She told newsGP women can often be left feeling like their pain is being disregarded or not taken seriously enough.
 
‘It’ll be a very useful inquiry to shed light on this issue – any health services that integrate consumer perspectives are going to be better,’ she said.
 
‘There is a stigma that women already feel about reproductive or sexual health issues. It’s often very challenging for women to come forward in the first place, and there’s not a very good understanding in the community about what’s normal, what’s not normal, and what needs attention.
 
‘In the past there have been very old-fashioned attitudes towards women … I hope that women’s health services will become more responsive to women’s needs and be evidence-based and affordable.’
 
The Women’s Health Survey Report investigated a range of women’s health conditions, including menstruation, pregnancy, complications of birth, and sexual and reproductive health.
 
It revealed some good news, with 71% of respondents saying they go to their GP for trusted and reliable information.
 
However, just 32% of participants said they had respectful and compassionate clinicians who listened and focused on their unique needs.
 
About 10% said their health practitioners did not know enough about women’s health to provide high-quality care and advice.
 
Some populations, including Aboriginal and Torres Strait Islander and LGBTIQA+ respondents, were left feeling especially vulnerable.
 
‘As an Aboriginal mum, I feel like I am automatically judged across the medical sector, and this comes through in the way services help and speak to me,’ one woman said.
 
Australia’s worsening cost of living crisis was also found to be preventing many women from gaining care, with more than one third of participants saying they had to wait too long to see a doctor.
 
About 25% of participants said the financial burden of medical care significantly affected their health and wellbeing.
 
They specifically pointed to the challenges of accessing bulk-billed GP services, as well as long wait lists or limited availability of public services.
 
‘The cost of medical care means I delay appointments until I can talk about lots of issues in one appointment,’ one respondent said.
 
Dr Mazza said there are many differing factors which need to be changed and overhauled, so all women are accessing best-quality healthcare.
 
‘The cost-of-living issues at the moment are ramping up and are centre of everybody’s minds, and health, paying for health, and paying for the things like contraception, menopause medication, medication to do with managing periods, pads and tampons, it adds to women’s cost of living,’ she said.
 
‘We need to explore the socioeconomic influences, cultural influences, gender influences, age differences, and issues around power imbalance in consulting.
 
‘If you’ve got a 15-year-old girl coming into the consulting room with a much older GP that they’re not familiar with, that dynamic is very different to if you have a patient who’s about your age and your cultural background.’
 
In the report, the women interviewed had many of their own ideas of what could be done to make them feel better cared for.
 
They suggested initiatives such as mandatory empathy training, trauma-informed care and women’s health training for medical students and practitioners, including GPs.
 
Women also want GPs to make ongoing referrals that do not expire, as well as allowing for self-referrals and giving preference to bulk-billing providers.
 
Professor Mazza’s advice to GPs is simple – listen to your patients.
 
‘Take a really good history and spend a lot of time explaining what’s happening to the patient so they can understand,’ she said.
 
‘If treatments get initiated, give a timeframe for review, encourage the patient to come back to ensure the symptoms are resolved or improving, and if they’re not, you have to step up your management.
 
‘Make sure there is a very clear plan for patients, for their symptoms to improve and to be reviewed.’
 
The inquiry will be informed by written submissions from consumers, clinicians, and health service organisations, as well as focus groups with healthcare workers, people with lived experience, and key stakeholders.
 
A final report will be delivered to the Victorian Women’s Health Advisory Council by December 2024.
 
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Dr Sanjeevan Nagulendran   24/01/2024 11:54:19 AM

Given that general practice is now dominated by women this is long overdue. Some of the gaslighting I have personally seen some female and male doctors perform when dealing with my chronic pain patients is really a human rights issue. The main areas of stigma and discrimination seem to be chronic pain, mental health and financial discrimination by drs against the most needy and vulnerable in our society. It’s rather shameful and embarrassing. Certainly did not see this kind of behaviour when I was working in the uk! Lots of system reform required to justify the Medicare rebates! Maybe an ethics and personality test before people are allowed into med school?. Many of these drs chose to work in areas such as disability knowing the patients are weak and vulnerable and don’t have the energy to complain. Those of us in the profession left to pick up the pieces as we still have a moral compass get damaged for life seeing this behaviour.


Dr Peter James Strickland   24/01/2024 2:30:35 PM

I see some naivety here with Prof Mazza. On FRACGP exams the most insensitive candidates to women's pain in my experience were female GPs, and especially with the use of vaginal speculi. Almost all my male GP and gynaecology colleagues I worked with have been very sensitive to female pain problems. In general, female patients are more likely to express their pain than male patients, but there is a great variation in dealing with pain by both sexes. Suffering with pain is an individual thing, and should not be directed to females or males --everyone with pain suffers to some degree either quietly or with vigour. Over 50 years I have treated 'wimps' and 'stalwarts' with accepting pain, and going into sexual and gender issues is exactly what is NOT wanted by our academics. Lots of people suffer pain --it is part of life, and it is NOT managed badly by doctors, whether they be male or female, or whether the patient is male, or female ! We all learn with experience as professionals.


Dr Patrick Fergal McSharry   24/01/2024 4:04:15 PM

"Those of us in the profession left to pick up the pieces as we still have a moral compass get damaged for life seeing this behaviour.".
Having worked on 3 other continents (and one being the UK - where they used to think they were "their own continent" but all that "baggage " of "old fashioned ideas " is gone now I believe and not a minute to soon ) , I've been quite surprised encountering these "old fashioned ideas" here still.


Dr Colin Scott Masters   25/01/2024 12:31:16 AM

I welcome the inquiry but I suggest a multivariate analysis should be done . Always problematic this area as public service s have very long waits and many can’t afford private system. Certainly GP s could BB and take a 40% pay it or the government could come good on their promise to fund multidisciplinary care that is needed for these persistent pain patients


Dr Sanjeevan Nagulendran   25/01/2024 2:21:58 PM

Due to health system failures and health inequity which should be obvious to all Australia has double the suicide rate of the UK as per the WHO. The feedback from australian patients in the domains of chronic pain and mental health is not always positive as the above enquiry suggests. Unfortunately when one has such numbers this clear it is hard to ignore. We could be defensive or as Professor Mazza suggests we could reflect on what improvements could be made to our already excellent healthcare system which is far superior in many other ways to the UK's NHS. Not least in terms of doctors pay.