By Dr. Elizabeth Shadigian

It is not safe for women to go to Status Quo Health Care alone.

Status Quo Health Care, or SQHC (my term for the “doctors at the top and patients at the bottom” current mainstream health care system), is set up to work against people in the patient role, especially women, girls, trans and gender nonconforming people. (In this article, whenever I use the term “women,” I am referring to “women, girls, trans and gender nonconforming people.”)

SQHC is sexist. SQHC, from the beginning and by design, continually reinforces the disempowerment of women by lowering women’s expectations, interrupting them as they describe symptoms and not believing them if they actually get a chance to explain their health issues. SQHC discourages its providers from practicing the best medicine by enforcing short, pressured appointments and by tolerating women through a thinly disguised veil of disrespect.

Women can choose to put our own safety first. Most medical abuse happens at SQHC when women are isolated or outnumbered during visits, especially during physical exams. Always having a woman advocate with us is a radical act of self care.

Women can get the best out of their health care provider by having another set of eyes and ears with them before, during and after medical appointments. Many women do not feel safe anywhere, and rightly so. We can build more safety into our lives by bringing at least one other person with us to all health care appointments. This single act repeated daily by women around the world will put SQHC on notice: disrespect and abuse will not be tolerated. There will always be a witness and our voices will not be silenced.

At first, bringing a woman advocate to medical appointments may not seem necessary or natural. Asking for support may increase feelings of vulnerability or powerlessness. The need for a woman advocate may seem to say that she cannot be heard on her own. A woman may not ask for what she needs or wants because of specific fears: looking bad, being exposed as weak, letting others know more than feels safe, lacking privacy, burdening others with obligations, feeling like it will not matter anyway and on and on. Often, it is more difficult to ask for support and easier to offer it.

Woman advocacy is an activity that everyone can choose to offer to friends, family and others. It can be empowering to be on the receiving and giving ends of woman advocacy. Woman advocacy is a central component of health care empowerment. I propose that every woman always takes a woman advocate with her to SQHC appointments, but especially when seeing a new health care practitioner, for second opinions, when the diagnosis is questionable, when procedures or surgery are contemplated and in potentially life-threatening situations.

A woman advocate differs from a health care advocate in at least three important ways. A woman advocate is aware of the: 1) woman seeking health care’s particular herstory, 2) power dynamics in all health care settings, and 3) sexism and other oppressions women are up against seeking health care. A professional health care advocate may not take into consideration these factors when providing advocacy. Often health care advocates are employed by agencies that have a vested interest in a health care system, a governmental body or a health insurance company. Therefore, they cannot truly be on the side of the woman seeking health care.

A woman advocate must demonstrate the ability to be accountable to the woman seeking health care as well as to herself. She must speak her own truth about boundaries and address their relationship in and outside of health care settings. This entails having both parties express concerns before, during and after health care visits. Before visits, it is advantageous to put in writing the extent of the woman advocate’s participation. Whomever the woman seeking health care chooses to have accompany her will benefit from discussing the topics organized in the Woman Advocacy Checklist.

Woman Advocacy Checklist (Abbreviated)

Before Becoming a Woman Advocate, I may want to ask myself:

Do I feel free to say “yes” or “no” based on my abilities and interests?
Do I feel confident that I can be assertive for her if required?
Do I think I can keep my emotions in check so as not to interfere or draw attention to myself, but keep the woman seeking health care at the center?
Specific questions the woman requesting me as an advocate should answer:
When is your appointment, and how long do you anticipate it being?
What do you want my main role to be? (silent listener, note-taker, vocal supporter, someone to discuss what happened afterwards, etc.)
Am I responsible for my own transportation?
General/ongoing considerations:
What can I do to help create as safe an environment as possible, free from disrespect, pressure or coercive tactics?
How would you like to clarify and discuss boundaries between us? (I’d like you to ask me for exactly what you need and want).
If I suspect you are upset, how should I inquire about your feelings and provide support?

Before an appointment:

What fears or concerns do you anticipate having during the appointment?
What do you hope to get out of the appointment?
Do you want me to take notes and/or audio-, video-tape the appointment?
What don’t you want me to do?
What fears or concerns do you have about me, or anyone, as your advocate?
Should we create a code to use when a time-out may be needed by either one of us?
Things to consider bringing:
a notebook/pen for note-taking,
a tablet, phone or computer to take electronic notes,
food/drink for the woman I am supporting and/or myself

During an appointment:

Would you like me to maintain a physical connection with you such as holding your hand or touching your shoulder?
Would you like me to jump in with questions I may think of during the appointment?
Would you like me to be prepared to step out to get you anything, or to step out for any or no reason?

After an appointment:

Do you want to process anything emotionally?
Is there anything else I can do to support you?
Did you feel respected by the health care provider during the appointment?

One of the most important services a woman advocate can provide is active, empathetic listening. Active listening includes the listener asking clarifying questions and summarizing what she has heard to increase accuracy. Empathetic listening includes hearing the emotions behind the words. Depending on how a woman seeking medical care feels, she may not remember accurately what was said or may hear only a portion. It is a woman advocate’s job to be the person who catches the information and is able to pass it back to her. Woman advocates should not attempt to make a woman's decisions for her, set the tone or mood of the appointment, tell their own stories or assume power. Advocates must be non-judgmental and focus on the client’s needs.

To aid the process of advocacy while navigating health challenges, I offer a set of four free WomanSafeHealth Empowerment Pocket Guides: Medical, Psychological Services, Gynecological Services and Rituals for Serious Health Conditions.* Each guide is designed to assist women and their woman advocates to have a starting place: for questions to ask, communication reminders and self care strategies. All of the empowerment pocket guides reinforce women’s rights and choices.

I challenge each of us to bring a woman advocate to our next health care visit and to offer woman advocacy. It is not safe for women to go to Status Quo Health Care alone.

*The four free WomanSafeHealth Empowerment Pocket Guides can be found on our website: http://www.womansafehealth.com/wsh_guides/medical.pdf
http://www.womansafehealth.com/wsh_guides/psychological.pdf
http://www.womansafehealth.com/wsh_guides/rituals.pdf
http://www.womansafehealth.com/wsh_guides/gynecology.pdf

Elizabeth Shadigian, MD, FACOG is a board-certified obstetrician-gynecologist specializing in the health, safety and well-being of women. She received her medical degree from Johns Hopkins University and studied, taught and practiced at major health care institutions for 20 years. She left academia as a Clinical Associate Professor to create WomanSafeHealth, a medical practice and new model of health care based on women’s empowerment.

Dr. Shadigian’s first book, WomanSafeHealth: The Antidote to Status Quo Health Care is being published in June, 2016 and will be available at Crazy Wisdom Bookstore. Crazy Wisdom is also hosting a book talk and book publication party in the Tea Room on July 28th at 7pm. All are welcome.

WomanSafeHealth offers professional woman advocates with varying backgrounds to women, girls, trans and gender nonconforming clients, as well
as woman advocacy training. For more information contact WomanSafeHealth at
734-477-5100 or info@womansafehealth.com.