So... An obese woman is given lifestyle counselling, Metformin for prediabetes, offered the contraceptive pill for hirsutism and counselled on cosmetic strategies to manage this... Her irregular periods don't bother her, she has the one child she wants, ... seriously, what benefit is adding a PCOS diagnosis??? It just seems like a huge fuss about nothing. An attempt to make women into perpetual patients, to create anxiety and distress/depression over this terrible "PCOS" they have, to apply another disease label to women en masse, to encourage them to view themselves as sick, diseased, at risk, and to obssess over their bodies
So who should really be treating pcos? The fragmented care has absolutely been an issue in my life. Gyno and therapist like ships passing in the night.
I was talking about a specialist friend of mine about this very thing recently.
I am biased, but I feel Family Medicine is the best positioned to “own” it, because our training is one of the only that focuses on shifting health across the entirety of the lifespan (“cradle to grave” as we say in the specialty).
Internal Med and other PCPs could do it but in my experience, general internal med training is weak on women’s health (one of the biggest reasons I personally chose not to pursue it).
but perhaps even more importantly, specialist need to step up and stretch themselves with these patients too:
- OB/Gyn needs to be able to counsel on their increased cardio metabolic risk and maybe even perform basic cardiometabolic testing and results counseling
- Psych needs to consider pmos for every woman presenting with anxiety/depression and is reproductive age. And then make sure they are connected to a pcp
-Cardiologists need to include insulin resistance as a treatment target in women with pmos (and others)
The name change is just going to shift bias from a women’s fertility problem to a women’s body size problem. Either way the name change will not reduce stigma, it will just shift it. It will presume insulin resistance in a patients even when that’s not the experience of an individual patient. It will continue to pathologize body size and delay care for those who refuse to engage in harmful restrictive eating behaviors or are who do engage in those harmful behaviors but are still unable to reduce their body size.
As you said, the name is a signal. But given our healthcare system and culture making this change will not change the poor treatment so many with the condition receive. For many, it will increase stigma and make the provision of care even more hostile.
“The name change is just going to shift bias from a women’s fertility problem to a women’s body size problem.”
Why do I have the sneaking feeling you are right 😭
We will need to stay vigilant about not just shifting the stigma to body size. Medicine has a baseline tendency to blame individual behavior for the totality for medical problems; but Medicine never wants to face or even fully name the ways the healthcare institution itself is a direct cause of harm to patients.
I’m grateful for the doctors and medical providers who are committed to weight neutral and weight inclusive care as well as those speaking out about the many forms of institutional bias in medicine.
We have so many people who need healthcare and can’t get it, and so many who need better care than they’re getting.
So... An obese woman is given lifestyle counselling, Metformin for prediabetes, offered the contraceptive pill for hirsutism and counselled on cosmetic strategies to manage this... Her irregular periods don't bother her, she has the one child she wants, ... seriously, what benefit is adding a PCOS diagnosis??? It just seems like a huge fuss about nothing. An attempt to make women into perpetual patients, to create anxiety and distress/depression over this terrible "PCOS" they have, to apply another disease label to women en masse, to encourage them to view themselves as sick, diseased, at risk, and to obssess over their bodies
You perfectly describe the disconnect between theory and real life.
So who should really be treating pcos? The fragmented care has absolutely been an issue in my life. Gyno and therapist like ships passing in the night.
I was talking about a specialist friend of mine about this very thing recently.
I am biased, but I feel Family Medicine is the best positioned to “own” it, because our training is one of the only that focuses on shifting health across the entirety of the lifespan (“cradle to grave” as we say in the specialty).
Internal Med and other PCPs could do it but in my experience, general internal med training is weak on women’s health (one of the biggest reasons I personally chose not to pursue it).
but perhaps even more importantly, specialist need to step up and stretch themselves with these patients too:
- OB/Gyn needs to be able to counsel on their increased cardio metabolic risk and maybe even perform basic cardiometabolic testing and results counseling
- Psych needs to consider pmos for every woman presenting with anxiety/depression and is reproductive age. And then make sure they are connected to a pcp
-Cardiologists need to include insulin resistance as a treatment target in women with pmos (and others)
Basically…the whole system needs to shift itself.
Thank you! I whole heartedly agree.
The name change is just going to shift bias from a women’s fertility problem to a women’s body size problem. Either way the name change will not reduce stigma, it will just shift it. It will presume insulin resistance in a patients even when that’s not the experience of an individual patient. It will continue to pathologize body size and delay care for those who refuse to engage in harmful restrictive eating behaviors or are who do engage in those harmful behaviors but are still unable to reduce their body size.
As you said, the name is a signal. But given our healthcare system and culture making this change will not change the poor treatment so many with the condition receive. For many, it will increase stigma and make the provision of care even more hostile.
“The name change is just going to shift bias from a women’s fertility problem to a women’s body size problem.”
Why do I have the sneaking feeling you are right 😭
We will need to stay vigilant about not just shifting the stigma to body size. Medicine has a baseline tendency to blame individual behavior for the totality for medical problems; but Medicine never wants to face or even fully name the ways the healthcare institution itself is a direct cause of harm to patients.
I can’t stand it
I’m grateful for the doctors and medical providers who are committed to weight neutral and weight inclusive care as well as those speaking out about the many forms of institutional bias in medicine.
We have so many people who need healthcare and can’t get it, and so many who need better care than they’re getting.
Thank you for validating these realities.