- BIOETHICS FORUM ESSAY
Early Detection of Differential Treatment
Many of us know that women receive differential treatment in any number of public places, whether buying a car, or entering the business world, or being catcalled on the street. But men and women alike still easily forget how insidious and importantsuch differential treatment can be. Being treated differently can be so pervasive in a woman’s world that she fails even to notice that the treatment is sub-par.
Recently, I scheduled a long-overdue appointment with a dermatologist. Because I moved to the area not long ago (shortly after graduating from college), I selected the doctor from a list that my insurance provider gave me. Having been diagnosed with malignant melanoma at the age of sixteen, I was eager to get an appointment; I’d waited far longer than the suggested six-month span between check-ups advised by former doctors. Heightening my anxiety was a suspicious spot that had appeared just an inch below the site of my original melanoma.
In the doctor’s office, I waited in my paper gown for long enough that I was startled when the door burst open. The doctor, apparently opposed to the custom of introducing himself as well as to that of knocking, reviewed his clipboard as he asked me what “the problem” was. I told him my name and explained that I was trying to establish a dermatologist in the area because I had a history of melanoma. Before I could go on, a smirk appeared on his face and he interrupted, “And is that a self-diagnosis?” “No,” I replied, somewhat confused. “Stand up,” he said, and as he whirled me around like a display case he continued, “where?” I started to explain that the melanoma had been on my right hip, motioning toward the site of the scar. Again interrupted, this time by his guffawing. “I don’t mean where on your body. I can see the scars. I mean where was this diagnosed.” Embarrassed by my inability to discern what “where” had meant, I hoped to gain at least a little credibility when I told him that it had been discovered at the University of Virginia Medical Center. No luck. He barely glanced at the rest of my body before telling me that my skin was not suggestive of the type to get melanoma and that the mark I thought suspicious was only a collection of blood vessels. Before leaving, he noted with a tone of skepticism that he’d be interested in seeing my biopsy reports. Finally, he closed the door, but not before ending with, “You be good now.”
Differential treatment in the medical realm is not a neglected topic. Seniors’ struggles with the Medicare system, the inadequacy of Medicaid for really giving low-income people access to health care, and the fact that birth control is not covered by insurance while Viagra is, are familiar examples of such inequality. Familiar, that is, because they get considerable attention in both the media and in the professional bioethical literature. But this attention occurs mostly at a policy level; it does not bring to light the many levels at which differential treatment takes place. We hear about abortion rights, the importance of passing Plan B, the necessity of insuring birth control, and the injustice of conducting medical research that primarily benefits men. But so ignored is the discrimination taking place in doctors’ offices that, as I left my appointment that day, I could not identify just why the appointment felt so dissatisfying. Indeed, it took me a good couple of days to consider that probably not everyone would have been treated so patronizingly. It’s possible that this doctor is just a jerk across the board, yes. It’s possible that he would have failed to introduced himself to a man, would not have shaken a man’s hand, and would have doubted a man’s report of melanoma and requested documented proof of a man’s diagnosis. It’s possible that the doctor would have interrupted a man, given him commands, and upon leaving, told him to “be good now.” It’s possible, yes. But awfully unlikely.
Having worked so hard to create policies that protect women’s health, we also need to think about the treatment of individual women in clinical settings. Indeed, for women who are multiply disadvantaged, not only by their gender but also by their race, socioeconomic status, or other factors, awareness of what constitutes differential treatment is essential. Certainly, at a time when bioethicists are so eager to talk about the doctor-patient relationship, attention deserves to be paid to patients who receive substandard care of the sort I did. If I did not know better, or if I did not have the means, time, and medical coverage that allows me to seek another dermatologist, it is more than likely that this dermatologist appointment would have been my last. For many women, it would have been.
It’s like a tumor, you see. One bad interaction, if not identified for what it is – differential treatment on the basis of gender – can ravage a person. When this happens, the metaphor risks becoming a reality, and women’s health suffers. Like any malignancy, differential treatment can be stopped with raised awareness and early detection. Once women become aware of differential treatment in the clinical setting, one bad interaction need not equal a bad prognosis for future care or, more importantly, for future health.