I have a list of symptoms I tell my doctor and a list I do not. The list I do not tell is longer. I learned which list a symptom went on the third time I got the answer "have you tried meditation."
I am 47. I have been seeing my primary for eleven years. She is competent and kind and overbooked. The list I bring to my annual is in priority order with the most defensible at the top. Defensible means: a number can be put on it. Defensible means: a man would also have it. Defensible means: there is a test for it.
The script that women complain more is not, in my experience, true at the patient level. It is true at the system level. The system has decided in advance that complaints from women above a certain volume are noise. The patient adjusts to the system’s threshold. The threshold determines what gets said out loud. The patient becomes her own filter, screening her body in real time for whether each symptom is system-grade or merely lived. After enough years of this filtering, the patient does not know what she has.
The undisclosed list, this year: night sweats that soak through sheets, joint pain in my hands when I wake up that lasts ninety minutes, a brain fog so thick I cannot finish sentences in client meetings, the panic-attack-shaped event I had in a parking lot in June and have not told anyone about. The Lancet Women’s Health Commission found women wait 2.5x longer than men for a diagnosis of their primary symptom. My primary symptom, on paper, is none of these. My primary symptom is what I let myself say.
The disclosed list, this year: a stubborn weight gain (objectionable, measurable, on the chart); a recent change in vision (testable, neurological, referable); the sleep issue (worth mentioning, will be told to drink less caffeine). That is the list that will go in my chart. The other list will be in my Notes app where it has lived for three years.
I have, twice, brought the undisclosed list. The first time, at 44, I was told I might want to "try a journal." The second time, at 46, I was told my labs were normal and "perimenopause is just a phase." I left both appointments with a feeling I now recognize as humiliation — the specific embarrassment of having handed a person something true and seen them put it down.
Last month I paid out of pocket for a specialist. She read my list. She read it. Twice. She said: "This is textbook perimenopause and you have been having it for at least three years." She wrote a prescription. She booked me a follow-up in six weeks. She did not tell me to drink water. The labor of getting believed cost me, conservatively, four years and $1,400 and the woman I was at 44. I would like her back. I cannot have her back.
The list I tell my new doctor is the long list. It is the list I should have been telling for years. The list I do not tell my primary is now, also, the list of things I no longer want to negotiate with her about. I will not be back. I made the appointment for my mammogram with someone else. The first doctor is competent. She is kind. She is overbooked. The system she works inside is the system that taught me which list a symptom goes on.
I am 47. The thing I would tell my 43-year-old self, if she could hear me: the list is the whole list. Bring all of it. Do not curate. The curator is the system, and the system has already decided what to do with women your age. Stop helping it.