by Carolyn Thomas ♥ @HeartSisters
We were driving home around dusk when I noticed that the fountain at our beautiful provincial legislature buildings here in downtown Victoria was illuminated in bright purple light. I immediately guessed that the lights must be part of some kind of awareness-raising campaign – but awareness of what? I asked my friends in the car, but none of us knew why the fountain was now purple.
So I looked up “landmarks lit up with purple”. I learned that lighting a landmark in purple raises awareness of pancreatic cancer – but that’s not all. It’s also the colour that’s supposed to raise awareness of Alzheimer’s Disease, epilepsy, ADHD, domestic violence, lupus, testicular cancer, Crohn’s Disease – and probably many other such causes.
It’s now been four months since the RED dresses of February’s National Heart Month, with four months to go until the PINK ribbons of October – which means the Mother Of All Awareness-Raising events: Breast Cancer Awareness Month (and don’t get me started on the sale of pink-handled Smith & Wesson handguns to support past campaigns). But, as University of Florida researchers Ann Christiano and Annie Neimand warn us in their provocatively titled report called Stop Raising Awareness Already:
“It’s time for activists and organizations seeking to drive change in the public interest to move beyond just raising awareness.”
Most awareness-raising campaigns – like National Heart Month in February, for example – bank on heavy public distribution of facts, information, data and statistics to help increase our awareness of a cause. Yet Christiano and Neimand’s work disputes the effectiveness of such distribution in their report published in the Stanford Social Innovation Review:
“Abundant research shows that people who are simply given more information are unlikely to change their beliefs or behavior.”
Ironically, here’s how the American Heart Association (AHA) confirmed that statement when it delivered the shocking results of its own latest survey on women’s awareness of heart disease – a condition which kills more women each year than all forms of cancer combined.
“Women’s awareness of heart disease – our #1 killer – is actually worse now than the results of our last awareness survey 10 years ago. The women we surveyed compared with women surveyed 10 years ago are 74% less likely to identify heart disease as a leading cause of death. Almost half of women we surveyed did NOT know that chest pain is a cardiac symptom!“
No matter how you slice and dice those stunning survey results, it’s no longer possible to pretend that what we’ve been doing is actually working to raise women’s basic awareness of heart disease.
It’s not that heart-related awareness campaign organizers can’t change direction. The iconic Red Dress, for example, was the official symbol of a national campaign called The Heart Truth® when it was launched in Canada in 2008 by the non-profit Heart and Stroke Foundation (H&SF). The H&SF described the Red Dress like this: “It’s feminine, strong and confident, capturing the spirit of the cause in a symbol that women across Canada can identify with and feel proud of. The Red Dress represents women’s courage and passion as they raise awareness about our heart health.”
That’s the kind of marketing fluff used by ad agencies when launching fundraising campaigns for their clients. But the H&SF later shifted gears and tried a shocking new approach: their 2018 Annual Report called Ms. Understood: Women’s Hearts are Victims of a System Ill-Equipped to Diagnose, Treat and Support Them. With a no-BS title like that, the H&SF dumped its vaguely sugar-coated “feminine/courage/passion” messaging.
In fact, here in Canada, our official Red Dress Day has nothing to do with heart disease! Instead, it’s the National Day of Awareness for Missing and Murdered Indigenous Women and Girls &Two-Spirit People, observed every May 5th.
We know that heart disease awareness-raising campaigns don’t come cheap. The original 2001 U.S. government-sponsored campaign to educate women about heart disease was The Heart Truth®. It was launched by the National Heart, Lung, and Blood Institute, and the campaign cost $17.7 million (that’s about $28 million in today’s dollars).
And what about those popular illuminated landmarks – like our purple fountain – to help raise awareness? When organizers of the campaign called Her Heart Matters here in Canada monitored the results of their February 2023 campaign launch, they counted among their success markers 77 landmarks – including Niagara Falls! – lit up in RED across the country. This sounds impressive – except for this one question:
- people already living with heart disease
- people who care about people in the first group
- people who are employed in the field of cardiology research/cardiac care/fundraising, or the education of future physicians, nurses, technologists, Emergency Services staff and medical/nursing students.
It’s that sub-group of students that stands out as most promising to me.
Basically, med and nursing students may be a far more prudent target for future awareness-raising efforts compared to the general public. That specific group of learners has actual future potential to finally address the reality of systemic clinical practices that so far have left women at significantly higher risk for under-diagnosis (and worse, under-treatment even when appropriately diagnosed) compared to our male counterparts. See also: Fewer Lights/Sirens When a Woman Heart Patient is in the Ambulance
We need a seismic change in the medical system, and that starts with medical school education. When cardiac researchers lamented the shortage of sex- and gender-specific educational material about cardiovascular disease in clinical training programs for physicians, they found that this irregularity in integrated curricula across all medical schools “may be a factor in persistent disparities in clinical care and outcomes experienced by women, compared with men.”(1) See also: Nine lessons about women’s heart disease that future doctors will learn in med school
That seismic change also applies to nursing school education.(2) Although university courses are taught on women’s unique health concerns (both directly and indirectly, as custodians of their family’s health), most courses have been offered through Women’s Studies programs – not nursing schools. Recently, a growing awareness of this gap has developed among nurses – although nurse educators have been “slow to develop courses that address women’s health issues other than traditional medically-defined focus on women’s childbearing and reproductive issues.”
When I spoke to the Canadian Women’s Heart Health Summit held in Vancouver recently, one thing struck me. Those attending this annual conference were already very well “aware” of the cause. The most powerful awareness-raising opportunities came from the unforgettable personal stories told by 15 of the speakers who were women with actual lived experience of heart disease.
The bottom line (as the American Heart Association itself learned from their disturbing survey results): women are less aware now than they were 10 years ago. So why would we insist on doing the same thing next year and each year after that – as if we don’t know what those survey results were?
For over 15 years, I’ve been dutifully sporting my Red Dress lapel pin every day each February to mark Heart Month. I’ve handed out thousands of these little pins at my Heart-Smart Women presentations. I’ve been asked about this pin while out in public exactly once in 15 years (by a cashier at my local grocery store). Maybe, just maybe, we must admit that lapel pins and red lights shining on Niagara Falls and wearing red one day a year is not working.
It’s never too late to rethink strategies. Let’s consider focusing the money and effort spent on failing to raise women’s awareness toward the doctors and nurses of the future instead.
1. Adreak, N. et al. Incorporating a Women’s Cardiovascular Health Curriculum Into Medical Education. CJC Open. 2021 Sep 28;3(12 Suppl):S187-S191.
2. Hagell, EI et al. Time for a Change: Women’s Health Education in Canadian University Schools of Nursing. Health Care Women Int. 1990;11(2):121-31.
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Image of hanging red dress in Venice: Sabine Kroschel, Pixabay
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Q: Is it finally time to put that Red Dress back in the closet?
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NOTE FROM CAROLYN: I wrote much more about what women know (and don’t know) about heart health in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop (please support your independent neighbourhood bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from Johns Hopkins University Press (use their code HTWN to save 30% off the list price).
Heart Sisters 
I totally agree that most “awareness” campaigns need to make serious adjustments. I dread every October and shifting to look closely at the education our HCWs get (all of them) is so key!!
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Thanks Abigail for sharing your perspective. Because I follow you on social media and on your “No Half Measures” blog, I know that you’ve been living with Stage IV metastatic breast cancer for a number of years now.
Your reference to dreading October is important – and may be a surprise to readers here who view National Breast Cancer Awareness Month as a happy month-long explosion of pink positivity, largely ignoring the reality of metastatic cancer for so many.
Improving the education of those who will one day work in a future health care system is critically important to me. I wrote here recently about Australian researcher Dr. Lea Merone, who suggests that the disturbing gender gap in diagnosis and treatment of female patients “also translates into a gap in medical education in which, outside of reproductive and sexual health, both medical/nursing schools and clinical textbooks frequently omit women entirely.”
This shocking statement explains a lot of what’s behind this gap.
It has to stop.
Thank you again Abigail for your comment. Please take care. . . ❤️
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Carolyn, ever the vanguard for us, thank you for raising awareness of the need to change course.
My WomenHeart focus a decade ago was in classes for nursing students and college anatomy and anatomy and physiology (a required pre-med undergraduate course). I had to modify my presentation materials to be relevant, and was told more than once that I was not supposed to alter the presentations. I did it anyway.
My own assessments showed it was making a difference for these students. I tried to encourage development of materials to target professionals in training, but it was too innovative.
While the data presented is discouraging, I am NOT the least bit surprised by it, and hope it pushes those of us who really care about making a difference to fight for change in the educational processes and audiences.
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Hello Pamela – I wonder what “too innovative” means? And I also wonder if it was the WomenHeart organization or the nursing school where you were teaching that told you you could not alter your class content?
My own early experience with senior staff at WomenHeart (I was in the Mayo class of 2008) left me with a comparable sense that they seemed to like the idea of their grads doing the speaking, group facilitating, political lobbying, fundraising and all the legwork as long as we didn’t get too uppity (was it those darling ‘Red Bags of Courage’ I could distribute to my audiences that kept me in for all those years?)
Don’t get me wrong – I learned SO MUCH about women’s heart disease at my training in Rochester (truly a life-altering experience) and I love many of the WH ongoing initiatives (like the online WomenHeart Connect support groups) that are so helpful, especially to what I call the “freshly diagnosed” heart patient.
Take care, stay safe out there, my heart sister. . . ❤️
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I was in Emergency in Kamloops in February and the nurse was asking me about microvascular heart disease, and then asked another ER nurse to come and listen to what I had to say.
Both listened to me and my husband about the lack of studies and info on women’s heart disease and symptoms, both said the same thing, “So these are the women that come in and we send them home not realizing that they were experiencing heart symptoms which were different from men”.
I also told them that most studies they studied were done on men. At least they listened which was encouraging for me. That being said, I have two adopted children with FASD (Fetal Alcohol Spectrum Disorder) and I had spent many years of my life getting this out into the public, and for a while it worked, but then it was no longer the flavor of the month and it was again put on the back burner. So very disheartening working in the school district to watch these children no longer get any help. FASD didn’t go away, didn’t get better, it just got put on the back shelf again.
For me, having microvascular heart disease and refractory angina it seems as though because I haven’t had a heart attack that this disease is somehow minor.
I have had doctors shrug as if it’s no big deal. And yet it has completely changed my life and I am now on longterm disability and I struggle every day with angina, shortness of breath and extreme exhaustion, just to mention a few symptoms.
I really believe that women’s heart disease needs to be recognized all year long, not just in one month. This needs to be on commercials just like diabetes or cancer. More awareness is important for everyone. And yes, medical students really need to have way more training on how women’s hearts and heart disease is different. This should be mandatory in their education.
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Hi again Tracy – I actually felt goosebumps reading the nurses’ reaction to your explanation of microvascular disease. You did both of those nurses a big favour by sharing your knowledge, and they were remarkably impressive nurses to listen so attentively to you. I too live with MVD and refractory angina – these used to be referred to by cardiologists as “trash basket” diagnoses. Not because they belonged in the trash, but because they were only thought of when every single other diagnostic possibility had been discarded. Nice. . .
I’ve often heard women sound almost apologetic that they didn’t have a heart attack, or that they “only” had a heart rhythm diagnosis like atrial fibrillation, or open heart valve replacement surgery. But as I wrote here, when you become a heart patient, it’s NOT a competition. For example:
“There is NO SUCH THING as a ‘mild’ cardiac diagnosis. Every cardiologist who tells a worried patient that there’s something wrong with their heart is delivering catastrophic news to that person and their family. ..”
Tracy, since you were at the Kamloops hospital, I’m guessing you are also a BC resident? If so, have you ever considered joining the Patient Voices Network? It’s a volunteer group of patients in BC with lived experience (all kinds of diagnoses, not just cardiac) who advise researchers, doctors, anybody who is looking to learn more about patients’ perspectives. I’ve been a member for about 14 years now. I get regular lists of Patient Voices requests, but only say YES to the ones that intrigue me (and don’t require any travel or sitting in long meetings!)
Just last month, for example, I volunteered to chat (via a Zoom call) with four young nursing students in Vancouver about my own patient experience with hospital nurses, the good and the not-so-good! Your story about the two nurses reminded me of some of the positive examples I was able to share with those Vancouver students. More info in case you might be interested: https://patientvoicesbc.ca/
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I would rather wear a T-shirt that says “Ask me about women and heart disease!” than a red dress lapel pin.
As a matter of fact, I am asking a friend of mine to make me a few T-shirts in different colors.
I would rather see commercials during any major sporting event to talk about symptoms and death rates – in other words, people should be somewhat scared into reality. Just one month is not enough.
By the way, I tell every woman about symptoms, and I tell new heart patients to buy your book.
Thank you!
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Hi Tracy! Before long, I’ll have to start paying you a commission for helping to publicize my book! 🙂
I love your T-shirt idea – that’s a direct ask for an action step (“Ask me!”) And I absolutely love that idea about inserting public service announcements in all major sporting events. I’ve been following the NHL hockey playoffs – that’s a great example of a captive audience of fans absolutely glued to their TV sets.
You may be on to something with your comment about “people should be somewhat scared”. That’s been effective in many quit-smoking initiatives. Smoking rates have been significantly falling each year, due to the combination of scary photos of smokers with lung cancer on cigarette packs, plus of course the general societal shift that has made smoking less acceptable in public places. When I was a kid, by comparison, every home had fancy ashtrays in the living room for company, and there was only one answer to “Do you mind if I smoke?” (which was “Of course not – go right ahead!”)
Thanks Tracy ❤️
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Sometimes fear is a good thing, as you said about smoking. And yes, was the same in our house, and of course everyone smoked back then. But awareness of cancer and other health risks changed that.
We only have one heart. I had no idea how far behind heart disease in women was until I became a heart patient. I have no problem telling everyone woman I know about the symptoms and how they are different and the lack of knowledge. They all say the same thing, “Why don’t we know this’?
I think every single sporting event such as hockey, NASCAR, golf, Olympics, the list is long – should have commercials about women’s heart disease, symptoms and yes the lack of knowledge in the medical industry.
Let’s get loud about this!
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I think an important question for a woman to ask a medical provider in virtually every medical situation (especially a crisis/emergency, and excepting gynecology) would be:
“If you were looking at the same date, symptoms and information from the patient, but the patient was a man, would your conclusions, diagnosis and treatment recommendations be the same?”
Maybe could at least disrupt the bias flow.
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Hello Kathleen – that is so amazing that you’ve brought up that “important question” to ask your docs! It turns out that disrupting the bias flow is a real thing. Dr. Jerome Groopman (in his terrific book “How Doctors Think”) recommends questions to ask a doctor to help avoid misdiagnosis if patients suspect their doctor seems to be on the wrong track. One question is simply “What else could it be?”
Dr. G. explains: “The cognitive mistakes that account for most misdiagnoses are not recognized by physicians; they largely reside below the level of conscious thinking. When you ask simply: ‘What else could it be?’ you help bring closer to the surface the reality of uncertainty in medicine.”
Whenever I hear a dreadful story from one of my readers about being dismissed or not heard by a doctor (like Jennifer’s story – see her comment below), I automatically try to imagine that doctor saying those very same things to a male heart patient. Most of the time, that answer is NO WAY.
Take care, and keep asking those questions! ❤️
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Hi Carolyn,
The problem in a nutshell is the fact that we are women and we aren’t respected by society at all. Whether doctors look at us as small size men or second class citizens, they fail to see us. Not even those women who are cardiologists see us as patients – but only as women. I don’t fault them as this is the way they are taught.
Case in point: I’ve been an established cardiac patient with stage D congestive heart failure. I was taken to the hospital by ambulance with the symptoms of a heart attack. They were told to start an IV before leaving my home. The first to ignore me was the paramedic placing the IV line and starting fluids, I told him the standard IV needle was too large, and what type I needed. He told me every adult can use it.
They were ignoring me because I was alert and talking. At my home, I had no blood pressure and registered a systolic pressure of 60 and no diastolic pressure – but I was alert.
I was moved to an ICU area and placed on a cardiac monitor. I laid there for an hour before someone came in to run an EKG and take blood. They came back within 30 minutes for more blood and to place an IV in my other arm. The nurse asked me ‘where was the blood coming from that was dripping on the floor?’ I told her “the IV that the paramedics placed” – and they found I was bleeding around the needle. They had to take it out and put in another.
That was in March, they had me on a 72-hour hold for observation. They did echo and nuclear stress tests. Set an appointment with my cardiologist in August. He informed me that I had a severe arrhythmia problem and needed an ICD as soon as possible. He stated I would be getting the most advanced device (A-ICD). I was then scheduled to see my now-electrophysiologist. They got me an appointment for October. I figured I had all the time in the world and the surgery was set for February. Because I never look sick, I am pushed back. The fact that my cardiologist called it urgent played no part in it.
I was a woman and I didn’t look sick.
I’ve had them walk in my room reading my medical records on the computer and then go back out thinking they’re in the wrong room.
Take care,
Robin
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Hello Robin – I’m guessing that you are a conundrum to most physicians! I loved your simple summary:
“I was a woman and I didn’t look sick!”
That says it all. This was my experience too the first time I walked into Emergency with heart attack symptoms. Being able to walk, talk, think, drive my car do not scream out impending HEART ATTACK to Emerg docs. As you describe, you too were alert and talking. And I did not look sick despite my textbook cardiac symptoms (central chest pain, nausea, sweating and pain down my left arm). “You are in the right demographic for acid reflux!” pronounced the very confident Emerg Doc. . .
You also seem informed about every procedure or treatment you’re about to undergo (probably more so than most healthcare professionals – who may be the ones ordering the procedure, but have not likely HAD the procedure done to them and are not the ones living with your diagnosis).
You may have to do some advance translation during future medical encounters. For example, when your cardiologist calls a procedure URGENT because you have a SEVERE arrhythmia problem and “need an ICD as soon as possible”, it likely means you do not have “all the time in the world”. It may however still mean that any doctor or nurse looking at you may be fooled by the fact that you do not look sick. Not “looking sick” is beside the point when your own cardiologist uses words like “URGENT” and “SEVERE”.
So when anybody attempts to “push back” your appointment, you may need to raise a little hell to emphasize how URGENT and SEVERE your condition actually is. This may not get you into the priority queue, but it could get you on the wait list.
Good luck to you. . . ❤️
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I have a very detailed theory about how our diseased hearts are a reflection of the diseased Heart of Humanity, and that Humanity evolving into a more loving, selfless society will lead to a decrease in heart disease among both women and men.
But until that happens, I believe as you have said that medical education needs an overhaul.
Back in the 80s I wrote my Master’s thesis on the effects of nutrition on respiratory muscle strength. I did this because I was witnessing daily that people in the hospital were unable to get off of ventilators because their doctors were starving them. Giving them only IV dextrose and water!! Medical students at that time did not even get a single course in basic nutrition. This has improved in the the last 2 decades.
More love and more enlightened health care are in the future. However, evolution in society and in medicine remains quite slow.
The cure needs to be from the inside out. The inner heart needs to be nourished even as we fight the disease of the outer heart.
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Hi Jill – what an interesting perspective you describe – that concept of inner and outer, and the “diseased heart of humanity”.
I wish I were as optimistic as you when it comes to predicting a decrease in heart disease. Or maybe I’m just feeling more impatient than you because this “evolution in society and in medicine remains quite slow.” SLOW!?! It’s positively glacial…
I was just reading the other day some stats from earlier this year published in the cardiology journal Circulation. This U.S. study reported that cardiovascular disease deaths saw a “steep rise” in the past few years, with the number of deaths surpassing the previous high in 2003.
COVID of course was mentioned as one of the possible contributing factors, especially among Asian, Black and Hispanic communities.
Your story about your patients on respirators and essentially being starved is a shocker. Thank you for making that practice the subject of your graduate nursing degree!
Take care – stay safe out there. . . ❤️
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Yes it is time to say goodbye to the Red Dress.
This symbol has been over shadowed by red dress/missing indigenous women and most people don’t have a clue about women and heart disease.
I personally am sick and tired of seeing tattered, dirty, strewn red dresses everywhere. Wasn’t the red dress also a symbol of prostitution where many madams and her girls wore. What is wrong with a symbol of multi-generational women holding a large heart? That would represent me, my sisters, my mother, my daughters etc!
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To scotsrish:
I LOVE that symbol! I have often wondered who the marketing person was that came up with the Kaiser logo of multi-generational figures in a Sunburst and the word Thrive!
The truth is that Women are a key to the entire transformation of society. Their unique ability to bear children and to nurture is the embodiment of self-less Love. It is said that a mother’s love for her child is the closest thing there is on earth to Divine Love. This does not mean you have to bear children to experience this self-less Love, but just speaks to the ability of women having the built-in ability to experience it easier than men.
So the increasing numbers of women in health care, in leadership positions, as scientists, brings the ability to weave a bigger dose of selfless love of mankind into these professions, over selfishness, power and profit as motive.
When in an ashram in India, it is customary for men and women to sit on separate sides of the room. When our guru came to walk amongst us students, he always spent more time on the men’s side rather than the women’s. When he was asked why he spent more time with the men, he said “Because they need it more.”
Google says there are between 40 and 400 shades of red and the dress as a symbol for women is anachronistic at best… going the way of pantyhose and heels… I hope anyway!
But Life is a Process moving towards greater Wholeness and Oneness. If we can find peace somewhere behind the injustices and patience behind the slowness of change, we are creating internal health guaranteed to reduce the strain on both our physical and spiritual hearts. ❤️
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Hello Scotsrich – I like your suggestion of a multi-generational symbol to help ALL women (every age, every skin colour) feel represented when learning about heart disease.
I have a different perspective re those “tattered, dirty, strewn, red dresses” hanging in front yards, gardens, fences or balconies. I believe they are supposed to make us feel uncomfortable.
That discomfort is nothing compared to the horror of what countless indigenous women and their families have historically endured. Our police agencies basically ignored reports of missing daughters, mothers and sisters. But if my (white) daughter is ever reported missing, you know that police would leap immediately into exhaustive investigation. The reality of countless families whose loved ones were murdered or missing with no consequence – and even worse, zero intervention from authorities specifically because the victims were indigenous – is a national disgrace.
My understanding is that the goal of this Red Dress project was to speak to the gendered and racialized nature of decades of horrific violent crimes against Indigenous women by “marking absence”.
When I see those hanging empty red dresses (tattered or not) around my neighbourhood, each one makes me feel sad for all those families who suffered unimaginably, yet hopeful that so many of my neighbours are now becoming their allies.
Sad and yet hopeful – not “sick and tired”.
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I agree that it’s the Doctors and students that need the “Red Dress” awareness!
I would have died had I not been persistent. The night I went to ER with odd symptoms, squeezing sensation near both armpits, severe headache, forgetting to breathe, overall anxious feeling ( I’m a laid back Finlander) and a feeling of doom, I was told “You’re fine, you can go home, but if it makes you feel better, I’ll let you stay in observation overnight and re evaluate in the morning. Now excuse me while I attend to the fellow next door who really is having a heart attack…”
I had a stress test the following morning with “iffy” results. My choice if I wanted to look further. This was now a Tuesday morning, I was dismissed twice now, but allowed another option, even though it’s really invasive, it’s your choice. I said I felt unwell, so let’s keep looking. Well, I had a triple bypass on Friday morning. Yep, something was wrong. Widow maker ready to blow and my heart was left dominate and the right side would have never sustained me.
Where I want to praise my emergency room doctor, and I did to his face, he did want to dismiss me and spoke down to me, but relented and let me stay. Had I gone home that Monday night, I would never had returned cuz I would have believed “it’s not your heart”.
I saw this doctor again, as a patient in the dental office I worked, about 5 months later after I had recovered from surgery. I told him he saved my life that night, and proceeded to tell him what took a week to diagnose after he left me in that emergency room to take care of a guy who really was having a heart attack.
I hope he learned to start really listening to his patients from that point on. I am lucky he relented and let me stay. I will also never forget how hard I had to fight that week to be heard. And to live.
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Hello Jennifer – what an ordeal you went through! Generally, male heart patients do NOT have to fight to be believed, yet what you describe is appallingly common for women. I’m so glad you kept insisting something was wrong, and that he “relented” (although it is truly revolting to accept that somehow doctors are doing us a big favour by believing what women say!) That’s what researchers call “implicit bias” – a remarkably common reason for diagnostic error.
But he didn’t do you a favour – he did what he should have done right off the bat, which was to believe you when you told him you were sick. A brief example: one of my readers told me about overhearing a conversation between the Emerg doc and the (male) patient lying on the bed next to hers behind the curtain. The doctor said: “All of your cardiac tests came back ‘normal’ – but we’re going to admit you for observation just to make sure it isn’t your heart.” That’s what did NOT happen to you – you should never have had to convince your doc to “relent”.
It’s possible that you may have convinced him to “start really listening” when you later told him the rest of your story in the dental office, but honestly, I’m not holding my breath until any future personality change.
Take care, stay safe. . . ♥
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