Mhairi Agnev has suffered from recurrent abdominal pain for more than half of his life.
When she first complained as a child, her longtime family doctor in New Brunswick suspected food allergies. When the tests ruled that out, he blamed the stress.
“That was always his answer …” You are too stressed, “said the 20-year-old student. “But no matter how much advice I got or no matter how many relaxing things I tried to do, the pain never went away.”
When puberty began, Agnev said, the pain worsened, but her family doctor did not want to do any gynecological examination or refer her to another doctor or specialist.
“He refuses to touch me,” Agnev said of her doctor. “I asked him, ‘Like, push here. It’s … hard or it hurts here “and it won’t touch me. I asked him to give me an exam if he didn’t want to send me to a specialist. He refused. “
Agneva’s struggle to find a doctor who would listen to her eventually led her to a private women’s clinic where she now pays for gynecological care out of her own pocket. She is part of a growing number of women who have given up on timely care in the New Brunswick public health system.
Agnev does not know why it is uncomfortable for her family doctor to perform physical examinations. She tried to find another family doctor, but with a shortage in the province, that is simply not an option.
“The waiting list is about five years long,” Agnev said. “So, I would have to rely on admission clinics if I lose my family doctor, and I have other problems that I need prescriptions. [for] … it’s just easier to keep him for those questions, and then I tried to find a way to treat my other problems that he wouldn’t cure. “
Jacqueline Gahagan, a professor of health promotion at the University of Dalhousie and director of the Gender Studies Unit, is not surprised by Agnev’s experience.
“Women are still struggling to get the kind of care they need for competent patient-centered, woman-centered care. And that’s the problem,” she said.
“If someone doesn’t feel comfortable providing an internal examination, then they probably shouldn’t be taking care of patients who have an intact uterus and ovaries.”
Women face barriers to health care
Dr Jeff Steeves, president of the New Brunswick Medical Society, said family doctors had the right to refuse to provide any type of care that seemed morally or religiously unacceptable to them, even though “the vast majority of family doctors would be comfortable and able to provide it.” care, ”he said.
“The moral conviction of the doctor should not interfere with the care that the patient receives … that the doctor is not obliged to provide it, but they are obliged to refer the patient to the resource [where] I can get that care. “
When the family doctor refused to refer her to another doctor, Agnev tried to visit the clinic for admission, but the doctors were told not to treat stomach pains there. For the past year, she has been referred to a hospital emergency room, where she waited for hours a day before leaving without ever visiting a doctor.
Gahagan said that the combination of attitudes and structural obstacles that Agnev faced in the health system is not uncommon and can often lead to what is known as “missed health care”.
“In other words, the interaction with the health worker is so unconfirmed and so unsafe that individuals will … give up or give up trying to find other ways to solve it in a health system that simply doesn’t hear them, but doesn’t see them and doesn’t know how to treat them. “
Gahagan said that this, combined with the lack of family doctors, creates a “perfect storm” for people who have not been treated or diagnosed for years.
‘It’s all in your head … sorry’
Agnev believes that she tried everything, except that she filed a formal complaint against her doctor, because she is afraid that he could leave her as a patient, and she depends on him for prescriptions.
At one point, she even tried to take her fiancé with her to meetings in hopes that her doctor would be more likely to take her concerns seriously if they came from another man.
To see how unheard of Agnev’s story is, Gahagan suggested that people reverse the scenario and imagine a male patient with a history of prostate cancer visiting a doctor who refused to examine him.
“In order for the doctor to say to the male patient:” I’m sorry, I’m not comfortable sticking my finger in my buttocks or rolling my testicles in my hand, even though I’m trained in how to do it – you will have to go to someone else. And no, I’m not going to see a proctologist – it’s all in your head … sorry. ‘”
Gahagan said it will happen “on the front page of every paper” and will not disappear quietly.
Meanwhile, Mhairi Agnev “has to bring her boyfriend to a meeting with a male doctor to say again, ‘No, it’s not all in her head. I live with her. I understand. I know she’s in pain. Can you help us?'”
As waiting lists grow, so does the demand for private care
In a last-ditch attempt to get someone to hear her symptoms and help find the cause of the pain, Agnev did what most people do: she typed her request into the Google search bar.
She opened a new private women’s health clinic in Moncton, called the ReConnect Health Center, where she managed to make an appointment for three days with a gynecologist for $ 180.
The price list was another obstacle for Agnev, who lost her part-time job when the pandemic started, but concluded that it was her only choice. After the consultation, Dr. Karen Desrosiers sent her for blood tests and ultrasound.
“It was immediately like, ‘Okay, I think you could have endometriosis or polycystic ovary syndrome just because of the sounds of your symptoms,'” Agnev said.
Since then, she has received the results of her tests, which indicate polycystic ovary disease and a rebuilt uterus, which is a congenital defect that could explain the pain she experienced as a child.
“It’s boring that there has to be a private clinic and you have to pay for it, and it can’t just be public,” Agnev said. “But at the same time … it’s really worth the money in the end.”
Gynecological problems are still “taboo”
Since the ReConnect Health Center opened last summer, the demand for women has been steadily increasing, says Katie Kelly, co-owner of the clinic, who is also a pelvic floor physiotherapist. Her next available meeting is only in mid-July.
Kelly said that in New Brunswick, if it is not urgent, women who need gynecological care can face waiting times longer than a year.
“Things like urinary incontinence interfere with their ability to play with their children or prevent their pelvic organ prolapse from going back to running because that’s what they wanted to do,” Kelly said of patients whose quality of life suffers.
“Or women have menopausal issues and don’t have someone who can give them practical exercises that could help with those conditions.”
Kelly said that women’s health issues are “taboo” and that they are not given attention or the necessary resources.
“We’re trying to fill a gap for women who may not have access to a family doctor, they may want a woman to take their exam, they may want access to a gynecologist a little faster than the public system can provide.”
Call for review of women’s health services
Steeves agrees that there are disadvantages for women who need urgent care.
“Almost everyone has access to care,” he said. “So we have to improve that to get rid of the word ‘almost.’
The New Brunswick Medical Society began calling for a review of “women’s health and reproductive services,” including gynecological care, family planning and fertility, a few years ago, and launched it with the current government.
Kelly hopes that more women will talk about their experiences and that New Brunswick will finally be able to “move the needle” when it comes to health services.
“Gynecological issues … are embarrassing. Maybe we’re joking with the best girls to laugh when we pee. We’re not talking about painful intercourse. We’re not talking about birth trauma.
“So if we don’t report these problems, we can’t expect the funds to help them.”
Gahagan believes that the ultimate impact of the type of structural and attitude barriers that Agnev has faced is that women’s health as a group will deteriorate over time.
“These micro-aggressions and this kind of sexism and misogyny that are being tried in an attempt to satisfy your health needs are so incredibly painful and long-lasting. You just say, ‘Fuck.’ I can’t count. ” ” She said.
“And later you show up in the emergency room with a heart attack or some form of cancer that could easily have been detected and treated.”
Agnev concluded that until something changed, in order to get the help she needed in New Brunswick, “yes, I have to pay.”
On Wednesday, the second part of this story will explore what led Dr. Karen Desrosiers to give up the regular practice of obstetricians and gynecologists and how doctors in New Brunswick can charge patients and offer private care.