When I was in college and riding my bike around Boston in the 70’s I had a few close calls with parked cars. Drivers would park and, without looking, open their door as I was riding closely beside the line of cars. Depending on where I was when the door swung open meant the difference between a polite interaction with the driver issuing an apology, and a flight over the handlebars, over the car door, onto either their windshield to the right, or traffic to the left. My brother, also an avid city cyclist, and I were discussing this one day and he told me the thing to do at each close call was to start screaming at the driver. Apparently, this was the bikers method of making them not do it again. I’m not sure if a study was ever done to see if it was effective, but that image stuck in my mind. (What was more likely was that drivers just started hating cyclists.) It has taken decades to get bike lanes in cities and I’ve been in advocacy groups having hours of discussion about how to make the roads safer for bikers.  The groups usually convene after a cyclist is killed.

Which brings me to women in our health care system.

I’ve gotten accepted to do a TEDx talk about what is happening to health care for women in this country.  This is a huge responsibility. I’ll have between six and twelve minutes to describe what is happening in our system, how women are at increasingly higher risk for long term consequences (including death) from unnecessary procedures, and how they suffer lack of access to safe care. I’ll want to describe how discrimination against women in our system is escalating for various reasons: finances, ignorance, fear, and the long-standing culture of medicine. Then I will want to give a few examples. Then I will want to explain what we can do about it.  How we all can act to change the tide of the RISING MATERNAL MORTALITY RATE IN THE UNITED STATES, because, someone has to be killed to have the advocacy group meet to discuss what we can do, right?  We can’t just use common sense and value human life. We have to show there have been human sacrifices on the altar of money and power. This is a lot for six minutes.

I get angry when I hear women’s stories. A woman refused an unnecessary procedure and was consequently denied care. She was labeled a “difficult patient” and sent on her way for refusing a procedure with no documented medical value.

I was irate when relating this story to a friend this morning.  He questioned why she would refuse the procedure, and I made the immediate assumption that he was siding with the medical establishment; that the average woman isn’t educated enough to know what is good for her. My assumption was that he believed that a pregnant women should hand herself over to those in control, specifically, doctors. Well. I went into praying mantis mode and, while biting his head off, started my rant about how she was actually the more informed one, despite the doctor’s years of medical education. The procedure is, in fact, irrelevant in that situation. Was my assumption correct? Was that what he was saying? No (I hope). But he hit a nerve and I reacted.

Did my point get made? Will the driver open his door again in front of a cyclist? Or just start hating women’s advocates? How in six minutes, or eight, or twelve, can I be informative and passionate but not angry?  And then I think…how can what is happening to women NOT make you angry??

“You’ll turn people off with that anger.”  I’ve heard that more than once.

I sat in church this morning and thought about this. The doctor who denied this woman care was probably not intentionally abusing her. He may have believed the procedure was necessary. Or he may have known it wasn’t but felt it would protect him from a lawsuit. I don’t know his rationale. And the woman may have been very well informed and challenged him with the data about the procedure, or she may have been very ill informed and just scared. It doesn’t matter. What matters is she was not well cared for and punished for advocating for herself. This happens over and over again in our system.  If you are female and advocate for yourself, you’re difficult.  If your life circumstances have led you to drug addiction, you’re difficult. If you are obese, you are difficult. And instead of looking at the situations our society has created through poverty and hopelessness as a problem we all must deal with, medical practices can say, “Too difficult! Out with you!” And this, apparently, is legal.

So what can we do? How do I channel the anger into action? Should we sue them? That seems to be the ultimate fear of providers and hospitals. They get sued for bad outcomes which, is an incentive to do more unnecessary procedures, which drives up the cost of care, which means fewer people can afford care, which leads to poorer outcomes.

I’m starting to see the one minute application video was the easy part. I’ve got to fit a whole career’s worth of women’s stories into six minutes and leave people with their heads intact. Yikes.