Nydrianna Raines was pregnant with her son within months of losing her grandmother and father, and she was feeling down.
The Little Rock, Arkansas, mother of three asked her doctor at an Arkansas women's clinic for mental health help. The doctor barely acknowledged her request, telling her she likely had "seasonal depression" and her symptoms would pass.
"They didn't recommend any services," Raines said. "They didn't recommend any medication. They didn't do anything to help me get over this."
Raines' symptoms persisted through her pregnancy and after she gave birth to her son in November 2020. Things were so overwhelming that Raines asked her mother who lived in Florida to take temporary custody of her two daughters, Kehlani and Nyla, while she cared
for her newborn son, Jaxon.
At the time, she was in temporary housing after experiencing homelessness. Her depression was so overwhelming that she could no longer breastfeed her son because her body stopped producing milk. She had to buy formula instead.
"It was just too much to be disregarded by the health system," Raines said.
New research suggests Raines' experience isn't unusual for many women seeking care from the U.S. health care system. Just over half of U.S. women, 51%, had trouble when accessing health care over the past five years, and one in three women strongly or somewhat agree that a doctor or other clinician has minimized or dismissed their pain symptoms, according to a survey from Gallup and Pivotal, a group of organizations founded by philanthropist Melinda French Gates.
Other problems women confronted when seeking care from a health care provider included misdiagnosis, not getting answers or clear direction about next steps and conflicting or inconsistent information. Women were more likely than men to strongly or somewhat agree they've experienced such common aggravations.
With inconsistent health insurance coverage, a doctor shortage and health care providers with busy appointment calendars, consumers commonly face difficulties or delays when seeking to schedule an appointment. Yet once they get time with a doctor, the Gallup-Pivotal survey suggests patients often encounter more difficulties.
The survey "uncovers an entirely additional set of challenges that exist within the health care system, and unfortunately exist to a greater extent for women than for men," said Stephanie Marken, a senior partner who leads Gallup's custom research division.
Why does the gender divide persist in health care?
Other research has revealed a similar disconnect between what patients consider important and what doctors ultimately note from appointments.
In a new book, "Seen but Not Heard; What Medical Records Don't Tells Us About Women's Lives," sociologist Jennifer Silva and epidemiologist Annemarie Hirsch examined differences between what doctors note in electronic health records and what patients told them. The authors examined records from an unidentified, mid-Atlantic health system and compared those notes to what dozens of economically-disadvantaged women shared with the authors during interviews. The authors didn't interview doctors but instead relied on their notes.
Silva and Hirsch said the accounts between what doctors note and what patients say can vary dramatically, enough that some patients might lose trust with their doctors or other health providers.
In some cases, women might've shared information with a doctor that the health provider didn't document in the records, said Hirsch, a professor and co-director of the Geisinger-Johns Hopkins Bloomberg School of Public Health Environmental Health Institute.
In other cases, patients might've withheld details from the doctor due to a history of being stigmatized or dismissed over conditions such as obesity or mental health. Or the details might've been so sensitive, such as circumstances related to a child custody dispute, that the patient feared sharing the information.
"The breach of trust results in women fearing they cannot share this information," said Hirsch.
Such communication breakdowns can mean a proper diagnosis is delayed for years. The authors found examples in which women waited a decade or longer for a proper diagnosis for conditions such as endometriosis or polyendocrine metabolic ovarian syndrome, a common hormonal disorder in women of childbearing age.
"They weren't getting the right test and often were seen as having psychological problems that caused the pain," said Silva, a professor at the Paul H. O’Neill School of Public and Environmental Affairs at Indiana University. "In one shocking case, it wasn't until a woman's husband went with her to the appointment and shared with the doctor charts and descriptions he had made of his wife's pain that the doctor actually believed her and ordered imaging."
Raines, the Little Rock mother of three, said she became disillusioned with the health care system. Instead of seeking care from a health professional, she leaned on her family and the father of her children for support.
She said she was hurt when her doctor didn't listen to her describing her depression.
"I just stopped trying to seek their (the women's clinic) help altogether," Raines said. "When I needed them the most, they couldn't provide the proper help that I needed."
Mental health, chronic pain take longer to diagnose
The Gallup-Pivotal survey of more than 5,200 adults over eight days in July found women were likely to wait longer for a diagnosis.
Two in thee men were diagnosed within three months of seeking care, but just over half of women received a diagnoses that quickly.
Sometimes it took several years for a diagnosis. About 23% of women waited at least one year to be diagnosed; 8% of women had to wait five years or longer.
Some conditions such as mental health and chronic pain took longer to identify overall. However, even when women and men had the same conditions, women usually had to wait longer for a formal diagnosis. The authors concluded the gaps persisted not only because women and men had different kinds of conditions but also because they experienced the health care system differently.
About one in three women skipped or delayed care because of cost in the past year, compared with one in four men who cited cost as a barrier to care.
These disparate experiences with the health care system can trickle down to other facets of life such as work. Women were more likely than men to say health has limited their career in some way or has discouraged them from seeking a promotion, leadership role or new job.
Gallup's Marken said the survey results should spur medical community action to take steps to improve relationships with patients.
"It's not just about getting into a doctor's office," Marken said. "It's actually having a quality interaction and relationship with the provider that leads you to an accurate diagnosis."
This article originally appeared on USA TODAY: Her postpartum depression spiraled and she couldn't get care. She's not alone
