Portrait of three surgeons standing surprised

Is there gender bias in appointments in the NHS?

Listening to the podcast of AVfM radio this morning at the gym, I heard the voice of Peter, who I had met yesterday in London. He had relayed the story about his doctor’s rudeness, but I had not made the connection to a policy statement about appointment length until I heard him speak to the team on the radio.

Working in health myself, and having experienced the 5 minute appointment scam that makes up a lot of care in the UK, when I got home I immediately searched, using the kinds of words I knew would throw up any guidance on gender based appointment length in NHS settings.  I didn’t find a gender based commentary, but there was a big cluster of news articles in 2010 on the drive in the NHS to save money by shortening GP appointments, so it would not surprise me if this is where it is coming from.

Those of you who don’t live in this country need a bit of an explanation of how the NHS works to help you get what is going on. General practitioners are the primary care physicians in the health service here. The vast majority of initial contact for health care is done via your GP. This is free at point of contact. However, GP surgeries are effectively private businesses, who contract to the local commissioning body (which is regionalised to within a local authority boundary e.g. London, Cambridgeshire, Peterborough) to deliver primary care services. As long as they meet their contract they get paid. And rather well, with the typical GP earning around £80 – £100 K and many of them working part time. This is their salary after paying for the expenses of running their business and the staffing, but before tax and pension contributions.

As you can imagine this set up makes for a lot of reasons to find as many ways of getting bums on seats as possible; as surgeries are also paid to achieve certain targets with key disease conditions on a capitation basis. One way this is done is to devolve care down to nurse practitioners (qualified nurses with specialist additional skills, often able to prescribe), practice nurses or health care assistants. Another way is to use telephone triaging. A third is having short appointments, where the doctor is almost writing the script for a medication before you open your mouth.

In fact, Peter mentions one important contract variation around appointments in his commentary – the appointment for pregnant women being 30 minutes. This is completely correct and is part of the contractual agreement for pregnancy services. The vast majority of GPs will not do this themselves, but will  pay their local health trust to provide a community midwife to deliver this service, and it is quite common for the community trust to have a community midwife and a midwifery healthcare assistant delver these services in a central point in a town for several GP surgeries. The actual face to face time with the midwife may be reduced to 20 minutes, with the first 10 minutes care being the measurements taken by a relatively unskilled and low paid HCA.

So, how can we work out if there is a misandrous policy on appointments? I’ve contacted Peter and asked him if he could get more information from his GP surgery regarding this. If he gets lucky he might well be slipped a document which will blow this wide open…we are all trained up on our rights as whistle-blowers in the NHS as mandatory training, but I don’t think I would feel confident on a lowly paid admin job to whistle-blow on my employer who probably earns 6-8 time what I do.

There is however another way that might work. Our Freedom of Information (FOI) legislation might help us expose an example of institutional misandry. Under the FOI legislation the responsibility of public departments can be summarised as follows

  • a general right of access to information held by [the public body] subject to certain conditions and exemptions
  • a duty on us to inform any person who requests information whether we hold the information; and to communicate that information to the applicant unless one or more exemptions apply.

There is a list of exemptions available here for anyone interested in further reading here.

So, failing the option of getting the data via the surgery, then an FOI response would be revealing, regardless of what information comes back. The only problem here is who owns this possible policy – is it a Department of Health policy, or one which belongs to the local NHS trust. I think some digging might be needed.

A disclaimer here: many people reading this will think that this article gives a good set of reasons to avoid moving to a state run healthcare system. I still support accessible healthcare for all, but would prefer to have some elements of means testing within the system. People don’t value what is given to them free. Needless to say, my opinion is not popular either, but I would prefer to tell patients the cost of their failed attendance, so they truly understood the nature of the costs in the NHS.

About Aimee McGee

Aimee McGee lives in rural Eastern England in the community where she
nworks as a health professional. She is a human rights activist with interest in gender equality and disability advocacy. She plays in a brass band and shares her house with 2 tabby boy cats. Good coffee and English beer are her main vices.

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  • Tawil

    Your proposition here, if I understand right, is that there exists a possible (probable!) sexism in waiting and consult times. It is tantalizing due to the fact that an FOI might just give us this bombshell information.

    Aimee, I encourage you to pursue the FOI and you have my pledge to help advertize the results to the world at large if they show sexism. This would be an absolute bombshell if a gender bias were discovered…

    Good luck

    • Steve_85

      How would this be a bombshell? Business as usual, nothing to see here, move along citizen…

      • Tawil

        It would be a bombshell if official data confirmed it and it was taken up by the media. If you have official data showing this is business as usual then show it to me bro. Saying we all just know this in our own minds doesnt get us very far.

        I’ve seen what can happen when good quality FOI material get released to the press for the first time. In fact I have applied for sensitive FOI material in the past and leaked it to the press and the results were impressive.

        • Steve_85

          The sexism in our courts is literally tearing families apart, and even worse is encouraging more of the same. We have decades of case studies, we have hundreds of thousands of disenfranchised Dads, we have court documents going back decades… and how much outcry do we hear about it? Have you even heard a single person who isn’t an MRA or Father’s Rights group member complain about it? I sure haven’t. If they don’t care about this level of injustice and stupid… then why would they care about waiting times in a GP’s clinic?

          I’m not saying don’t do it… I just don’t expect anyone to care. Like I said, business as usual.

          • Tawil

            When it comes to the family law things are difficult to shift, agreed. Its easier in the medical and health area – eg. recently increasing attention, funding, research and services for prostate cancer in the last few years. This thread is about health proper, not the family court.

            Even in the family court I’ve seem countless people making a difference…. if you think the family court is bad now I can tell you its lightweight compared to the legislation feminists have attempted to pass into family law but failed to achieve- they failed to achieve it because a lot of men and women wrote submissions to parliamentary committees on same, submissions that cited a lot of cases, studies, data, stats, personal experiences, etc. These submissions made a difference – the Australian 2006 father freindly ammendments being an example of success, along with derailing the attempted watering down of those revisions by feminists in 2011. There is a lot more to do and it isn’t going to happen by moving along and ignoring it.

            We’ve got a long way to go and it won’t happen without a effort to fight it. The slow progress is cold comfort to dads alienated from kids now and I sympathise with them… but hopefully our efforts can at least make a difference for dads of the future.

      • Aimee McGee

        I have a role in my department ensuring we are compliant with the Equalities Act 2010. The act specifically names gender as a “protected characteristic”. To say men had less clinical need without some pretty compelling evidence (and I mean compeling to the level of “we can say without refute men have better health, lower suicide rates etc than women, so don’t need as much healthcare time)
        Written policy would be directly in contravention of the Equalities Act. There is not yet much case-law on the Equalities Act, but its starting to get there, and this would be a serious breach if my understanding is correct.

        Put it this way: our HR people have interpreted the Equalities Act to say we can’t give number or frequency of sick days in a reference for another job. This would be seen as potential discrimination on the grounds of (in many cases undiagnosed) disability.

    • Aimee McGee

      It would be a bomb shell if there was a written policy document. If there was none, we are not at the end of the trail by any stretch. Electronic patient systems could give us how long patient appointments were actually booked for in individual GP practices. It might take some careful phrasing of the questions to get the FOI right.
      Having responded to FOIs before, the question is critical. I might be asking for assistance from folk here to get the questions right.

  • MrStonedOne

    One little thing you left out. the relevant info from the podcast.

    He said that he can only get 5 mins max with a GP, but women get 15 and pregnant women get 30

    • Aimee McGee

      It may be happening in a regional manner to have the male/female split in time of appointments. As a woman I usually get a 5 minute appointment, but I am in a different region of the country.

      One of the reasons I want to know if this is regional or national, is it will influence how we present it to the media. If it is a national pattern, it needs to go in via the national press, if it is regional we are more likely to get interest at a local level first, and then it make national if it is picked up.

  • ChrisD

    There is bias in the NHS. Let me give you some examples I know of.

    Male friend (yes really a friend) suffering from depression after two family deaths, he’s coped with it for 6 months but now it’s too much. He’s gone to the doctor after telling several people he feels like killing himself, goes to the doctor and she basically tells him it’ll get better and everyone feels down after a bereavment. Kicks him out after maybe 10 minutes.

    Female friend goes to doctor because she lost her job, it’s only been 3 weeks and she feels a little down, doctor prescribes SSRI’s and lets her talk for 20 minutes.

    You might also want to look up discrimination in the benefits system. I would love to get some hard figures on it but I havea sneaking suspicion that men get turned down for certain benefits more often than women. I’m thinking disability and ESA.

    • Aimee McGee

      I’ve got a similar situation with a close male friend getting a nasty lack of care after a suicide attempt…and I am sure it is a gender bias issue.

      Problem is, individual cases make the headlines in the popular press, but if we want this to make a big ripple we need to see if there is a systemic bias, even at a local comissioning level. That would be picked up by more serious media outlets.

      Also, if we do find regional differences, approaching the local MP with evidence would be a way of getting our message out there – it doesn’t even have to be framed as an MRA issue. We only need to mention our male suicide rate and ask how men are supposed to be identified as suffering from depression in 5 minute appointments.

      • http://www.imnotamensrightsactivistbut.wordpress.com Isaac T. Quill

        This thread got flagged up in a Google Search and belatedly I have a few facts to add. I still find it amazing that in the UK it is seen as antisocial and sinful to be critical of the NHS – the greatest Sacred Cow in the UK. Thankfully as the Baby Boomers and their parents die off the reality is getting clearer as the NHS collapses and the reality just can’t be hidden.

        1) There is a general perception of Equality in the NHS which comes from the central tenant that health care is free to all at the point of delivery and based upon clinical need. It may be free but getting clinical need assessed mean you do need to get in the front door which has been a controlled and secured access point for decades.

        2) Access to the NHS has always (and still does suffer) Gender bias, and this has become an elephant in the room due to social perceptions. Access to healthcare care is not the same as provision of health free and based upon clinical need.

        3) When the NHS was founded the contacting for doctors to provide services to The NHS operated 9-5 Monday to Friday with Out of Hours emergency coverage (National Contract). In the 1940’s this meant that men (who were in employment mon-fri 9-5) did not have Equality of access – they could not get to the front door let alone through it. The vast majority of people with access were women and children. Social views in the UK were that it was women and children first – men suck it up and only get to see a Doctor when they were too ill to work – or during holidays. There was a known issue from early on of what was known as the Holiday rush with all appointments being for men when there were large manufacturing operations which could only allow holidays by the whole business shutting for a fixed period.

        The men with the best opportunity for access were those on shift work – either permanent night shifts, or rotating shifts from day to night and back again. This meant that many men were simply denied access to health care due to the systemic bias caused by Doctor Contracting Times and social norms. It was seen as normal for men to do without.

        Even when it was recognised that workplace injury and illness existed and Health and Safety Legislation was introduced (1974) with the vast majority of people made ill, caused permanent disability or death were men – not even then was there any attempt at a provision of medical services for work related injury/illness within the NHS. Occupational Health never made it into the NHS as a clinical speciality, only as a service that employers found themselves contacting in to avoid potential litigation. Even with such medical conditions as asbestosis and compensation, the NHS had minimal involvement and it was due to litigation that employers had to locate diagnose and treat past workers “”Prior”” to death.

        Only once the male was unfit for work did he obtain equality of opportunity to gain access to health care. This has caused many to describe the NHS as a National Sickness Service for men and Health Service for women and children. Historically men have only gained access due to Sickness, not due to health need or concerns over health. Scares over Heart Disease in Women connected to prescribed contraception resulted in women gaining preferential access to and even specific female heart health screening (Litigation Fear Being the Primary Driver). It should be noted that as women gain preferential access to The NHS in the UK the vast majority of adverse drug reports relate to women and not men.

        Men have had to contend with both the social bias that required then to be utile at all costs and at the same time to not place themselves in precedence of Women and Children. The Patriarchy has caused much bizzare skewing in health to the point where the NHS and the health inequality history indicate that the Patriarchy has never existed or if it has it has been female in form and massively geocentric with men denied access to this Patriarchy of health care and free services.

        The often heard screech of men being terrible in going to a see doctor has not been valid when you consider that Access to the NHS has been limited by contracting and how it has interfaced with society. Men have not had equality of access to health care in the UK ever, and historical bias is now seen to play out in modern management systems based upon IT and historical data. Lack of male access to the NHS just relating to work related illness has skewed mortality as more men have and still do die of work related illness than women. The only area of employment where female illness and mortality is higher than men is in hair care/dressing/barbers. This is due to the incidence of bladder cancer linked to specific dyes which have been found to be carcinogenic. Female vanity and hair dye has killed more hair dressers than people can believe. The increased incidence of bladder cancer has been sued to argue that women need better work cancer screening – and yet vastly more men still die more from work related respiratory cancers.

        4) Changes in the intervening decades (Primarly 1970’s onwards) were additions to the 1940’s NHS Doctors contract – Evening surgeries to see patients – Saturday Surgeries – these were all additions and money earning services for doctors. However, throughout the bias towards women and the child’s need deriving from the mother caused these additional services to be swamped by women. Exclusion of men continued. Media claims that men were bad at using health services simply concretised the fallacies and were seen as linked to excuses to not fund specific areas of medicine in ways that were socially accessible to men from within UK society.

        5) The biased National Contracts were only replaced fully in 2005 – nearly 60 years after it was first introduced and only after decades of fighting between governments, the General Medical Council (GMC), the British Medical Association (Doctors Union) and Insurers providing compulsory coverage to Doctors – and with them emergency out of hours coverage was also dumped and sent out to tender for contacting. The change was started back in the 1980’s but took 20 years to be made reality.

        But the history of bias still goes on …

        6) With the advent of Sex Discrimination legislation (The Sex Discrimination Act 1975) it protected women in the workforce but not men. Should a woman need time off work for health reasons it was made antisocial and illegal to obstruct women from accessing health services. However no such protection existed for men – hence access to health services received a new boost in bias. Women could have paid time off work for medical need – men did not. I saw this play out in the area of fertility treatment where the women could attend any appointment at any time and her male partner could not as his employer would not allow him time off – the employer feared her litigating and he had no protection. The couple eventually addressed the bias by selling their home to pay for fertility treatment privately – the Fertility specialist from the NHS also ran a private clinic covering evenings and weekends. If they had been two lesbians using IVF there would have been no issue(?) as they would have both been backed and supported by Feminist Dogma, but as soon as a male was involved that dogma only supported one party and the only solution was to BUY the needed care and medical support out of working hours.

        I also saw the issue with single fathers – they only got access to the NHS when the child’s health was the issue. If their health was at risk it was only an issue if they were not able to care for the child.

        Many Companies with high ratios of female employment have gotten into bed with the NHS and are able and do provide Gynocentric health care in the work place from Breast Screening to Pap Smears and wider health checks. There are whole mobile systems which arrive in corporate car parks to meet female health need and reduce female paid time away from the work place – no equivalent provision exists for men unless fully funded by employer with no NHS contribution. Such male positive provision has become extremely rare and now only exists in large manufacturing venues where the work force is predominantly male. But even there the situation has often resulted in bias with women receiving NHS funded care and men having to rely upon the largesse of their employer for equivalent in work opportunities.

        Men have no legal right to have time off work to gain access to health care as men – they only derive such opportunities where a secondary issue is present such as race, disability, gender reassignment and even Industrial injury. If you have a pre-existing health condition your employer must assess if you represent a risk to others. A heart murmour and risk of heart attack gets attention – chronic colitis or even prostatitis does not as the risk to others is minimal.

        7) With the advent of further legislation, such as the Disability Discrimination Act 1995/Race Relations Act 1976/Equality Act 2010 it has provided protection to men if they are from a Racial Minority, Disabled, Gender resigned etc, but not as a male. The NHS if terrified due to litigation of discriminating on any grounds, except against men (Who have no legal protection) which is why It has been so easy to ignore screening for men’s health issues – there has never been a single legal protection for men to require Equality in the NHS and still the culture of negation which was present from the first day of the NHS and which is still being made manifest today. A Disabled man may not be denied time away from work if he needs NHS or any Medical Treatment, so you have to become a cripple before you can get equality of access to the NHS, but still gaining access as a man is noted to be harder. When booking appointments it is all too often assumed that a male has no family responsibilities such as child care – so females are given precedence due to presumption of child care. This is indirect discrimination and very hard to prove. It should not be occurring as it’s illegal under the Human Rights Act (Article 14) but would have to be brought to court under The Equality Act where pro female discrimination is made lawful.

        Within the NHS there is also the Schizophrenic management issue of Equality Vs Diversity. The Equality issue are often weighted to employment and related litigation risk with union involvement, which is seen as high risk and costly. Discrimination against people/patients using the service is seen as a Diversity Issue which has a lower litigation risk as third party support is harder to obtain. There is no Patients Union. This has caused a cross fertilisation of the Employment Equality Bias (Primarily in favour of women) to cross over into the views of and management of patients.

        8) The Equality and Human Rights Commission (EHRC) is not fit for purpose and also operate under a massive conflict of interest. The Human Rights Act makes it illegal to discriminate on grounds of sex (Article 14) whether by deliberate act or by act of omission or seven simple negligence. The Equality Act requires discrimination in favour of females else it is illegal. These two pieces of legislation are in conflict and the EHRC is the watchdog and arbiter for both. The EHRC defacto supports discrimination in favour of women across the NHS and has no objections to men lagging behind in health care, provided the discrimination against men can be shown to be just a consequence of playing catch up. Men are always to be made legally one step behind the medical and health needs of women. There is no right of equality as a man and so NHS management and litigation adverse administrators have no reason to consider anti male services, failures in provision or even basic health care.

        The EHRC are also arrogant, negligent and error prone – thier internal bias is so deep seated that it can be made public and not noticed or commented upon. See AVFm Wiki – Woozle effect – Domestic Violence – United Kingdom

        9) Indirect consequences of this multi generational and now multi factoral bias are legion. As men die younger (all too often from late diagnosed conditions and lack of adequate treatment) this has caused gender bias to enter into emergent areas of medicine such as gerontology – Anaesthesiology for Pain Management and even into palliative care and the hospice movement.

        Computer based assessment tools for management and even triaging ( LIMA Software – Logical Integrated Medical Assessment) have HISTORICAL bias against men with the bias not being biological but the consequences of multi generational systems bias.

        Men are encouraged to die in hospital and not at home when they have a spouse, so as to alleviate the emotional burden of the female spouse. If the female spouse is dying the male spouse is advised that she will be happier dying at home and he should provide emotional support in a none clinical setting at home. Costs are higher for palliative care in the home. Women benefit from financial bias too.

        The NHS and UK medical/health industry have become very good at covering up the bias. If you are looking for stats to reveal the bias there is no use looking for general stats, you have to go for departmental stats and then look at issues, such as clinical assessment for knee replacement – where age has been sued to cover gender bias. men suffer higher levels of Industrial Injury to knee and need replacement at a younger age – but age limits mean that by the time they are assessed and provided with replacement women have caught up in the injury stakes. This hides the gender bias which is better assessed by analysis of “Disability Days”, (Statistics on the number of days of restricted activity and bed disability per person per year, days lost from work per currently employed person 16-64 years of age per year, and days lost from school per child 5-17 years of age per year). It’s self evident that if the Disability days for just Knee replacement are not calculated and so are not know – and the age for replacement is made an upper one of 65 years of age, it’s very easy to hide the earlier age need for men and the bias of not meeting clinical need. Carpet Fitters and men working with Flooring have been screaming about this NHS bias for decades as they are the premier group for needing work related knee replacement in the 50’s and often having over a decade of disability and work loss before being considered suitable for medical treatment and surgical replacement. The same often applies to sportsmen too.

        One thing about the NHS – they are very good at mismanaging stats and buying the bodies. As they say Doctors don’t make Mistakes – they Bury them.

        If you want to know more about the functioning of Disability Discrimination in the NHS and medical legal field it gets even worse. Just try and get an Inquest for a disabled person who has died due to medical error and bad stats. Disabled people don;t suffer any form of Discrimination or negative Triaging within the NHS – they just have this biazzare habit of dying needlessly whilst a patient or leaving hospitals in a worse physical condition than when they entered … and then dying promptly, even in the ambulance on the way home.

  • Rper1959

    Thanks Aimee, certainly if this is a practice policy it should be exposed ( I am assuming it’s not global NHS policy – that would be incomprehensible wouldn’t it? )

    In Australia we have a compulsory system based on a medicare levy ( really a tax, but called a levy because a health care tax would be unconstitutional) About 70% of GP consultations in Australian are billed directly to medicare for the government prescribed “rebate” fee. This is referred to as “bulk billing”. GPs who exclusively “bulk bill” services, often practice the so called six minute medicine, will not deal with more than one issue at a consultation, make multiple follow up appointments and essentially do anything necessary to maximize throughput and income, their clientele value no payment at the point of service over quality of service. This system encourages over-servicing and inadequate servicing.

    At the other end of the spectrum you have “privately billing GP’s” who see one patient on average each 15 minutes,( and will book long appointments when needed) the patient pays at the point of service and claims the “rebate” amount back from the government. This is how my practice operates, but we have the option to simply accept the rebate amount in cases of hardship. Successive governments have toyed with the idea of nationalizing our health system but have met resistance, their is an increasing push to a blended payments system, with some incentive payments to practices for targeted outcomes.

    In the case you mention in Australia the patient would be more likely to get a good hearing and appropriate therapy via the second option not the first.

    • Aimee McGee

      Nothing would surprise me with NHS policy after 6 years of being on the receiving end of having to interpret policy documents.

      Nothing at all. If they told me that all hospital beds were going to be made 1 foot shorter to save money, I would barely blink.

      I’m fortunate that my boss has a similarly warped sense of humor and we entertain each other by finding the worst examples of pen pushing madness.

  • ChrisD

    Aimee, I do not think a private system will work in the UK. If you start privatising major parts of the NHS then you will quickly see all of it privatised, costs rise dramatically at the patient end and life expectancy go down as people put off appointments to save money. Conditions being diagnosed late because of this just end up costing more to treat.

    What we need to introduce are fines for people who miss appointments. Also I’m for fining people who turn up at A&E more than twice due to alcohol intoxication.

    • Malestrom

      Costs rise dramatically at the patient end but fall precipitously at the taxpayer end. The NHS in Great Britain will have to do be away with eventually. Tt’s a socialist program that is nearing the end of its inefficiency cycle, it’s getting more expensive at an ever faster rate while quality of service slowly but surely deteriorates. There will come a point eventually when it delivers such a low standard of service for such a calamitous cost that voters will finally be willing to do away it.

      • ChrisD

        Check out the efficiency of a private system like the USA. You’ll find they spend almost 3 times as much per capita and have worse outcomes for most illnesses. So if you want to spend more for poorer healthcare that looks flashier then petition for a private system.

        So no, the NHS despite the Daily Mail headlines is not that inefficient compared to private systems. And it’s also pretty wrong for people to go bankrupt in order to stay alive. Morally that’s just not defensible.

    • Aimee McGee

      I see the only way of getting the NHS to continue to work (other than your excellent suggestions, which I would endorse), is to frontload to preventative services, so people can maintain their health…but this is not going to happen as the vast majority of preventative health is not sexy and doesn’t make the drug companies any money.
      Fortunately, I am an incurable optimist and keep pushing the prevention agenda in my workplace to anyone who will listen. I wonder if this explains why most people run in the opposite direction when they see me coming 😉

      • ChrisD

        I hate to say it but I can’t blame the drug companies for not pushing the preventative approach. Preventing illness is something everyone can do and we’ve had tons of campaigns about it so there is no excuse to not know. Most people really don’t want to give up the bad foods and exercise on a regular basis.

        Good on you for at least trying to push the preventative stuff and not giving up. I imagine it can get a little frustrating at times when you see so many people with completely preventable illnesses.

        And hey, if they run when they see you coming at least they’re elevating their heart rate :)

        • Aimee McGee

          Campaign work is a total waste of paper and pixels.
          Good preventative work involves working in an intensive manner in family and community settings using individualised approaches broadly based on social marketing parameters.
          It is about giving back ownership of the prioritisation of health agenda to populations. When I was working in diabetes prevention in a poor urban setting we asked what they wanted to learn. They wanted to know the signs and symptoms of different illegal drug use and how to access services…we got curious as to why, and one of our translators pointed out that loads of the children and grandchildren were drug users and this would help the community develop knowledge and skills within families to address the issues. We got very good feedback and a request for annual updates from this community – it is hard to measure the impact long term but there was some evidence of an increase in accessing addiction services in the next few years.

          • ChrisD

            I completely understand where you are coming from, but when it comes to simple healthy choices I think people generally know what they should and should not be doing.

            It’s just lazyness. People don’t want to exercise, they don’t want to give up a large pizza 3 times a week, they want what they think are easy solutions, 7 day diets and surgery.

            I know I’m being a bit cynical here but it’s my experience while coaching people that this is the reality.

          • Aimee McGee

            @ Chris,
            For a long time I felt it was laziness, until I started doing a lot of research into the dertminants of behavior change.
            I’m not anywhere near 100% successful, but I find that now I “get” this area a lot more, I am increasingly successful at finding the “key” for motivating “lazy” people. Often it is surprising…this afternoon I had a situation where patient was doing the “yep, I did this bad, this bad and ths bad”, I listened then said “OK, scale of 0-10, how compliant does this make you?”
            She said “Three”, I said “Lets review the success you are having at an effort of 3, and talk about what is preventing you from being at a 5.”
            We chatted about the success, and we bounced some ideas about why she was stuck at this level, and just as she was going out the door she suddenly went “Oh, I know the problem – this has happened. I’ve got a worry about [x issue]” I acknowledged the worry and said “What could you do to reduce the anxiety?” She said “Its about the writing it down isn’t it?” (A tool we had explored before). I said “Yep, same old” She said “Can I email you with my progress next week.” I agreed and she went out the door quite a lot happier.

            She has done this cycle before, but the big difference, this was a 3 week lapse not a 3 month one. She is learning skills.

  • http://thereluctantmysogynist.blogspot.ca/ limeywestlake

    OT – We could do with some intellectual muscle on The Vancouver MRM Feminism Debate page on Facebook. They are many, we are few. Help appreciated.


    • http://thereluctantmysogynist.blogspot.ca/ limeywestlake

      Thanks, everyone!

    • tallwheel

      I checked it out, and I think my IQ just dropped a few points. “Intellectual” should have been the key word of your original request…

  • Raven01

    Well, Ontario sure as hell is discriminating against boys very openly.


    Grade 8 females only are eligible for publicly funded vaccination.
    The reasoning from another page on that site is:
    “Q: Do boys get HPV too?

    A: Yes, males can be infected with HPV, but they are not at risk of cervical cancer as they do not have a cervix. Males can also be carriers of other HPV types that may be transmitted to their partners during sexual activity. Without experiencing visible symptoms, they can pass the HPV virus unknowingly to their partner.
    Answered by:
    Dr. Vivien Brown – MDCM, CCFP, FCFP, NCMP”

    It seems this “Doctor” is unaware that HPV in males can cause, oral cancer, anal cancer, penile cancer and genital warts.



    • Aimee McGee

      Yes, the HPV campaign has been a matter of open discrimination the world over. I have a family member who is an oncologist who is challenging for the right to vaccinate boys.

    • Jay

      Same here in Australia. Absolute garbage. My only option for the vaccine is to shell out around $700, yet if I were female I would have been able to get it for free. It’s just the usual – let’s look after women and girls, but we only care about men and boys if they can provide something which is useful to women and girls.

    • chris3337

      Raven, Where did you find that answer from Dr Vivien Brown ? I would like to persue that response from her further.

  • chris3337

    The health services of Ontario Canada does discriminate against boys in that the HPV vaccine is only publically funded for girls. This despite the fact that the National Canadian Committee on Vaccines now recommends the HPV vaccine for boys. I hope that a disgruntled parent will lodge a complaint with the Ontario Human Rights tribunal about this blatant unequal service since its own government now recommends this vaccine for both girls and boys.I cannot see how they could fail in this complaint since it is clear cut discrimination. The morbitiy for boys is just as poor as it is for girls since boys get warts. penile, anal and oral cancers as well.
    To their credit the the Association of Medical Women of Canada recommended that their be equity in the disctribution of this vaccine in one line of a press release.

  • chris3337

    The Ontario Ministry of Health has sex discrimination written right into their physician payment methods. Most Family Doctors are paid fee for service by the government. Male and female patient services are obviously paid the same fee. However there is also a patient rostering incentive. This means that for every patient rostered to the doctor , the doctor gets paid a monthly amount. This averages about between $1-$2 per month per patient. the value depends on the age AND SEX of the patient. In other words females are paid at a higher rate which therefore rewards a doctor more for having female patients. The governments rationale is that women make more doctors visits. This perverse reasoning perpetuates the the status quo, that men dont take care of their health and dont visit doctors, and now are further discouraged by doctors who are now discouraged from rostering men. A family physician with a larger mens practice will earns less per patient rostered than a physician with a largely female practice.
    Our constitution guarantees equality , so WTF?

    • Aimee McGee

      Yep, this is wrong thinking.
      I will need to dig further but I seem to remember there is a single rebate for sexual health appointments regardless of gender in the NHS…a nurse colleague used to recode all her health promotion activities around testicular cancer under this code, as it gave her employers reason to accept her health promotion efforts (her brother had died of testicular cancer, she felt if she prevented one death through her work it was all good)

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