Shortage of N.B. health-care providers forces student to pay out of pocket to see gynecologist
Professor says structural, attitudinal problems can lead to patients going undiagnosed and untreated for years
Mhàiri Agnew has suffered from recurring abdominal pain for more than half of her life.
When she first complained as a child, her longtime family doctor in New Brunswick suspected food allergies. When tests ruled that out, he blamed stress.
"That was always his answer … 'You're too stressed,'" said the 20-year-old university student. "But no matter how much counselling I got, or no matter how many relaxing things I tried to do, the pain never went away."
When puberty began, Agnew said, the pain got worse, but her family physician wouldn't do any sort of gynecological exam or refer her to another doctor or specialist.
"He refuses to touch me," Agnew said of her doctor. "I've asked him, 'Like, push here. It's ... hard or it hurts here,' and he won't touch me. I've asked him to give me an exam if he doesn't want to send me to a specialist. He refuses."
Agnew's struggle to find a doctor who would listen eventually led her to a private women's clinic where she is now paying out-of-pocket for gynecological care. She is part of a growing number of women who have given up on getting timely care in New Brunswick's public health-care system.
Agnew doesn't know why her family doctor is uncomfortable doing physical exams. She has tried to find another family doctor, but with a shortage in the province, it simply isn't an option.
"The wait list is something like five years long," said Agnew. "So I would have to rely on walk-in clinics if I lost my family doctor, and I have other issues, too, that I need prescriptions [for] … it's just easier to keep him for those issues, and then I've been trying to find a way to treat my other issues that he won't treat."
Jacqueline Gahagan, a professor of health promotion at Dalhousie University and director of the gender studies unit, isn't surprised by Agnew's experience.
"Women are still struggling to get the type of care they need for patient-centred, women-focused, competent care. And that's a problem," she said.
"If somebody doesn't feel comfortable providing an internal exam, then they probably shouldn't have patients in their care 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 have the right to refuse to perform any type of care they find morally or religiously objectionable, although "the vast majority of family physicians would be comfortable and capable of providing that care," he said.
"The physician's moral belief shouldn't get in the way of the care a patient receives … that physician is not obliged to provide it, but they are obliged to refer the patient to a resource [where] they can get that care."
When her family doctor refused to refer her to another doctor, Agnew tried visiting a walk-in clinic, but was told doctors there don't treat abdominal pain. In the last year, she visited a hospital emergency room three separate times, each time waiting for hours before leaving without seeing a doctor.
Gahagan said the mix of attitudinal and structural barriers Agnew has faced in the health-care system is not uncommon, and can often lead to what is known as "foregone health care."
"In other words, the interaction with the health care provider is so unaffirming and so unsafe that individuals … will forfeit or forego trying to find other ways of getting that dealt with in a health-care system that just doesn't hear them, it doesn't see them and doesn't know how to treat them."
Gahagan said this, combined with a shortage of family doctors, creates a "perfect storm" for people to go untreated and undiagnosed for years.
'It's all in your head ... sorry'
Agnew believes she tried everything, short of making a formal complaint against her doctor, because she fears he could drop her as a patient, and she depends on him for prescriptions.
At one point, she even tried bringing her fiancé with her to appointments in hopes her doctor would be more likely to take her concerns seriously if they came from another man.
To appreciate how outrageous Agnew's story is, Gahagan suggested people flip the scenario and imagine a male patient with a history of prostate cancer visiting a female doctor who refused to examine him.
"For a female physician to say to a male patient, 'I'm sorry, I don't feel comfortable sticking my finger in your butt or rolling your testicles in my hand even though I've been trained on how to do that — you'll have to go see somebody else. And no, I'm not going to refer you to a proctologist — it's all in your head … sorry.'"
Gahagan said if that were to happen, it would be "on the front page of every paper" and wouldn't go away quietly.
Meanwhile, Mhàiri Agnew "is having to bring her boyfriend to meet with a male physician to again say, 'No, it's not all in her head. I live with her. I see. I know she's in pain. Can you please help us?'"
As wait lists grow, so does demand for private care
In a last-ditch effort to get someone to hear her symptoms and help find the cause of her pain, Agnew did what most people do: she typed her plea into the Google search bar.
She discovered a new private women's health care clinic in Moncton, called ReConnect Health Centre, where she was able to book an appointment within three days with a gynecologist at a cost of $180.
The price tag was yet another barrier for Agnew, who lost her part-time job when the pandemic began, but she decided it was her only choice. After a consultation, Dr. Karen Desrosiers sent her for blood tests and an ultrasound.
"She was instantly, like, 'OK, I think you could have either endometriosis or polycystic ovarian syndrome just by the sounds of your symptoms,'" Agnew said.
She has since received the results of her tests, which point to polycystic ovarian disease and a septate uterus, which is a birth defect that could explain the pain she experienced as a child.
"It's annoying that there has to be a private clinic and you have to pay for it and it can't just be public," Agnew said. "But at the same time … it's honestly worth the money in the end."
Gynecological problems still 'taboo'
Since ReConnect Health Centre opened last summer, demand from women has increased steadily, according to Katie Kelly, co-owner of the clinic, who is also a pelvic floor physiotherapist. Her next available appointment isn't until mid-July.
Kelly said that in New Brunswick, unless it's an emergency, women in need of gynecological care can face wait times of more than a year.
"Things like urinary incontinence is interfering with their ability to play with their children, or a pelvic organ prolapse is preventing them from returning to running because that's what they wanted to do," Kelly said of patients whose quality of life is suffering.
"Or women have questions going into menopause, and they don't have someone that can give them practical exercises that might help with those conditions."
Kelly said women's health issues are "taboo" and don't receive the attention or the funding that's needed.
"We're trying to fill a gap for women who might not have access to a family doctor, they might want a female to do their exam, they might want access to a gynecologist a little bit faster than the public system can provide."
Call for review of women's health services
Steeves agrees that there are shortfalls for women in need of non-urgent care.
"There is access to care for almost everyone," he said. "So we need to improve that so we can 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, several years ago, and has also raised it with the current government.
Kelly hopes that more women will speak out about their experiences and that New Brunswick will finally be able to "move the needle" when it comes to health-care services.
"Gynecological issues … they're embarrassing. We maybe make jokes with our best girlfriends that we laugh when we pee. We don't discuss having painful intercourse. We're not discussing birth trauma.
"So if we're not reporting these issues, we can't expect funding to help them."
Gahagan believes the ultimate impact of the type of structural and attitudinal barriers Agnew has faced is that the health of women as a group will worsen over time.
"These micro-aggressions and this sort of sexism and misogyny that is experienced in trying to get your health-care needs met is so unbelievably painful and time-consuming. You just say, 'Screw it. I can't be bothered,'" she said.
"And you show up in the ER later on with a heart attack or with some form of cancer that could have easily been detected and treated."
Agnew has come to the conclusion that until something changes, in order to get the help she needs in New Brunswick, "yes, I have to pay."
On Wednesday, part two of this story will explore what led Dr. Karen Desrosiers to give up her full-time practice as an obstetrician-gynecologist and how it is that doctors in New Brunswick are allowed to charge patients and offer private care.