In this monologue Dr. Aaron Hartman introduces the concept of a “medical feminist”—a clinician who recognizes and advocates against systemic mistreatment of women in healthcare. He surveys several entrenched practices that disproportionately harm women, explaining how legal liability, cultural bias, and outdated guidelines drive over‑intervention. He contrasts U.S. continuous external fetal monitoring and high C‑section rates with the intermittent monitoring and low surgical rates of countries like Ireland and Scandinavia, arguing that fear of lawsuits—not evidence—fuels the U.S. approach. He then examines breast cancer screening, showing how annual mammograms increase false‑positive biopsies and even breast‑cancer risk, and highlights the shift toward biennial screening and emerging AI‑enhanced ultrasound (QT‑Image) as a safer alternative. Next, he discusses Pap smear over‑screening, noting that early‑age annual tests lead to unnecessary biopsies and fertility‑impacting procedures, and describes the evidence‑based move to 3‑5‑year intervals with HPV co‑testing. Throughout, Hartman frames these issues as examples of medical gaslighting and gender bias, urging both patients and providers to become educated, proactive advocates. He concludes that understanding past errors—driven by legal risk and special interests—empowers individuals to navigate and improve a system that has historically undervalued women’s health.
Chapters
Welcome back everybody. And we're going to make a slight detour and start talking more about the idea of what does it mean to be a medical feminist? This is someone who recognizes a group that's being mistreated, maltreated, whatever terminology you want to use, and advocating for that group. And in the context of that, I want to speak to women in general who, you know, for many, we talked about the heart attack issue, about how we mislooked at heart attacks in women. I want to talk about a couple topics that used to be controversial, aren't anymore, are becoming controversial, particularly with women's health. And knowing about this is going to be huge, particularly if you're female or married to a female or have females in your life, which is, which is all of us, you know, and realizing that women are different than men. Women's bodies act differently than men. Just the, the miracle of bringing life into this world, which is a crazy thing to think about, um, requires unique physiology that only women have. And that also means that when things go south and go awry and hormones get off, we're going to have a lot of unique— it's going to be difficult sometimes to figure out what's going on because of the unique biochemistry and the unique makeup of a female to do what only women can do, which is bring life into the world, which is a pretty, pretty cool thing to think about. And we'll talk about this, about that process. So first, let's talk about having a baby. And let's talk— we already talked about the hand washing and puerperal fever previously, so I won't go in that. That's a great example of how like literally women dying because someone wouldn't wash their hands, right? And that the guy who figured that out lost his life over it, which is, you know, this is history, y'all. This is not, this is not myth. This is history. So, but let's, let's move off from there and talk about having babies. Now, the process of having a baby is a very legally risky endeavor in the United States. And so there's a common practice of external fetal monitoring. So any woman who's had a baby knows you have to put the monitors up. They watch the heart rate, maybe his heart rate's going 140 beats a minute, speeds up, goes down, does that so many times, is fetal distress, let's do a C-section. But let's go to a country like Ireland that does not do that, that basically will just listen to the heart rate every couple hours. If mom's having symptoms, we'll listen more often. They do not do continuous fetal monitoring and they have better outcomes. And actually the American College of Obstetricians and Gynecologists actually said we probably shouldn't be doing this. It's actually harmful. Yet we don't do it because it's a legal issue. If you don't measure and don't test and something happens in the court of law, you're going to use— you're going to lose. And so we literally do something now in our country that the literature is clear that you get worse fetal outcomes, um, more C-sections, yet we do it because of the medical legal environment. So how does that play into medical feminism? Women being proactive in their health. And that's actually happened. We now have birthing centers. We now have people doing more. At home births, not to say what's good, better, different, but we're having more of that happening. And oh, by the way, countries that do that actively have better outcomes. So that's an interesting concept. That'd be great if we do some research here in the United States to see what it looks like here. Um, the other thing is C-section rates. You know, C-section in the United States, we look at our rates, some states have a 50, 60% C-section rate. Let's go back to Scandinavian countries and Ireland, 5, maybe 8 to 10% C-section rate. Because of the way they deal with women in pregnancy differently, because of the way they let things go more naturally, because of the lots of reasons, you can't put them all, but you get a different outcome. And here in the United States, we look at things differently. We look at things procedurally. We look at them technically. We have a big medical legal thing, which probably causes a lot of harm. You know, I remember when I was doing my medical training at the Medical College of Virginia, young lady came in with abdominal pain. I examined her. I was gonna send her home, talk to my attending. He's like, why didn't you do a CAT scan? I'm like, well, no rebound, no guarding, you know, no, yeah, went through all this stuff. He's like, okay, student Dr. Hartman, I'm the judge and we're in a court of law. Student Dr. Hartman, Mrs. J or Ms. J comes into the Medical College of Virginia at 9 o'clock at night on Friday. She's concerned about her health. She comes to the, the trauma center. She could have gone to many reasons. She could wait the next day, yet she came in. Why did you not do a CAT scan on her? And like, what's the response? My physical, you know, point is that a lot of things we do in our healthcare system are driven primarily because of medical legal risks. Um, and C-section rate is one of those things that's driven by that. Mammograms is another great example. You know, if a female does a mammogram every year for 20 years, she increases the risk of breast cancer 25%. In Europe that for years they've been doing, starting— actually, the UK, we talk about socialized medicine, we talk about there's good, bad, and different. One of the good things about socialized medicine systems is they collect data like no one's business. I mean, Scandinavia, UK, you have amazing, amazing data and these healthcare systems having access to tens of millions of people. And because of that, the UK has decided we're going to start mammograms at 50 and do it every 2 years because population-wide, we look at Millions of women cause more harm just doing it younger and doing it more often. There's a false positive rate on mammograms of about 10%, meaning you do 100 mammograms, 10 women will have a positive that's not really a positive. They get a lumpectomy, they get a biopsy, they get a partial removal. Oh my gosh, this is indeterminate. We gotta remove more. That's gonna cause medical trauma. You know, all those kind of things solely because we do a lot of procedures and every procedure has a risk. And so that's a big issue. Maybe 10 years ago, the AHRCQ made a recommendation, which is a big organization in the country that recommends screening for public health stuff, cutting back to every other year in the United States. And the outrage was crazy. You hate women. Oh my gosh. Why would you do this? More women are going to die. Yeah, actually the opposite was true. Less harm, less risk, better outcomes. But because of medical legal and because of special interests, We kept it at yearly mammograms starting at, you know, screening 35 to 40, and every, every year 40 above. We just recently this past year, recommendation has been changed to every other year in the United States. But this is something that is ongoing now. And there's a new technology, new, actually it's called the QT-Image test. It's a test that actually uses ultrasound and AI-powered technology. It's almost like getting a CAT scan of your breast using ultrasound. And you get MRI quality images. The point is it's better than mammogram but not covered by insurance. Hopefully that will help alleviate all these issues. But the point is, is something— why is all this a big deal? The biggest reason for a radiologist to get sued is actually a missed breast cancer. So you tend not to get sued by doing too many procedures, and you, um, they get sued if you missed one. Result is a lot more harm than good's been done. Pap smears I was in the military, 2000 and 2003 to 2007. By 2005, 2006, the data was clear that we actually didn't need to do pap smears every year and we didn't need to start them until women were 21. Actually doing pap smears on a 15 or 16-year-old resulted in more procedures. Very young cervixes change a lot. You might see abnormal pap cells from, you know, abnormal pap smears are more likely to happen. Intercourse at a younger age, smoking, and immature cervix just has more inflammatory, more stuff going on. And so what happened was if you had a pap smear when you were younger, you're more likely to get a biopsy, a colposcopy, which can affect fertility. And so by 2006, that was clear. We can do these every 3 to 5 years. And if you do an HPV test, you can do it every 5 years. So I got out of the military, came back up here to Virginia, started seeing patients. Hey, look, let's do a pap smear every 3 years. People looked at me like, what are you even talking about? I do it every year since I was like 5, you know? That's joking, of course, but every year since I was 16, and it was, it took about 10 years for that recommendation to take on. Why? Because the fear for cancer, et cetera, et cetera, the fear for missing stuff and the concern for getting sued. And which, you know, when you look at things just gender-wise, women are more likely because they interact with healthcare system more, they tend to be more the caregivers. These kind of biases affect them a lot more. We've already discussed the whole thing with heart attacks and that's like a medical gaslighting. And gynecomastia kind of combined where we've got heart attacks and women were wrong for decades. Now we finally realize, hey, a female middle-aged has GI upset, some abdominal pain, do an EKG, right? So point is, I could go on and on about examples of how we mistreat, undertreat women in our healthcare system. The point is not to get upset, not to be like, oh my gosh, it's just to say, look, you need to be educated, know how, what the biases are and work around them. And as an individual, male, female, either way, you need to be educated and proactive for your own health. But this applies to all, applies to kids as well. We're having a lot of debate right now about vaccines is being brought up. Um, a lot of issues with antibiotics in kids, you know, used to be thought to be safe. Actually, now antibiotics in childhood makes kids more obese, more allergies. We'll talk about that probably later on in these, this medical blind spot series. That's a big blind spot that We got wrong for so long. The point is like being educated, knowing where our system has got things wrong before, knowing the data points in the past can help you predict future data points. It's not clear. It's history. Doesn't repeat itself, but it often rhymes. And so learning these things can help us be better advocates for ourself as well as better engage the healthcare system and providers, doctors, providers who don't acknowledge the errors in the system. Those are the ones you need to be concerned about because if they don't, they're not willing to recognize we messed things up before, they're more likely to mess things up again. Anyway, I hope this one was helpful for you, and keep on diving into this topic of medical error, medical gaslighting. And this one, this past one, was more about the idea of being a medical feminist, more towards women taking charge of their health, because our healthcare system, I mean, in all honesty, has had some biases against women that, you know, from not washing hands and women and children dying to excessive procedures, poor fetal outcomes. Um, it's a thing and need to be educated about so we can eliminate it. So hopefully this information was helpful. Take care, we'll talk to you soon.
