Sara Szal MD and guest post by Dr. Lucy McBride
I’m bringing you a guest voice today, Dr. Lucy McBride. She has spent 25 years as a primary care physician in Washington, D.C. She writes the Are You Okay? newsletter, hosts the Beyond the Prescription podcast, and her work has appeared in The Atlantic, The Washington Post, and USA Today. Her first book, Beyond the Prescription: A Doctor’s Guide to Taking Charger of Your Health, arrives August 11. You can order it here.
I asked Lucy to write about something I hear from you frequently: being told your labs are normal while your body tells you otherwise. Most women know the feeling of dismissal and disillusionment that accompanies this statement. The gap between the chart and the truth is often a failure of what got measured.
What Lucy has written here does more than validate that gap. It asks you to bring your story into the exam room and treat it as clinical data. We are in complete agreement on this topic.
Here’s Lucy.
Dr. Lucy McBride
I recently saw a 45 year old woman who came to see me for complaints of fatigue and irritability. She just knew something was wrong. But her gynecologist took one look at her labs, told her they were normal, and suggested she work on stress management.
The same week, I saw a patient in her late 60s who had been bouncing between specialists for months for recurring UTIs and a sore hip the orthopedist attributed to arthritis and old age. Her labs had been normal but she didn’t feel normal whatsoever.
If you’ve ever felt dismissed by a doctor, I feel your pain. And I know what comes next—you think “Is this my new normal?” or “Am I making this up?” Then you go online, searching for answers, hoping that Claude or TikTok will help you. Why wouldn’t you? The problem is that chatbots and influencers can look at your data but they cannot know YOU—your life, your situations, the realities of your everyday health.
So my advice isn’t to give up but rather to become a more empowered patient. As a reader of Sara’s newsletter, you know more than most about the ways the system fails women. So here is what I will continue shouting from the rooftops: The most important health data rarely shows up in labs. It lives in your biography. And your biography needs to show up in the exam room.
Modern medicine can sequence a genome and 3D-print beating hearts. But it’s terrible sitting with things it cannot measure. It’s great at analyzing labs; it’s awful at understanding the person who owns them. Which means that when lab tests come back normal, patients are often given a pat on the head and dismissed. It’s not the doctors’ fault. We just don’t have time. The average medical appointment is a hurried 15 minutes. That’s not enough time to elicit the invisible metrics like sleep, stress, pain, who you are as a whole person.
Take my 45-year old patient above. She didn’t need another lab test; she needed someone to listen and treat her for what was clearly perimenopause. Perimenopause is a clinical diagnosis. A woman is deemed perimenopausal based on her age, menstrual history, symptom pattern, and a doctor willing to listen to all three. The utility of hormone testing is limited without clinical context because estrogen, progesterone, and FSH levels fluctuate dramatically during perimenopause.
For my patient, normal hormone levels didn’t mean she wasn’t in perimenopause; she most certainly was. So I started her on low-dose estrogen therapy, and within weeks she felt like herself again.
My 60-something-year old patient with the hip pain and UTIs was suffering from the genitourinary syndrome of menopause. Yet she had been told by her gynecologist that hormone therapy was out of the question because of a family history of breast cancer, a calculation based on outdated fears, not current evidence. Her orthopedist had pointed to an X-ray showing age-related wear and tear on the joint. Each specialist had a partial answer but no one had her whole story.
But when I asked her about vaginal dryness, sexual discomfort, and whether anyone had ever offered her vaginal estrogen, she looked at me like I was from Mars. Because what she had was postmenopausal estrogen deficiency. Over time, the absence of estrogen causes the pelvic floor muscles to weaken (in addition to increasing the risk for UTIs.) My patient’s hip pain had nothing to do with her X-ray findings and everything to do with the invisible decline in muscle tone of her deep core muscles, the ones that support the hip from the inside. After 6 weeks of vaginal estrogen therapy and PT for her pelvic floor, her hips didn’t bother her. (She also became more interested in sex for the first time in a decade.) For patients like her, the words, “this is normal aging” is far too common, a product of ageism plus outdated fears about estrogen therapy.
The solution here isn’t to grind your teeth and give up hope. It’s also not to blame doctors. (It’s the fault of our broken system that we hurry you along.) Rather, it’s to practice the following skills to make sure your doctor is treating YOU, not just your test results.
First, recognize that the invisible parts of your life matter just as much as your test results, so bring them with you. Think about the parts you’re embarrassed to say out loud—the vaginal dryness, the avoidance of sex, the number of times you pee in a day, the hot flashes that hit smack in the middle of your work presentation. Those details are exactly what your doctor needs. Write them down before you go in. The things that seem irrelevant could be exactly what your doctor needs to know.
Believe it or not, I also think it’s reasonable to use AI—and I’m shocking myself by recommending this out loud)—but not to make diagnoses. Rather, I would ask it to ask YOU questions, to prompt you on things you may not have thought to bring up. Something like: “Claude, I’m exhausted and my labs are normal. I’m worried my doctor is going to wave me off. What are the things I’m not thinking to inquire about—my habits, my everyday life, the things I can’t measure with blood tests?” I’m not suggesting Claude be your doctor. I’m suggesting you use it to excavate all the data that lives in your body already, instead of bringing just a snapshot of it to your doctor’s office.
Then, when your doctor says “everything’s normal” and you know it isn’t, or “this is just aging” and you know it isn’t just aging, in a non-adversarial way, try saying something like this: “Doc, I understand my labs are normal, what are the next steps to figure this out?” Or “Doc, I understand everything looks normal; what should I look out to get to the bottom of this problem?”
Just because your doctor wants to land the sentence “everything’s normal” or “this is just aging” with a period, you can make it a comma. Make sure you don’t leave without another visit scheduled or a suggestion for what clues to look for and questions to ask yourself in your everyday life. Use your doctor less as someone to give you a verdict that day and more as someone to help you elicit the information you need to figure it out, together.
And finally, know that you are not alone. Patients increasingly feel dismissed and unheard, like they’re being treated like a set of organs. Believe it or not, doctors are suffering too. We want to treat the whole patient—body and mind—but the system won’t let us. So, the more time you take to understand what I call your broader health “ecosystem”—including the mundane aspects of your everyday life, relationships, goals and vunerabilities—you are demanding what every patient needs and deserves.
To the woman still wondering if she’s making it up—you’re not. You’re not crazy, either; you’re human.
