Down in the lobby of the medical center, I caught my reflection in the glass and realized I was practicing my ‘reasonable woman’ face. It is a very specific expression-brows slightly raised, a faint, non-threatening smile, eyes clear and unblinking. I had been sitting in the parking lot for 14 minutes rehearsing the exact cadence of my voice. I didn’t want to sound like I was complaining. I didn’t want to sound like I had been crying, even though I had spent the previous 24 hours wondering if my nervous system was actually melting.

I’m thinking about this because earlier this morning, I accidentally joined a high-stakes video call with my camera on while I was still in my bathrobe, mid-panic because I couldn’t find my notes. The look on my face was raw, messy, and decidedly ‘unreliable.’ For 44 seconds, my colleagues saw the version of me that I usually hide from doctors-the one who is tired, overwhelmed, and physically struggling. It was a mistake that left me burning with shame, not because of the bathrobe, but because the performance was broken. And in the world of medicine, the performance is often the only thing that buys you a seat at the table of clinical relevance.

The Burden of Proof and Grace

Grace W.J., a woman I’ve known for years who works as a competitive debate coach, once told me that the outcome of a round is rarely about who is right. It’s about who manages the ‘burden of proof’ with the most grace. If you look like you’re losing your cool, the adjudicator subconsciously decides your evidence is weaker.

But when she started experiencing the crushing fatigue of an undiagnosed autoimmune condition, all that coaching failed her. She found herself in an exam room, her voice trembling as she described the 34 specific symptoms she had logged in a spreadsheet, only to have the physician look at her and ask, ‘Have you tried a mindfulness app? You seem very high-strung.’

The Emotional Overtones

This is the routine downgrading of women’s physical reality into emotional overtones. It is the persistent, low-grade fever of medical gaslighting that suggests your physiology is merely a byproduct of your personality. If you are articulate, you are ‘anxious.’ If you are quiet, you are ‘depressed.’ If you are frustrated, you are ‘difficult.’

The medical gaze often bypasses the cellular level to land on the social one, interpreting a woman’s reporting of pain as a request for psychological validation rather than a request for a blood test. It turns the diagnostic process into a character study.

The Paradox: Sedatives Over Painkillers

I remember reading a study-I think it was about 234 pages long-detailing how women are significantly less likely to be prescribed pain medication than men in the same clinical circumstances. Instead, they are given sedatives. The message is clear: the problem isn’t the pain; the problem is how you are reacting to the pain. We are being asked to calm down while our bodies are on fire.

The Mental Preparation Tax

This performance of likability is an exhausting tax we pay for the hope of a diagnosis. We learn to soften our edges. We learn to say, ‘I might be wrong about this, but…’ or ‘I know I’ve been under some stress lately, however…’ We provide the doctor with an out, a way to blame our stress, just to keep them in the room long enough to listen to the rest of the list. We become architects of our own credibility, building it brick by brick through self-deprecation and carefully timed smiles.

It shouldn’t take 114 minutes of mental preparation to ask for a thyroid panel, yet here we are.

Authority Beyond Performance

I think back to that accidental camera moment on the Zoom call. The horror I felt was rooted in the idea that if I am seen as I am-vulnerable, struggling, unpolished-I will lose my authority. But maybe the authority should never have been tied to how well I can hide my distress.

In the medical world, the ‘difficult’ woman is often just the woman who has stopped performing. She is the woman who has had 4 symptoms ignored for 4 years and has finally run out of polite ways to ask for help. She is the woman who is tired of being told her palpitations are just ‘life’ and her dizziness is just ‘hormones.’

Categorized Before Cured

We are taught that if we are the perfect patients, we will get the perfect care. We follow the instructions, we bring the logs, we stay under the 14-minute time limit allotted for the consultation. But the reality is that the system is often designed to categorize us before it cures us. If you fit into the ‘anxious woman’ box, every symptom you report will be filtered through that lens.

If your joints ache, it’s because you’re tense. If your hair is falling out, it’s because you’re stressed. It is a closed loop of logic that is almost impossible to break from the inside.

The Baseline of Practice

Grace W.J. and I talked about this over coffee last week. She was finally diagnosed with a rare connective tissue disorder after 84 visits to various specialists. She told me that the most healing part wasn’t the medication-though that helped-it was the moment a doctor looked at her and said, ‘I believe you.’

That shouldn’t be a revolutionary act. Believing a person’s report of their own body should be the baseline of medical practice, not a luxury awarded to those who can maintain a calm enough demeanor during a crisis.

The Weight of Minimization

I find myself wondering how many women are currently sitting in their cars, just like I was, practicing their ‘reasonable’ tone. There are likely 444 women within a ten-mile radius of me right now who are editing their symptoms so they don’t sound ‘too much.’ They are deleting the mention of the weird tingling in their hands because they don’t want to sound like hypochondriacs. They are minimizing their pain from a 7 to a 4 because they’ve learned that a 7 is perceived as ‘dramatic.’

It is a strange contradiction to trust science but feel betrayed by its gatekeepers. I believe in the power of the blood test, the MRI, and the clinical trial. But I also know that those tools are only useful if someone agrees to use them. When we translate physical suffering into emotional distress, we aren’t just misdiagnosing a person; we are erasing them.

The Radical Idea

I’m trying to stop rehearsing. The next time I’m in that exam room, I want to be able to say I feel awful without worrying if my mascara is smudged or if my voice is too loud. I want to be able to report that my energy has dropped 64 percent without needing to apologize for ‘not being my usual self.’