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Obstetrician-gynecologist Priya Panneerselvam discusses their article “How medicine reflects women’s silence.” Priya discusses how the quiet deference observed in their mother’s generation continues to manifest in patients who apologize for their pain and hesitate to ask questions. The conversation explores the cultural and national forces that suppress female voices, linking personal family history to the broader political landscape regarding women’s rights and leadership. By examining the cost of this inherited silence, Priya advocates for speaking out as an act of rebellion and gratitude for those who could not. Breaking this cycle is necessary to honor the past while securing a freer future.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Priya Panneerselvam. She is an obstetrician-gynecologist, and today’s KevinMD article is “How medicine reflects women’s silence.” Priya, welcome to the show.

Priya Panneerselvam: Thank you so much. I am excited to be here.

Kevin Pho: All right, so let’s jump right into your KevinMD article. Before talking about it, what led you to write it in the first place?

Priya Panneerselvam: I work at the county hospital. It is a safety net hospital. Ninety percent of my patients are Spanish-speaking. We also teach residents. It is a very fulfilling job. I notice a lot of patients coming in with the same hesitation, the same silence, and the same inability to express what is actually happening in their life that I felt myself.

Growing up in an immigrant family and an Indian family, you are always told to put everyone else first. You are always told to be quiet and obedient. A lot of those dynamics that I had seen with my patients hit me. It made me reflect on my journey as a human, my journey as a woman, and my journey as a woman of color. It made me think about my mom.

She had a traditional arranged marriage from India. She came to the U.S. with my dad after knowing him for ten days. She was the perfect Indian daughter. She was quiet and obedient, and she did what everyone always said. Now as an adult, I see my family in India comparing me to her and noting how different I am from her.

It hit me that it was not that long ago that women were silenced and told to behave a certain way. Now we are coming full circle. We as a country are in a situation where women are being silenced again, and women’s bodies are being controlled. As an OB/GYN in California, I am very fortunate to be in a state where we still get to care for our patients in the way that is best for them. However, it is really unfortunate. It is not what you would think the U.S. would be like for women. You would think that we would be far more progressive than we are. That is why our parents came to this country. There are a lot of emotions that come out when I think about this.

Kevin Pho: When you talk to your patients, you said they are mostly from an immigrant population and they are silent in the exam room. Are they there for routine gynecologic and obstetrician appointments? What is it like in the exam room?

Priya Panneerselvam: I do a lot of GYN care more than OB honestly because I love to operate. When patients come to me and they bring up GYN issues or even menopausal symptoms, it is hard for them to tell me that something is wrong. Sometimes they do not even realize something is wrong with their bleeding patterns or with their pain. That is not something that is talked about in the community. Sometimes people do not even realize this is not normal because they do not know what normal is. We have not educated the community, or health literacy just is not where it should be.

I see this in the Indian community too with my family and my friends. It is very hush-hush. Everything is taboo. Nobody wants to talk about infertility. No one wants to talk about fibroids or bleeding. No one wants to acknowledge that. Everything feels foreign. It is an injustice to women.

Another thing that comes to mind is that we do a lot of colposcopy clinics. We have so many patients that are HPV positive or that have abnormal Pap smears and need procedures. There is no current testing for men for HPV. It is a total injustice to women.

Kevin Pho: Now in the exam room, especially coming from the cultural story that you shared with us, how do you connect with these patients who are silent? What are some of the things that you do as a physician and from someone with your cultural background and the story you shared?

Priya Panneerselvam: I think the first thing is giving them that space. We have to learn to listen and understand that each culture is different. We must try to be culturally competent. It might take more time, but it builds so much more empathy and allows us to connect with them on a different level so they feel safe. Maybe it takes two or three times of meeting them.

I had a patient who once told me something when I was trying to rush through because I was trying to get her to the OR for a procedure. I said, “Well, you can read about this later.” She looked at me and said, “I can’t read.” It was things like that. I did not know for maybe seven meetings that she could not read. Finally, she felt comfortable with me to say that she needed me to slow down and really help her through this. That was a big lesson for me to slow down. It is OK. We take it easy. We build that relationship and become a person that they can trust.

Kevin Pho: In your KevinMD article, you mentioned how medicine has kind of come full circle from your mother’s story. Tell us more about that article for those who did not get a chance to read it.

Priya Panneerselvam: My mom passed away from ovarian cancer when I was 13, so I never got to know her as an adult. I have heard so much about her. I remember her. She had this vision that her daughter would be different. I see this in all my mom’s generation. They had these arranged marriages. They were very dependent on our fathers. They did not have a career of their own. They were homemakers who raised their kids. Because they were put in this position where their job was to take care of the family, they made their daughters incredible. Their daughters have careers. Their daughters can take care of the household. Their daughters can do it all. This was the fallout from this situation.

Now you have all these women who are incredible and can do everything. I was thinking about it, and it is awesome. They have achieved it. They have created daughters who are strong. But now what? If this country is not OK with a female president, what difference does it make? I think about my own department, which is awesome. We have a great chair, but our chair is a white male, and most of us are women of color taking care of women of color. Maybe at a personal level there has been a lot of difference made, but what about at a regional or national level? Why haven’t we as a community been able to accept women in these powerful positions?

Kevin Pho: So what are some of your hypotheses? What do you think are some of the reasons why women, and especially in your case women of color, are not in leadership positions? What do you think is happening?

Priya Panneerselvam: I do not know if I can say this, but I think there is a sense of keeping us down. There is a fear of how powerful we can be, how competent we can be, and how incredible we can be. It is threatening. I see that all the time where men who are commanding are seen as real leaders. However, people say that women are really bossy. The language is different. The views are different.

OB/GYN used to be a male-dominated specialty. Now it is a female-dominated specialty. The minority in the specialty are men. I think that is a very cool thing. It shows how women are taking back this power to care for women. It is an interesting shift that we are seeing. It is powerful and good. But now you have legislation that is limiting how people take out student loans. It is kind of pushing back at people who maybe thought a dream was impossible and thought they could achieve it. Now maybe it is not possible anymore. It feels like things are going a little bit backwards now, and we are coming back to this oppressive and less progressive part of society.

Kevin Pho: Now for those aspiring women physician leaders, what kind of advice do you have for them? Especially as you said, the hierarchy, the traditional hierarchy of medicine is male-dominated. What kind of advice do you have for women leaders to try and get into leadership positions? And it doesn’t have to be regional or national, but just even within a local institution. What kind of advice do you share with your female colleagues?

Priya Panneerselvam: Truthfully, I am in a position where I need advice. I would say have a good mentor. If you can find a good mentor, that helps. I was very fortunate at my job now. I have a great mentor who is the current program director of our residency program. Find people who understand the system, who have been through the system, who will fight for you, and who will give you great advice. I think that is honestly the only thing I can truly say.

Also, believe in yourself. If you have a dream, believe in yourself and build yourself up with the skills that will get you there. I used to be the type of person who would do 17 million things because I thought 17 million things would help me get to wherever I need to get to. But that is just dispensing energy in things that might not benefit you or anyone else truly if you are not able to do it all well. Maybe you choose a few things that will help you get to your path in a more effective way. Put your heart into it and do what you love. I think that might help.

Kevin Pho: Now, I know you have a platform. The goal of which is to break the cycle of silence regarding women and women’s health. Tell us more about some of the things that you’re doing.

Priya Panneerselvam: Absolutely. It is called Ask Akka. “Akka” means older sister. It is a way to get information out there. Initially, it started as a platform to break down these barriers. I do small videos and talk about what fibroids are, infertility, and what plagues the community. I discuss what is normal and what is not normal and when to go to your doctor. We talk about abortion, birth control, and menopause. We just allow a space for it within the South Asian community.

I will be honest, it is kind of hard to keep up with. I went from doing videos to doing little posts just to make it more feasible for me. If people send in questions, I answer those questions. That has been a way that I have directed those posts. I say, “Here is a little bit of information about it. Talk to your doctor about more, or ask if this is right for you.”

Kevin Pho: Now you’ve alluded several times earlier about the political climate of suppressing women’s health. As you know, half the country voted for the current administration, and many of those are women, of course. What do you say to those who currently support the current administration and their policies? People who don’t agree with you. So how do you engage with them and what do you say to those women?

Priya Panneerselvam: That is a loaded question. We can agree to disagree. We are all still brothers and sisters in humanity in all of this. We just try to support each other as best as we can. Truthfully, that is all I could say, frankly.

Kevin Pho: We are talking to Priya Panneerselvam. She is an obstetrician-gynecologist. Today’s KevinMD article is “How medicine reflects women’s silence.” Priya, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Priya Panneerselvam: I would just say love your patients and love yourself. We can all grow together and take back women’s rights.

Kevin Pho: Priya, thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.

Priya Panneerselvam: Thank you. Thank you so much.