Eight Medical Myths Keeping Women from Getting Proper Diagnosis and Treatment

Myths serve as powerful and inspiring stories and metaphors for life. They’ve also been used throughout history to reinforce political, religious, or other power structures – as cautionary tales of what happens when we mere mortals go up against the gods. Medicine is, without a doubt, a cultural institution and power structure, and like other systems it has perpetuated myths that keep us believing in its power, while disbelieving in our own.

When I started on my path to becoming a midwife in 1981, it was, in part, to make a difference in the over-medicalization of birth that was already rampant at that time. I had no idea that my journey would be filled with women's stories of how they'd been mistreated, insulted, and demoralized by encounters with medical and healthcare professionals. It was these stories that provided the intense amount of energy it took to become a medical doctor as the working mom of 4 children, and along the way to becoming a doctor, I saw far too many doctor-patient (and sometimes nurse or other provider to patient) encounters that reinforced just how difficult a road it can be for women to navigate the health care system given the many myths, biases, stereotypes, and attitudes about women and women's bodies that remain operational modern medicine, driving so many women away from the answers and care we may desperately need, or forcing us to ‘play nice' – to behave in ways that are inauthentic in order to get our basic medical needs met.

In this article (and corresponding podcast) I break down 8 prominent medical myths – from ‘It’s All in Your Head’ to ‘It’s All Your Fault’ – that are alive and well, and are profoundly – and sometimes dangerously – affecting women’s health, preventing countless women from receiving important diagnoses and timely treatment – sometimes for conditions that have proven life-threatening or worse. These myths have even led to women reporting symptoms of a heart attack, sometimes different than the typical chest pain men experience, to be sent home with anti-anxiety medication – the heart attack completely missed, to women with autoimmune diseases being told their fatigue and aching are ‘just stress,’ to women doubled over with severe endometriosis pain or a ruptured ovarian cyst to be asked in the Emergency Department, “Are you sure it’s not just that time of the month?,” and frighteningly, has led to many deaths, including, notably, several recent cases in which Black pregnant women reported symptoms to their doctor, and had those symptoms minimized, dismissed or ignored. In fact, Black women are much more likely to be affected by the very conditions that are most likely to be missed and misdiagnosed and are less likely to have pain taken seriously,

My hope is that this will help you to spot these medical myths in action, will help you see that it’s not all in your head and it’s not your fault, and help you  break free of these myths right now. And I give you tools to get more health empowered so that before these myths never prevent you from getting medical care you might need.

Medical Myth #1: It’s All in Your Head

If you’ve been made to feel – or have been told – that your symptoms could be all in your head, whether just stress, anxiety, or overwork, you’re not alone. Medical gaslighting is now a well-documented phenomenon in women's medical care, and a topic I will be devoting an entire episode of my podcast to.

Well into the 1970s, many common women’s symptoms were attributed to personality types and women’s emotional ‘whims’ or described as hysteria, a term that not only dismisses women as emotional, but which persisted literally from Ancient Greek times into the modern medical era as a diagnosable condition – appearing in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until the 1980s. Hysteria, stemming from the Greek root work for uterus was originally believed to arise from a ‘wandering womb' – that is the uterus losing its moorings in the pelvis and wandering around the body, causing everything from melancholy to madness. For the record, the uterus does not do this; it is nothing but an insulting, outdated medical term with no basis in reality.

Common women's gynecologic symptoms, for example, PMS, period pain, and menstrual migraines have been part of a long history of psychologizing women’s conditions. A few common examples of how very real medical conditions have been conflated with women's personalities and behaviors, particularly when these do not conform to those expected for women, and for which women therefore did not receive a medical, but a psychological or personality diagnosis include:

• Women with migraines were described as a having a “migraine personality,” meaning “neurotic,” ‘frigid,’ and unable to accept their ‘womanly responsibilities.’
• Chronically painful periods were considered a symptom of a personality disorder.
• Endometriosis was referred to as ‘the career woman’s disease,’ because it was thought to affect women who were “intelligent, compulsively perfectionist, anxious, and willing to place personal achievement over having children.” n fact, one of the treatments recommended for endometriosis even into the late 1990s was getting pregnant.

These attributions remained in the medical literature – and wended their ways into diagnoses – and patient charts – also into the 1980s.

Further, women have been viewed as using reproductive symptoms for personal gain – as an excuse to miss work or ditch out on our perceived “womanly responsibilities” as they were called, from housekeeping and childcare to sex!. It was also thought that we’d go from doctor to doctor until we got the diagnosis that suited our ulterior motives.

The belief that women are hysterical – that our conditions are psychogenic in origin – persists today. Doctors far more commonly default to a diagnosis of psychologic origin in women than in men. However, instead of being told directly that ‘it’s all in our heads’, we’re now told it’s depression, anxiety, stress, or we’re given the latest diagnosis – “medically unexplained symptoms.” And if you happen to tell your doctor that that you’re under stress or that you’ve had a mental health challenge in the past, this dramatically increases the likelihood that your doctor will chalk your current symptoms up to being psychogenic. There’s even a name for this: it’s called a “meaning shift.” Women who have a mental health diagnosis in their chart – anxiety or depression, for example, which is now the case for about 1 in 4 women – are significantly more likely to have their physical symptoms written off as psychological in origin.

On top of that, going from one doctor who didn’t find anything wrong with you, to the next doctor, has been associated with an increased likelihood that this next doctor will also consider your symptoms psychological. This is compounded if you tell that doctor that you were frustrated by the previous doctor’s lack of ability to diagnose you.

Further, when the cause of a condition is unknown, as remains the case with PMS, endometriosis, and even most of women’s pelvic pain syndromes, it’s common for doctors to shrug these off as psychologically based. But lack of medical evidence for a condition doesn’t mean it’s not happening – it may just mean someone’s not doing the right testing or asking the right questions.

In a recent study of women with endometriosis, one in ten women was overtly told ‘it’s all in your head” and 20 percent saw 4 to 5 doctors before receiving a diagnosis! In another study of women with endometriosis, many had struggled for at least 3 years before their condition was medically confirmed, and 50% had previously been told nothing was wrong by at least one doctor. In yet another study, 70% of teenagers with severe menstrual pain “for no apparent reason” were eventually found to have endometriosis. This problem is not specific to endometriosis (though it should be noted that at least 1 in 10 women have this condition – so it's a major issue in gynecologic health that's being overlooked). It is endemic in medicine. For example, when it comes to autoimmune disease, in the US, 75% of those affected are women, and it takes an average of 4.6 years and five doctors before getting a correct diagnosis – and along the way, many women are led to feel that their symptoms are not as serious as they are making them out to be, that there's ‘nothing wrong', that it's just stress, that they are difficult patients – or commonly, some combination of all of the above.

Chalking symptoms up to psychological causes not only causes women to feel self-doubt, but it often stops further inquiry into the real causes of the symptoms. It also pushes us toward trying solve physical, medical problems solely with therapy, relaxation, antidepressants or anti-anxiety medications, preventing or sometimes dangerously forestalling appropriate diagnosis or and earlier treatment.

When a woman who has been dismissed eventually comes to me for medical care, and I’m able to confirm or provide a diagnosis, her relief fills the whole room. “I knew something was wrong,” I’ve heard so many women say. The validation that she’s not “crazy” is often the first step in her reclaiming her power and confidence. As one woman said, “If just one doctor had listened to me, I wouldn’t have lost 20 years of my life to this.”

Bottom line: When we say something is wrong, our doctors must have enough respect to trust and believe us. If you’re being ignored or dismissed, and need tools to be more empowered in medical encounters, please listen to my podcast or read my article Being a Good Girl Can Be Hazardous to Your Health, and grab a copy of my book Hormone Intelligence which has an entire chapter on being medically empowered.

Medical Myth #2: It’s Normal for Women to Suffer

Who among us didn’t grow up thinking that period pain was par for the course of being a woman? Perhaps that PMS was just the way it is? Or maybe that sex is supposed to be painful?

We’ve been taught to think it’s just normal to need to curl up with a hot water bottle and Netflix, pop Ibuprofen and call it a day (or two, or more) – on the sofa, doctors tell women women painful sex to just relax more or have a glass of wine first (not kidding here – this is a common ‘prescription'), and at best, we're given an anti-depressant for our PMS symptoms.

Doctors not only reinforce discomfort, suffering – and outright pain pain – as normal for women – they may be some of the biggest myth-makers. According to a recent study by Healthy Women, 1 in 3 women who were later diagnosed with endometriosis were initially told by their health care provider that her pain was “a normal part of being a woman.” Women in pain are significantly more likely than men to receive a prescription for a sedative for their pain symptoms, suggesting that we just need to relax, rather than the pain medication that might be indicated and women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain in the ER in the United States, 16 minutes more than men – which can feel like a lifetime if you’re in severe pain.

This assumption of ‘normal’ keeps the medical profession – and us – from digging deeper when we have pain, and leads to countless missed diagnoses of endometriosis, adenomyosis, autoimmune conditions, and under-treatment of a wide variety of pain syndromes in women, including even the severe pain that accompanies sickle cell disease, which is overlaid with racism – a medically-based perception that Black women tolerate more pain, a myth perpetuated by slavers to justify abusive physical conditions, combined with the belief that Black folks are drug seeking.

Gender biases in how pain is approached in our medical system can have serious, even fatal consequences. A study published in The New England Journal of Medicine in 2000 found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack than men, which also explains why women in most age groups  have higher rates of death during hospitalization for heart attack than do men.

Why isn’t this better understood? Though 70% of the people affected by chronic pain are women, 80% of pain studies are conducted on men (or male mice). Few studies have looked at gender differences in the experience of pain, but one that did found that women tend to experience more severe pain, and pain more frequently than men.

Bottom line: If you’re experiencing pain, don’t worry about being considered a pain in the ass by your doctor – be persistent and get a proper diagnosis and treatment. Your real pain is more important than their ass!

Medical Myth #3: Women are Complainers

Being stoic and ignoring our symptoms doesn’t come from nowhere. From the time we’re little girls, we’re taught not to complain. Then as teens and adults we learned that voicing our needs, expressing our dissatisfactions, our discomfort, our pain, is whining, is complaining, and is unacceptable. So, we don’t complain; instead we tough it out. We tend to make our health and well-being the lowest priorities in our lives, putting our partner’s, children’s, parents’, friends’, and even co-workers’ needs before our own. This aversion to what is considered complaining is so ingrained that studies show we even judge other women who complain harshly in the setting of support groups.

Many women delay getting help because they worry that they’ll sound like they’re complaining, and instead, they assume they’re overreacting, or even blame themselves for their symptoms. I’ve heard many stories from women who discovered that bringing their husband, boyfriend, or father with them to appointments resulted in their symptoms being taken more seriously by their medical provider. As much as these patients find it frustrating and infantilizing to need a male presence in the exam room, they're doing whatever is takes to get help in a system with terrifyingly little accountability.

As much as we may recognize that the medical industry is dismissing us and we'd often prefer to avoid it, we sometimes want or need the diagnosis that will validate what we know, and feel is going on in our own bodies, and the care that ensues. So we endure the vulnerability and mistreatment, playing the good patient game, in the hopes of answers and care. We avoid seeming like we’re complaining by going silent, sucking it up, putting on a brave face. We learned somewhere along the line that voicing our real needs, expressing our dissatisfactions, our discomfort, our pain, is being too demanding.

Further, we may intentionally downplay our symptoms and dress to appear ‘credible’ as a patient. The problem is that studies show we can’t win. If we downplay our symptoms, we run the risk of not getting any diagnosis; if we look too put together, we couldn’t feel that unwell; if we look too disheveled, we’re thought to be seeking pain killers or an excuse not to work!

Bottom line: We lose our inner compass when becoming hyperaware of how we appear to others – a strange form of self-objectification we too often internalize as part of our socialization as women, and as part of interacting with the medical community. We’re already darn tough enough – we should have to put up with pain, fatigue, doubling up maxi-pads, or any other discomforts.It’s really important to quiet the voice of doubt in your head that starts to believe that you are ‘just complaining’ or ‘overreacting.” Not sure how to use your voice or too timid to do so? Check out my article How to Talk to Your Doctor and Get the Health Care You Need or listen to my podcast episode What's Sasha Fierce Got to Do With It?

Medical Myth #4: You’re a Difficult Patient

“Where did you get your medical degree, Google University?” is a comment at least a dozen women in my practice were asked by a doctor when they presented their thoughts on what might be going on with them. The opposite of the chronic complainer myth, this is the “difficult patient” myth.

Difficult patient is a real label, articulated commonly by doctors (or nurses), given to “that kind of patient” a.k.a. the woman who exerts herself in the doctor’s office, labor room, or in any medical encounter. The one who challenges medical authority – or simply asks ‘too many’ questions.

She’s often a woman who has:

• Done her own research
• Has formulated a hypothesis about what’s going on
• Has her own opinions
• Wants to be pro-active in her health care
• An interest in trying ‘alternative therapies'

Again, medical racism adds a layer of intersectionality: any woman of color, and especially a Black woman, who express herself with any force, power, or a raised voice, may be stereotyped into the trope of a loud, Black woman – yes another way to dismiss, invalidate, and intimidate women of color from speaking up – and which keeps too many women of color from receiving not only respect – but needed medical attention.

None of us should be accused of being difficult when actually what we are is confident, intelligent, involved, and engaged in our health. And the reality is that sometimes we do have to be what might be considered difficult – pushy, persistent, assertive. It has been statistically demonstrated that women who have had their conditions repeatedly dismissed may have to become confrontational or aggressive to advocate for themselves. It’s what saved Serena Williams’ life when she had symptoms of a potentially fatal blood clot in her lungs, told her medical team, and they told her to relax – that it was normal. Further, women with ‘medically unexplained disorders’ are far more likely to be dismissed, met with skepticism, and have negative experiences during medical encounters.

Bottom line: While I know you’ll be walking a tightrope between pushing for the care you need and trying no to antagonize your medical provider – you have to advocate for yourself. Again check out my article/podcast Being a Good Girl Can Be Hazardous to Your Health.

Medical Myth #5 Medical Solutions are the Only Safe and Reliable Options

It would be nice to believe that medical practice is based on the most current, accurate, and reliable information. But that's not always true. I can rattle off at least 10 practices, medications, or procedures that medicine was “sure” of – that turned out to be major medical whoopsies – just in the few years of my residency training!

We don’t have to look that far back in history, either, to find examples of some major medical mistakes – Thalidomide, DES, the Dalkon Shield, and the Essure Device are examples. The scary part is that each of these products was used before it was properly researched in actual human women, and some remained on the market long after it was clear that they were causing serious harms.

Hormone therapy is another area that has shown us just how uncertain medical knowledge can be. By the 1970s, estrogen was being taken by over 30% of women in the US, , in the form of hormone replacement, thanks in part of to a bestselling called Forever Young. – which promoted just that. Yet the first full studies of its safety and effectiveness weren’t conducted until 1991. A major study conducted in 2001 found that risks of hormone therapy in women, particularly estrogen alone and estrogen and progesterone in combination, were far greater than anticipated – causing the study to be halted prematurely.

These examples aren't just relics of the past. Women’s health remains big business as our expense. Two of the top income producing surgeries done in the US are hysterectomies and cesareans. One in three women will undergo one or the other – or both – in her lifetime. Yet at least 20% of both are are considered medically unnecessary and increase a woman’s risk of complications, infections, hemorrhage, and even death. And hysterectomy, when done before natural menopause occurs, increases a woman’s risks of bone loss, heart disease, and possibly dementia. In a study of the medical records of several thousand women, over a third were never informed about reasonable medical alternatives to hysterectomy, including women in their 30s, though it’s in recommended medical guidelines to do so.

We all know people whose lives were improved or saved by a medication or surgery, but medicine’s primary credo of “first do no harm” is not necessarily what’s driving health care today, and not everything being offered to us is ‘good medicine. Diagnostic and treatment errors are a major problem women face disproportionately to men and in worrisome numbers. According to a 2015 Institute of Medicine report, diagnostic errors are a serious silent problem and a major blind spot in medicine, yet there is little to no accountability for misdiagnoses despite medical error being the third leading cause of death in the United States.

Though we have the most expensive health care in the world, we’ve ranked amongst the most abysmal for health outcomes in the world in terms of safety and quality of care. Too often, conventional medical practices leave us trading one set of symptoms or risks for another – often unnecessarily – and sometimes the new set has more serious consequences!

Despite our abysmal stats, we are perhaps the most arrogant medical system in the world. Most other nations acknowledge and even include a wide range of therapies in what patients may be offered or guided in using – from herbal medicine to acupuncture – yet Western medicine in the US not only has an extremely limited toolkit to offer us that includes primarily drugs and surgery – but those seeking options that are outside of this box may be mocked, disparaged, and discouraged – even when those therapies may have strong evidence behind them.

Bottom line: A good medical provider discusses the risks, benefits, pros and cons of all medical interventions with you, informs you of alternatives, and listens with an open mind when you ask for help and information about alternatives that she/he might not be knowledgeable about. That's the heart of what I'm here to offer you – a third way – which is a balanced approach to knowing when you need medical care, when more natural approaches are a reasonable option, what's safe, effective, and how to be empowered in making the choices that are best your health.

Medical Myth #6: It’s Your Fault, Especially if You’re Overweight

As women, we’re culturally hardwired to assume we’re doing something wrong or causing our own problems, reinforced by the way we’re spoken to in the doctor’s office. We’re told it’s our diet, our lack of exercise, we’re too stressed, we’re working too hard, or it's simply that our female bodies are – well – sort of lemons that are just going to break down – especially if we don't care for ourselves optimally.

Women who are overweight are especially likely to be told it’s because they’re fat – even if barely above what would be medically considered a healthy weight – which is a far wider range than convention medicine has led us to believe. Fat shaming and fat blaming are common – and aren't even necessarily subtle or hidden. A 2003 survey of 620 primary care physicians found that more than half viewed obese patients as “awkward, unattractive, ugly, and noncompliant.”

A 2014 study found that 53% of women interviewed had experienced fat shaming by a medical doctor while a 2016 survey found that 45% of women cancelled or delayed medical care because they feared being fat-shamed. This is a very common problem in women with PCOS, which affects up to 10 percent of women. Many go undiagnosed for years because doctors view them as “just fat.” Physicians blame these women’s excess weight on over-eating and lack of exercise rather than looking at the root cause – which in the case of PCOS is a metabolic imbalance leading to an imbalance in our sex hormones. In fact, we know that BMI is an overrated assessment and further, has been used as a medical weapon against women and people of color – blaming and shaming about weight, rather than looking at the actual condition at hand, and also ignoring social and cultural aspects that can lead to weight problems – instead, blaming the individual.

One important step you can take when going in for a medical appointment is to join the movement of women across the country who are requesting that they be weighed routinely in the doctor's office. You can learn more about this campaign and even download cards that read here: “Please don't weigh me unless it's (really) medically necessary,” adding “If you really need my weight, please tell me why so that I can give you my informed consent” that you can bring to your appointment. The cards are available in English and Spanish.

The alternative medicine world can also make us feel that our health problems are our fault – that if we just ate ‘cleaner,’ did the right yoga class, took the right supplements, and had all the right thoughts, we’d feel great all the time. While there are practices that really can make a difference in your health, that’s a far cry from all of this being your fault!

Bottom line: Your symptoms, your conditions, your diagnoses are not your fault and your weight may have little or nothing to do with your symptoms! So put internalized shame and blame down, and get the diagnosis you need – and if your doctor (or any provider) is blaming or shaming you, you can point out that you don’t appreciate their bias.

Medical Myth # 7: We’re Just Small Men

The pharmaceutical industry exerts significant influence over medical practice. In 2004 Richard Horton, the editor of one of the premiere international medical journals, The Lancet, said, “Journals have devolved into information laundering operations of the pharmaceutical industries.” It is these same medical journals that most doctors use to keep abreast of latest diagnoses and treatments that are then handed to you on a prescription pad!

Yet when it comes to pharmaceuticals, which we should be able to assume are properly tested, safety is a major issue. Most medications have never been tested in women; before 1990 only 13% of all pharmaceuticals were studied in women at all, and the situation has improved only slightly. Yet 70% of all pharmaceuticals are prescribed to women, with half of all women over 50 are on at least two and some on as many as ten drugs for daily use. Ninety percent of women are prescribed a medication during pregnancy, however only 10% have been tested for safety on the developing baby, and 50% of those prescribed have actually been associated with fetal harm.

Differences in how we metabolize medications puts us at major risk for adverse events compared to men. Yet research in women's health remains a low research priority. While women in science are trying to change the research agenda to include more women conducting and participating in studies, it doesn’t change the risks of the existing medications we’re using. Even common pharmaceuticals we’ve relied on for common symptoms, ibuprofen for menstrual cramps and migraines, for example, has been associated with a significantly increased risk of heart attack in women users, and just 10 days of use has been found to reduce fertility temporarily. The track-record of safety for most pharmaceuticals may be less robust than we’d like to think. However, side-effects and risks are universally downplayed while benefits are strategically exaggerated by pharmaceutical companies and then unwittingly by our prescribing practitioners.

Bottom line: We’re not just small men. If you start a medication and have symptoms or side-effects, remind your prescribing physician of this. And before you start one, make sure you know what the risks are.

Medical Myth #8: “We Just Don't Know What’s Causes That”

If you look in any conventional medical textbook you’ll find the phrase “we just don’t know” a whole lot. We just don’t know what causes endometriosis, we just don’t know what causes PCOS, we just don't know what causes Hashimoto's, we just don't know what causes Fibromyalgia, we just don’t know why women are experiencing higher rates of chronic disease than ever in history.

The list of what we just don’t know goes on and on. And while it’s true that most doctors don’t know, because they’re not taught how to is how connect the dots on women’s health and our environment, sense of safety, trauma, socioeconomic status, racism, etc., we do know that fewer than 20% of all medical conditions are caused by genetics – and at least 80% are due to preventable or reversible lifestyle causes.

That doctors “just don’t know” it isn’t that surprising – first of all, we’re not looking for answers in the right places, and second of all, it’s a well know statistic that it takes, on average, about 17 years for medical practice to catch onto what science knows.

I’ve been unable to accept the answer ‘we just don’t know’ for over three decades now – and I’ve never stopped looking for deeper answers. If we were simply to look at the list of symptoms that can arise from trauma or being the victim of domestic violence – you'd see exactly what I mean. Nearly four decades of practice in women's health has shown me that there's a lot we do know about the root causes of many women's health conditions – and that science strongly validates that there's complex web of factors that influence our health – and that we can do a lot about.

Bottom line: There’s actually a ton that we do know, with literally thousands of published scientific studies that explain exactly what these reversible lifestyle factors are and just how they’re impacting our health as women. Just because doctors don’t know it, doesn’t mean that the answers aren't there. While answers may not always be right at our fingertips, we can look to a wider variety of reliable resources as citizen scientists and take ownership of lifestyle factors within our reach to improve our well-being.

Breaking the Myths that Bind Us

Until now we’ve carried a legacy of silence, marginalization, dismissal and embarrassment over our bodies, and when it comes to reproductive health issues, it runs deep. This has done wonders for the medicalization of our bodies serving the bottom lines of the medical industry, but it has done a great disservice to our health as women, and to furthering much needed research in women's health more broadly.

We’re never taught a good comprehensive lesson on what’s normal and what’s not, and then when we visit our doctors we feel unheard and unseen. For so long we’ve been encouraged to distrust our bodies and ourselves and that distrust has only been enforced by the medical industry. The message that we get about our bodies is that they’re unreliable and that we should quiet and ignore as much as possible. The harm done by medical biases against women, and medical ignorance about women’s bodies has led to millions of women having had medical conditions dismissed as stress, anxiety, depression – or as normal, with tremendous opportunity loss to make an early diagnosis and prevent suffering, loss, and harm.

The truth is that we’re not complaining when we tell our care providers about our symptoms, and we’re not difficult when we advocate for our health. We’re not fabricating symptoms to get a diagnosis, and we’re not just fine when we say we’re not. But breaking the myths requires us to reject “We don’t know” as an acceptable answer, or simply accepting a diagnosis and medical treatment and moving on. Our health care providers should trust us when we say we're sick. 

But we have to do our part, because it's not gonna' happen otherwise. We have to: 

• Stop being so polite when we’re being ‘doctor-splained’ to (my spin on the term ‘mansplaining”)
• Trust your body perceptions, and instincts
• Use your power and rights to advocate for yourself, ask questions, and get another opinion when needed
• Get loud, however loud it takes to get heard and to get the proper testing, treatment, and care you need, deserve, and have a right to.

For tips on exactly how to do all of this see my article/listen to my podcast episode How to Talk to Your Doctor and Get the Health Care You Need  and grab your copy of Hormone Intelligence to go deeper.

Your health may depend on being a bit of a badass.