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How Do We Differ from Other Primary Care Practices?

There are a number of ways, endless ways, that we differ. We are more different than we are the same to be honest, but today when I was asked by a clinician how we set ourselves apart from the rest, I thought about connection, about seeing the entire person, about empowering through education, and about true wellness. I thought about how we recognize the Kin Keeper.



Kin Keeping is the root of stress in most women's lives. Men have stresses certainly too, traumas as well, and those are very valid, but I think this point about the Kin Keeper is a good one to illustrate our point - how we are different. We recognize the soul beyond the role.


When others may identify a woman as irrational, and throughout history she was often diagnosed as hysterical, we work to identify her reality. Consider that when a theatre wants to put on a play, they don't just hire actors; they also hire people to manage the lights and sound, to pull back the curtains, to rearrange the furniture between sets, to usher people to their seats, to clean after each show, even to market, and collect tickets. There is a lot of effort that goes into a play, right, but at the end of the day, people aren't clapping for the people they didn't see. They are clapping for the actors and actresses that they witnessed. In this analogy then, men are the actors and actresses. Women are those who are unseen.


Consider the holidays where again, there is a lot of work to be done. There isn't just the cleaning and cooking the day of, but also the preparations, gathering recipes, assuring you have proper cooking supplies, ingredients, things are thawed, and you need serving dishes and decorations. Not everything cooks at the same speed or temperature, so coordination of the oven in itself is labor-some. This doesn't even account for the wrapping of presents or entertainment otherwise. Most of this goes unnoticed though; the whole intent of this job is to become invisible. This person performs convenience for other people - they put on a show.


Maybe you notice during the holidays the women are in the kitchen, bonding and talking, but also working. It isn't just your mom though, it's your aunts, your grandma, your teen girls - and it isn't because they were asked to help. Women subconsciously know that mom needs help, so they create a bonding experience of it. Men though are often watching the game or sitting at the table, laughing and enjoying themselves. They may have their feet kicked up, relaxing, not knowing when anything starts or even what is being created.


It might even be that you notice when the family goes on a road trip, mom is counting the children, running down her mental checklist asking if everyone packed their toothbrush, their swim suits, their pajamas, all the things that often go forgotten. They ask about unplugging equipment that may cause the house to burn down while the family is gone, and assuring there are enough snacks and items for entertainment along the way. Dad says, "Calm down. Why are you being so anxious and irrational? Everything is going to be fine."


The father doesn't see all the work that has been done, nor really do the children. They don't know the name for this; it's kin keeping. It's the unpaid labor that women are assigned to subconsciously as a gender and not only does this cause a lot of stress in women's lives, but it also breeds a lot of ignorance in men. Did your Dad plan that vacation? Ironically, he may even have grumbled at the idea because it seemed like too much work. Did Dad ever buy the Christmas presents under the tree that the children enjoyed every year, all that said, "Love Mom & Dad." Does he know your dentist appointment? What size pants you wear? Does he know your school teacher's name? If not... who did that? And who took credit?


This is not to say Dad's are bums, but it is to say that we recognize the mental load that women often carry that too often goes ignored as part of our wellness and vitality. I can write an entirely separate post about all the ways we recognize the struggles many times more authentic to men, so please don't feel this post is a dig at men. In fact, even as I wrote this one, none of this relates to my current partner, Jeremy. He actually is the one in the kitchen, the one planning, and while he isn't wrapping, he is planning and purchasing much without my help at all. This is part of the reason I am well aware of how significantly life changes when you move from being the kin keeper to being part of a team.


Women Have Multiple Roles


These roles might have beneficial health outcomes, but they might also put women at higher health risk. What I've described above, isn't a matter of opinion. Research tells us that women are more likely than men to be responsible for managing the myriad demands of work, children, ill or disabled family members, and household chores (Jarrett, Banks, & Yee, 2017). Caretaking is a familiar role that is assumed by most women, but it is a role that in many ways is about love and connection, but can also be quite a burden.


As caregivers, women regularly place the needs of other family members first and their own physical and emotional needs second; again, this one is evidence-based (Jarrett, Banks, & Yee, 2017). One fourth of women in caregiving roles report their own health is poor, and more than one half have one or more chronic health conditions themselves. Women are less likely than men to engage in preventative health behaviors, such as exercise, rest, taking time off when sick, and remembering to take medication. Imagine the psychological and emotional impact! Well, we don't have to because the literature tells us women have more depression and anxiety.


Providers must be cognizant of these roles when working with women, because they do lead to a variety of stressors that leads to a variety of dis-ease presentations, even emotional impairments such as inappropriate crying, nervousness, anger, and irritability. Breaks my heart to hear men speaking about their pregnant women like they are hysterical and on the brink of sanity, when in reality, we no longer live in tribes who would take over the responsibilities of this kin keeper so she could better care for herself and her growing child. Her partner fails to see her additional work load and she is overwhelmed, mentally, physically, and emotionally.


Women under chronic stress often exhibit cognitive issues such as foggy thinking, distractibility, and forgetfulness. Yes, we evaluate for thyroid, HPA axis dysfunction, ADHD, emotional dysregulation, blood sugar, inflammation, and insomnia but what about her Kin Keeping burden? Maybe she has unexplained backpain, painful muscle tensions, stomachaches, indigestion, increased heart rate, and hypertension? There are a plethora of underlying causes for those issues, for which we explore with the resources available in conventional, functional, and integrative medicine, but we also see these as potential outcomes of her stressors. We implement stress management skills. We facilitate problem-solving skills. We increase her social and practice support. It is vital to educate women about the importance of self-care as this is true primary care.

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