The Nice Dismissal - Part 2: The Brotherhood of Surgeons Strikes Out

Sylvia Reisman, Principal & Founder, Private Health Advisor

This is Part  2 of my series on “Nice Dismissal” — a term I use to describe how women with hiatal hernias are often overlooked or underestimated in surgical care.

If you missed Part 1, you can read it here.

I've been athletic my entire life, playing competitive sports in high school, where my team won the state softball championship. Even with ongoing, valid concerns about my large hiatal hernia symptoms, I was determined not to let them hold me back.

In 2024, I sought out a softball team and returned to play after a 35-year break. Staying active and committed to my health has always been one of my biggest passions, especially after losing my quality of life for over ten years due to a delayed, correct diagnosis.

As a survivor of a 30 year, two time misdiagnosis journey that nearly cost me my life, I recognize the Nice Dismissal for exactly what it is: a dangerous precursor to "medical neglect."

Why This Happens More to Women

There are multiple reasons women are misdiagnosed or ignored when they have symptoms of a hiatal hernia.

As leading hernia surgeon Dr. Shirin Towfigh explains in this Forbes article from 2024: " Medical professionals have historically been far too quick to dismiss symptoms reported by women, who are at risk of developing grave complications."

In the case of diagnosing a hiatal hernia in women, one big reason it is often missed is that the condition is not on the radar of most primary care physicians, internists, or even gastroenterologists.

As a result, hiatal hernias can easily slip through the cracks. Women suffer from symptoms such as reflux, bloating, constipation, gut dysbiosis and may experience pain so severe that it can mimic a heart attack months or years before a practitioner considers the possibility that a hiatal hernia is at the root cause.

Hiatal Hernia size isn't supposed to matter. It's the severity of the symptoms that SHOULD matter. However, insurance companies love to use guidelines to dictate what defines a moderate size hernia versus a large hernia, and what criteria warrants surgery

— most likely designed to make it as difficult as possible, leaving patients to suffer with little regard for quality of life.

After all, it's profits over patients, right?

Surgeon #1 — Strike One

I first learned about surgeon #1 through another physician specialist who is highly experienced and respected in his area of expertise. Dr. D (the referring specialist) instructs all of his patients to be evaluated by a surgeon to determine if they have a large hernia (structural issue) contributing to ongoing reflux issues that may require surgical repair.

I hadn’t even heard of this surgeon before, but I was told he was one of the top specialists in the state for this type of work. 

Surgeon #1 administered the BRAVO test — an endoscopic procedure that measures acid reflux— and if a patient meets certain criteria, may implant the LINX reflux management system for severe gastroesophageal reflux disease (GERD).

I trusted the referral and his reputation, assuming that as one of the top specialists in the state, he would take my symptoms seriously.

I had taken the time to create a detailed written history of all my symptoms potentially linked to a hiatal hernia.

As an athlete for life, I had been extremely concerned that lifting weights was triggering my severe reflux, and other symptoms that I became fearful and stopped working out in 2023.

With a family history of hernias, including a strangulated hernia and hernia surgeries, I wanted to make sure that nothing was overlooked.

At my follow-up Zoom appointment to review the BRAVO test results, I discovered a

5-centimeter hiatal hernia finding on my endoscopy report. Oddly enough, surgeon #1 didn't even bring it to my attention until I expressed concerns about it.

Folks, I'm 5' 5" inches tall and weigh 116 pounds. As a small framed athletic woman, a

5-centimeter hiatal hernia is considered large for my size but yet this surgeon played down the size.

The Insurance Excuse

He looked at the 5-centimeter measurement on my endoscopy report and went straight to the insurance excuse:

Surgeon #1: "It’s not large enough for surgery. Your insurance company won't cover surgery. It's a risky surgery."

But as a health advocate, I knew he was choosing a policy over my physical reality. According to the Gastroenterology Report, symptom severity—the kind that stops an athlete like me from lifting has nothing to do with the size of the hernia. A 5-centimeter hole in my 5’5” frame is a mechanical disaster, no matter what a surgeon’s arbitrary "cutoff" says.

A 2014 study published in the World Journal of Gastroenterology indicates that surgical decisions for hiatal hernias should prioritize symptom severity over anatomical size [1.1]. This, along with professional bias, explains surgeon #1 focused on measurements rather than my symptoms.

I expressed legitimate concerns based on my exercise induced symptoms, as well as my family hernia history to him multiple times, both verbally and in writing.

Surgeon #1: "If you would like to come back in a few months, we can run some more tests."

Me: What tests? We already know I have a large hiatal hernia. I already had an unreliable barium swallow and BRAVO test. My symptoms were obvious. So WHY wait a few months?

I took his behavior as an obvious "brush-off." My concerns weren't just ignored  — they were minimized, despite clear, documented symptoms.

.

I wonder if I had been a man and started complaining about how I couldn't play golf, lift weights at the gym or cycle, what might have occurred?

Not one time, did surgeon #1 show any empathy for the fact that my symptoms were impacting my ability to lift weights, build muscle and bone density and participate in athletic activities.

Shortly after this experience in late 2023, I recorded a video trying to process what had happened  — my confusion, my frustration, and the limits placed on my care by our broken healthcare system.

Watching my own video from 2023 made me stop in my tracks: if this is how they respond to someone like me, what does it mean for my overall health and for anyone else in my shoes?

Consider This:

Can you imagine if this surgeon himself had broken his hands and legs in an accident but was told by three other surgeons, "I'm sorry but we can't help you" — the same way my concerns were brushed off despite clear, documented symptoms.

Surgeon #2  — Strike Two

First Impression:

He seemed pleasant, was a good listener and engaged in our conversation. He also appeared to be open to understand mast cell activation when I shared my concerns about mesh used in hiatal hernia surgery.

Upon introducing himself during my initial office consultation, I gave surgeon #2 permission to audio record our complete conversation so, according to him, he wouldn't miss any important details.

I was pleased that he validated me by reviewing my endoscopy report. He stated: "It's obvious that you have a structural issue." He seemed perplexed as to why surgeon #1 hadn't operated on me.

Surgeon #2: "You saw the "Guru!" Why didn't he want to operate?"

Me: "Great question!"

Second office appointment: two weeks later, surgeon #2 plays "flip flop" on my diagnosis, after I brought him my inconclusive BRAVO test results from 2023.

Deflections:

• Shifting focus to a patient story unrelated to my case.

He started rambling about a patient of his — a woman. At first, I was confused. “Huh? Where is he going with this?  What kind of cryptic message is this?"

He explained: she had come to him seeking a LINX device, an implanted device for severe reflux. I had no desire for anything implanted in my body, and I certainly didn’t come to him for that.

I came to him because of experiencing severe symptoms caused by my untreated large hiatal hernia. Yet he kept comparing me to her. Why? I couldn’t understand. 

He said she had gone to a different surgeon because he (surgeon #2) wouldn’t do the procedure, ...and then she returned to him at a later date.

In that moment, I realized I wasn’t being seen as an individual patient with a 5-centimeter hiatal hernia structural failure; I was being filtered through his past frustrations with another woman. He wasn't practicing medicine; he was practicing prejudice—using a completely unrelated case to justify his Nice Dismissal of mine.

I realized he was stereotyping me before even understanding my situation. My interpretation was that he thought I had seen the "Guru" of hernia surgery and was shopping for another surgeon to perform surgery.

Instead of being transparent, he was avoiding adult conversations. He should have been saying something direct like, "Here's my concern, let's make sure we're on the same page."

Instead, he relied on a story, making me guess what he was thinking.

It felt patronizing, like I was talking to a teenager rather than a professional colleague.

• He deflected again, relying on an unreliable BRAVO test and unable to form an independent medical opinion without a positive result.

He became nervous as if he were backed in a corner. He started overexplaining my 2023 BRAVO test results, seeming concerned that I didn't have heartburn and that he didn't have enough test "data."

When I asked him what was making him feel so uncomfortable, he nervously pointed to the color photos on my endoscopy report and stated: "I'm not sure about this- I can't see these photos in "real time."

He told me that he wanted me to see a gastrointestinal specialist and have the BRAVO test retaken. I consulted with a new GI specialist a few weeks later. Upon questioning him with regards to the accuracy of the BRAVO test in patients with a large hernia, he advised me that I should NOT retake the test.

The Paper Trail of Fiction

But the most alarming "strike" wasn't what was said—it was what was written.

When I accessed my patient portal initial appointment notes from Surgeon #2, I found a documented phantom physical exam that never happened.

He noted my abdomen as "non-distended and non-tender'"claiming to have performed a 13-system review. He never touched me or used a stethoscope.

As a Private Health Advisor, I know this isn't just a "template error"—it is a falsified record used to justify a high-level billing code while erasing my physical reality from the legal record.

When I called his office to advise the office manager of the "phantom physical," she called me back and stated: Dr. X wanted me to tell you that he would be happy to conduct a physical exam on you if you would like to stop by. "SERIOUSLY??"

Folks, This is Potential INSURANCE FRAUD!

My "Phantom Physical" conducted by surgeon #2, October 2025

I closely re-examined surgeon #2's initial consultation notes through my patient portal.

His notes looked like a complete train wreck full of errors. He left out important details we had discussed in his office. including when he had stated: "It is obvious from the endoscopy report you have a structural defect."

This was one of the most damning statements he made right in front of me as he pointed to my scope report...and he had even audio recorded it!

I sent him written corrections so he could update his notes but he refused to. His office manager advised me that he was confident with his consult notes.....even though I noted that my hernia is large (not small) and I don't use herbals to treat my hiatal hernia!

The Final Straw

Less than two weeks after my second appointment, I vomited undigested food in the middle of the night, following a 21 mike bike ride. I called and emailed his nurse the morning after I became ill. I was hoping she would fit me in to see the surgeon.

Instead, the nurse called me and encouraged me to go to the emergency room to rule out an obstruction.

While the nurse was polite and provided instructions, such as starting slow with liquids, it was clear that legal protection came before a timely, patient-centered appointment with the surgeon that day. She advised me that she probabably couldn't get me in to see him for weeks. This was an OBVIOUS brush-off and quite frankly, medical neglect.

Surgeon #3 — Strike 3

Surgeon #3 also appeared to have a problem forming his own independent conclusions about my diagnosis.

Instead of engaging with my symptoms, understanding my history, or asking probing questions, he seemed focused on:

• Downplaying Serious Symptoms

Surgeon #3- Avoiding the discussion of my serious vomiting episode, which is a red flag for structural issues such as a hiatal hernia. He also downplayed the size of my hernia, suggesting it was smaller than the 5-centimeter hiatal hernia documented on my endoscopy report.

News Flash: With a 5-centimeter hernia, exertion-induced vomiting of undigested food is a major mechanical red flag for obstruction or strangulation. To ignore this isn't just a "brush-off"—it's a refusal to acknowledge a physical emergency.

Did I forget to mention that surgeon #3 advised me at my first appointment with him that he formally worked for surgeon #1! Hmmm...I wonder if this might be a biased opinion?

Trusting my instincts, as a woman with keen intuition and someone who has been athletic most of my life, I could tell these surgeons were more focused on avoiding risk and cherry picking easy patient cases than understanding my unique situation and helping me.

I almost felt like a fraternity little sister observing a

"Brotherhood of Frat Surgeons" who were sticking together instead of focusing on potential surgical solutions for me.

But what’s even more disturbing is that rather than listen to my clearly documented symptoms, each surgeon seemed to rely solely on unproven, unreliable tests to justify or deny surgery.

During my first meeting with surgeon #3, he admitted these tests (e.g. BRAVO, barium swallow) aren’t always accurate.

The harsh truth is, if you fail one of the insurance — driven tests through no fault of your own, you may end up in the emergency room — praying the delay doesn't cost you your retirement fund and your life.

This is called Reactive Medicine

A good surgeon or practitioner uses diagnostic tests as tools, not crutches.

If a clinician cannot make a correct assessment from a clearly communicated patient history — including timing, severity, and pattern of symptoms — and instead relies solely on tests, they are failing their patient.

In my case, the symptoms were clear. Several hours after a long, intense bike ride, I experienced increased intra-abdominal pressure from leaning forward. Combined with dehydration, this forced stomach acid upward, causing severe acid reflux and burning across my hiatal hernia area.

Eating food after the ride only added to the pressure, ultimately resulting in my violent vomiting of undigested food in the middle of the night.

Folks, this isn't my first rodeo. Twenty years ago, I went through a five year medical merry-go-round in Florida where I was brushed off and not taken seriously, This medical neglect stole an entire decade of my life; years I spent fighting just to obtain multiple correct diagnoses and proper treatment.

I made it clear to every one of these surgeons that I am an athlete, and that my ability to cycle and lift weights is a non-negotiable requirement for my long-term bone density and health.

All three surgeons effectively conveyed through their lack of interest and excuses —that I was expected to sacrifice my health (bone density, spine, fitness) to fit into their insurance-approved timeline.

Surgeon #1 told me that my 5-centimeter hiatal hernia wasn’t large enough to fix. Rather than speculate about his reasoning, I decided to research it. I reviewed the SAGES clinical Guidelines — the professional standards published by the Society of American Gastrointestinal and Endoscopic Surgeons. These guidelines outline best-practice standards that surgeons are expected to follow.

Guideline #1 is clear:

Repair of a hiatal hernia should be considered in ALL patients with symptoms. The medical literature is clear: there is "no pathognomonic relationship between hernia size and symptoms." It doesn't say wait until it's 6 centimeters or wait until insurance agrees.

Yet, I was dismissed by three surgeons who obsessed over my 5-centimeter measurement while ignoring the fact that I was vomiting undigested food and losing my ability to be an athlete.

They ignored the science to protect their own metrics.

By ignoring their own society’s standards, these surgeons weren't just missing a diagnosis—they were re-triggering two decades of medical trauma.

They didn't see an athlete fighting for her future; they saw a "small" problem they could safely ignore while I sat on the sidelines of my own life.

By refusing to fix the structural defect at the opening in my diaphragm, they have effectively handcuffed my ability to protect my spine. They didn't just "wait and see"—they allowed my physical foundation to erode.

Three male hernia surgeons. Three strikes. Not one physical exam.

These surgeons didn't just dismiss a patient—they protected a hierarchy. They chose to "play it safe" for their careers while leaving a 116-pound athlete to navigate a 5-centimeter mechanical disaster on her own.

I recognized this pattern immediately, not just as a concierge health advocate, but as a survivor of a decades-long medical battle I documented last year.

In Part 3, I’ll explain why my history with Cat Scratch Disease and Inflammatory Bowel Disease (IBD) made these "Nice Dismissals" not just frustrating, but an unacceptable risk to my life.

I am also going to reveal the physical and emotional cost of this neglect, including the medical trauma they leave behind.

To Your Health,  

Sylvia Reisman  

Founder & Principal Consultant  

Note: I now refer to my practice as a private health advisor service.

This newsletter contains my personal opinions and observations, based on my experience, and should not be interpreted as verified fact or professional guidance.

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