Gender bias in healthcare? Women are more misdiagnosed.
Have you ever left the doctor’s office feeling insignificant and unheard? If you’re a woman, there’s a fair chance you know how it feels to sit on an exam table and share a long list of symptoms that burden or even consume your life, only to be sent to the check-out desk with no plan in place.
Study shows women have to wait four extra years for medical care.
More and more women are coming forward, sharing their stories of how it took several years and at least as many doctors to arrive at a correct diagnosis and start the path toward getting their lives back.
Researchers are paying attention to these reports, and starting to dig deeper. Here are some examples of studies done on the topic so far:
- A large Danish study found that women are diagnosed with diseases nearly four years later than men with the same disease
- Women are more likely to die from a heart attack both in the hospital and once they are sent home because doctors treat them differently than men
- Women who come with pain are more likely to be told the source of their pain is “emotional” or psychological and dismissed without proper treatment
- Women are more likely than men to experience sleep apnea without diagnosis, even though men and women experience and report the exact same symptoms
If you want to bring mental health or racial disparities into the fold, the gender gap widens even further.
Why is it taking so long for women to get the care they need?
Study after study shows an inherent bias against women in the medical field. It’s not that doctors have any ill feelings toward women -- over a third of U.S. licensed physicians are women themselves.
It’s more a systematic bias that attacks from all angles. Here are a few possible explanations.
Symptoms look different in women and in men.
Women and men can have different symptoms for the same condition. For some diseases, the research we have was conducted on all-male study populations and standards of care are based on men’s symptoms and response to treatments.
For example, heart attack research that influences the standard of care was done on men’s bodies.
What comes to mind when you think of a heart attack? Chances are, you’re thinking of an elderly man grabbing his chest in agony. Women often experience chest tightness but it’s not as common for women to report full-on chest pain during an active heart attack as it is for men.
Did you know that a lot of women who have survived heart attacks reported upper back pain, heartburn, or vomiting? If doctors are looking for chest pain to start evaluating for heart attack, they’re not as likely to find it in women.
Men and women having a stroke have the same list of symptoms, but women have additional subtle signs that are easy to miss. Women can feel general fatigue, body weakness, or confusion with no other symptoms during a stroke.
Another example is thyroid disease, which predominantly affects women but the research that influences treatment standards was historically done on men.
As of the 1990s, there are laws that require clinical trials to include women, but there is still a lot of catching up to do.
It starts with education.
It’s hard to say what subtle cues add up to gender differences in medicine, but some say it starts with differences in men’s and women’s experiences as medical students. Here are some statistics worth a second look:
- Over half of medical students are women, but only one-third of actively licensed, practicing physicians are women. Something is happening along the way and it’s up to researchers to identify where the snag is.
- Women medical students were more likely to be associated with “family” and “family medicine” and men were more likely to be associated with “careers” and “surgery.”
- Another study found that women were more likely than academically comparable men to be described as ‘‘compassionate,’’ ‘‘sensitive,’’ and ‘‘enthusiastic,” while men were more likely to be labeled ‘‘quick learners.’’ Interestingly, the gap widens with achievement and the differences are most noticeable with men and women with the highest grade point averages.
Chances are, faculty and administrators do not realize they are treating men and women differently. It’s not overt behavior, but the subtle biases are there and it’s causing disparities.
Does that hurt patients? If this is the norm during the years that you’re developing the way a medical student practices, there’s a good chance it carries over into the way a medical student views patients.
Blame everything on Aunt Flo.
At times, when doctors aren’t sure what is causing symptoms, they will attribute your problems to the menstrual cycle. Appendicitis, stomach ulcers, irritable bowel, treatable mental disorders, and other diseases can be dismissed as premenstrual syndrome when symptoms don’t fit neatly into the established criteria.
When doctors default to gynecological reasons as a source for problems, treatment plans (if you even get one) will be completely ineffective.
Symptoms aren’t real, you’re just being emotional.
In medicine, there used to be an inherent perception in medicine that women are more anxious and emotional than men, which made some doctors snap-judge symptoms as “not real.” Every doctor is different, and it’s less common today, but the unconscious bias does still exist and harms women this day in age.
When a female patient visits the doctor’s office repeatedly and leaves without answers, sometimes the doctor will diagnose her as a hypochondriac -- someone who thinks she is ill but is not. Or, they will blame “imagined” symptoms on anxiety or depression and prescribe medications to stabilize her moods. Once a doctor arrives at the mental component, they are likely to stop looking for the source of the patient’s symptoms.
What to do if you think being a woman is influencing your care.
We are supposed to be able to trust our doctors. Doctors do want to be healers and have their patients’ best interests at heart. At some point, you may run into issues with gender bias, but you don’t have to let that take your power away. Here are a few things to keep in mind…
- Do some preliminary research. Doctors tend to discourage Doctor Google, but it doesn’t hurt to come up with targeted questions for your situation. Use what you learn to open the discussion.
- You can always get a second opinion. There’s no harm in getting your condition evaluated by another doctor or a specialist.
- You have every right to fire your doctor. Your doctor has zero agency over your body. The decision to move forward is yours and yours alone. Feel free to interview other doctors about their care approach and find one that you’re comfortable with.
- Take a trusted spouse, friend, or family member to help advocate for you. Some illnesses come with weakness, mental fatigue, and other symptoms that make you feel weaker and more vulnerable. Bring someone along who has your best interests in mind and understands what you want out of your treatment plan. It helps to have a second voice to make yours stronger.
- Ask pointed questions. You can ask, “are symptoms the same for women and men?” Or, “do hormone fluctuations from [pregnancy, monthly cycles, menopause] make a difference?”
- Point out gender bias when you see it. This doesn’t have to be confrontational. You can say things like, sometimes the medical profession sees it this way for men and that way for women, and I want to get the appropriate care for me.