Doctors explained away my friend Sarah's severe abdominal and hip pain. Just part of a tough pregnancy common with twins, they said. Her persistent cough was just the lingering effects of a virus or flu. Pregnancy, one doctor said, can challenge immune function. After the birth of her two daughters and a few months of continued pain and coughing, Sarah's mom suggested another visit to the doctor. By this time it was too late. Sarah was diagnosed with terminal cancer. After a determined fight against the disease, she passed away when her daughters were just over a year old. My friend Pamela frequented the emergency room with severe abdominal pain and fatigue. Her general physician had diagnosed her with heartburn and suggested she purchase some Tums. Over a two-year period, various emergency room doctors suggested that her pain was no doubt stress-related from juggling work and parenting twin toddlers. Their diagnoses and suggestions did not solve the pain. Finally, two years after her initial visits and on yet another visit to the emergency room, the attending physician ordered an ultrasound. A failed gallbladder was the problem. When the gallbladder was removed, Pamela was relieved of all the symptoms that a Tums couldn't come close to alleviating. Charlotte, a young mom of two and pregnant with her third, complained to the doctor of debilitating stomach and intestinal pain, worse than anything she had experienced in her previous pregnancies. None of the doctors took her pain seriously. They told her it was just the baby growing. When she was diagnosed with terminal stage 4 colon cancer after the birth of her baby, specialists said she had likely had the cancer since she was in her twenties. Before Charlotte's death, she was interviewed by a state newspaper. Charlotte urged young people to schedule routine colonoscopies as part of their healthcare practices and look for doctors who would take their concerns seriously. Recently, my daughter's close friend, Parissa, expressed her disappointment on Facebook that her doctors continued to suggest that she was suffering from anxiety common among college students. Parissa had seen several doctors and insisted that she sensed something was wrong, but one after another, doctors ignored her concerns. It wasn't until a huge tumor formed on her neck that doctors paid attention. Parissa was diagnosed with an aggressive lymphoma and is praying that Thanksgiving and Covid19 will not prevent the treatment she desperately needs for this cancer to not spread. Gender inequality in medical care is an ongoing problem, one that must be taken seriously. Historically through the present day, gender, just as race and class, influences the quality of medical care provided. The history of stereotypes and discrimination against women continue to influence medical and healthcare providers, often unconsciously. Women tend to be taken less seriously, are given less time, not fully listened to, misdiagnosed, and therefore not treated properly. At the institutional level, funding for research and research itself, is recovering from a history of focusing on and supporting the health of white men.
While I'm not here to provide a deep-dive analysis of this wide-spread problem, I will share a few facts to empower you, some proactive questions you can ask your healthcare provider, and some suggestions for healthcare providers to consider. Some Alarming Facts around Gender Bias in Healthcare Treatment
Women are not listened to and not taken as seriously (Schopen)
Women's pain is often minimized, mocked and coaxed into silence (Fassler)
Women's symptoms of pain are often diagnosed as anxiety-related and misdiagnosis occurs as a result. (Billock)
Before 1990 most clinical trials focused primarily on men; women have been left out of research (Mazure)
Longer lag times from onset of symptoms to diagnosis exist, not because women wait longer to seek medical attention but because general physicians minimize and explain away symptoms. It can take anywhere between 3-8 visits for women to get an accurate diagnosis. (Dusenbery)
Women and minorities are 20 to 30 percent more likely to be misdiagnosed. Approximately 12 million people are affected by diagnostic errors in the US each year, and 80,000 people die from complication from such misdiagnoses. (Mastroianni)
Questions to Ask Healthcare Providers
Why have you come to the conclusion this is stress-related? What if it is not?
What is the worst this could be and why is it not that?
How does this office and the providers keep up with the most advanced and innovative approaches to treating various conditions and diseases?
How are the healthcare providers and staff in this office working to overturn implicit bias?
What does collaboration look like this in practice?
What's the overall consensus in this practice about implementing both traditional and integrative approaches to treat disease?
Since medical error is the number 3 cause of death, how do you all treat medical misdiagnosis and medical error? What are you doing to prevent misdiagnosis here?
Additional Considerations for Healthcare Providers (Paulson)
Diverse healthcare teams must commit to focused discussion on bias as part of team meetings. Doing so will create more comfort around a challenging issue that must be addressed in an ongoing manner to produce change.
Use updates and revisions of checklists and guidelines for all patients, not just white males or white upperclass females.
Ongoing training to uncover and eliminate implicit bias. Normalize the reality that we all have learned bias. If we can learn bias, we can dedicate ourselves to unlearning it. The value of doing so means saving lives.
Teach healthcare providers communication skills so they are trained to ask some of the following questions: What brings you in today? What other concerns have we not talked about? What is your sense of the situation? How satisfied are you with the recommendations?
Together we can empower ourselves to be proactive in our own healthcare. Bias is part of our troubled individual and collective past and will not be overturned overnight. To forge change, we must become consciously aware and acknowledge the problems that exist. We must avoid the tendencies to minimize and deny these long-standing problems. We must work together and encourage each other to look at the tendencies and patterns we have inherited and weed from our midst any trace of discrimination.
Then we must commit to the ongoing process towards the vision of equality in medical and health care. This process will require dedication and perseverance. As with all necessary change, setbacks and new challenges emerge. The path to success is not a straight line. Doctors and healthcare providers must learn new patterns--new ways of asking questions, listening, respecting the rights of all patients and understanding that the patients are the ones who have lived in and know their own bodies, and that they bring knowledge and sensibilities and intuition to the doctor-patient interaction. Patients must avoid perceiving doctors as gods and play a proactive part in their medical care. They must be encouraged to proactively assert themselves and view the doctor-patient interaction as a two-way interaction.
Imagine the path to achieving gender equity as a long one. We are walking this path together. We are keeping our "eyes on the prize." We are avoiding the tendency to point fingers, blame one another, bicker or fight about the past or missteps in the present. We are collaborating. We are learning from our mistakes. We are encouraging one another. We are upholding justice. We are empowering ourselves to make changes. We understand that dedication to the process of dismantling inequality in any arena will take generations of an unwavering commitment. We understand that everyone plays a part in the process--patients, healthcare providers, medical staff, researchers, faculty teaching at medical schools, and others. We know that NOW is the time to work and move forward together.
Billock, Jennifer. “Pain Bias: The Health Inequality Rarely Discussed.” BBC Future, BBC, www.bbc.com/future/article/20180518-the-inequality-in-how-women-are-treated-for-pain.
Dusenbery, Maya. “'Everybody Was Telling Me There Was Nothing Wrong'.” BBC Future, BBC, www.bbc.com/future/article/20180523-how-gender-bias-affects-your-healthcare.
Fassler, Joe. “How Doctors Take Women's Pain Less Seriously.” The Atlantic, Atlantic Media Company, 2 June 2020, www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/.
Mastroianni, Brian. “Why Getting Medically Misdiagnosed Is More Common Than You May Think.” Healthline, Healthline Media, 22 Feb. 2020, www.healthline.com/health-news/many-people-experience-getting-misdiagnosed.
Mazure, Carolyn M, and Daniel P Jones. “Twenty Years and Still Counting: Including Women as Participants and Studying Sex and Gender in Biomedical Research.” BMC Women's Health, BioMed Central, 26 Oct. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4624369/.
Paulsen, Emily, and Emily Paulsen. “Recognizing, Addressing Unintended Gender Bias in Patient Care.” Duke Health Referring Physicians, physicians.dukehealth.org/articles/recognizing-addressing-unintended-gender-bias-patient-care.
Schopen, Faye. “The Healthcare Gender Bias: Do Men Get Better Medical Treatment?” The Guardian, Guardian News and Media, 20 Nov. 2017, www.theguardian.com/lifeandstyle/2017/nov/20/healthcare-gender-bias-women-pain.