Gender Inequality in Healthcare: Misses and Misdiagnoses

 

Carolin Geis is a third year International Development student with a specific interest in gender and health.

[Featured Image: Women dressed in scrubs and a doctor’s coat.] 

Women are used not being listened to. Whether it be in the environment of a job, in a political discussion at a bar, or at a family event, most women are used to having to be louder, clearer and more of a presence than the men around them, to have their opinions heard and respected. And while in everyday scenarios, this rates from slightly bothersome to fully aggravating, when it comes to healthcare, it becomes painful and deadly. Ranging from diagnosis, to treatment, to aftercare, women are not heard, and their concerns are downplayed or straight up ignored.

Already commencing at the diagnosis, women are not taken as seriously as their male counterparts.  Their diagnosis is lengthier, and the assessment of the severity of symptoms by doctors is often incorrect. The waiting time to get a diagnosis alone is already unequal. When presenting the same abdominal symptoms, men waited 49 minutes in a waiting room, while women waited 67 minutes.

Especially when it comes to pain, women are likely to be disregarded, and their pain instead being justified as “emotional”. Specifically with chronic pain conditions, a study has shown that women are more likely to get diagnosed with mental health issues instead than men, even when presenting the same symptoms (J. Crooks, E. Trunk, 1982). A fair amount of misdiagnosis also happens in other fields of medicine, for example regarding heart attacks. A drastic number of women each year are misdiagnosed, with a 41 per cent greater chance of misdiagnosis than men, due to them being labeled as panicky or “simply nervous”. The longer a heart attack goes undiagnosed and untreated, the greater the heart muscle can be irreversibly damaged, making the consequences of a misdiagnosis only more severe.

However, perceived hysteria seems to not be the only issue in misdiagnosis. Simple lack of knowledge also seems to play into it. This is best presented by the case of endometriosis, an Illness in which endometrial tissue grows outside the uterus, which can lead to severe pelvic pain, abnormally painful menstruation as well as infertility issues. However as this is not an issue that affects cis men, there seems to be a significant lack of knowledge about it with an overly large amount of GP’s.

There have been several case studies about a controlled group of women being sent to a GP to explain the exact symptoms of endometriosis, and a majority of GP’s diagnosing them with simply strong menstruation pains. The Illness is not rare or exceptional, as it is estimated about one in ten women will have endometriosis during her life, yet overall it still takes an average of 6-10 years from the onset of symptoms to a definite diagnosis (Hadfield et al., 1996). Women suffering from Endometriosis are also 15- 20% more likely to be depressed (Rogers PA, et al., 2009), and about 30% to 50% of women might experience infertility, both of which could be reduced by a quicker diagnosis.

Diagnosis relates directly to treatment, and the inequalities persist. Women receive significantly less pain medication than men presenting the same symptoms (controlled for weight), and will more likely receive sedatives prior to pain medication, in what seems to be an attempt to “calm women down” before treating their actual pain. Women are also more likely to be prescribed psychotropic drugs, rather than actual pain medicine, as their symptoms are being seen as “being in their head”.

A lot of misdiagnosis and mistreatment rears from cultural and biological beliefs, some of them truer than others. While women are in fact more sensitive to pain then males, and according to studies have a lower pain threshold, they still receive less aggressive treatment than their male counterparts. However, women also have more coping mechanisms to deal with pain, and thus their pain is assumed to require less attention. Due to the remaining idea of the “hysterical women”, female accounts of pain are often also seen as being less severe than actually expressed, and are accounted towards being emotional and psychogenic, and therefore not actually real. Additionally, Hoffman and Tarzian (2001) also found that if women attend a meeting with their healthcare provider wearing makeup and looking “attractive”, they are significantly less likely to be diagnosed as they are perceived as healthy due to their attractiveness.

When looking at this issue from an intersectional standpoint, white women tend to get off easy. While they often have to raise their voices to be heard by healthcare professionals, women of ethnic minorities are often neglected even more.  In a study by the National Perinatal Epidemiology Unit reviewing the experience of 24.000 women receiving maternity care in the UK, they found that black women out of all were least likely to receive pain relief, and most likely to deliver via emergency caesarean section. Most shockingly, black women are four times more likely to die via or after childbirth than Caucasian women in the UK.

The quintessence of all of this should be that our healthcare systems need a desperate reminder to take their female patients of all backgrounds seriously and listen to their pain, as the drastic consequences of ignoring or underestimating their accounts can clearly be seen. Sexism persists in healthcare as much as in other areas of life, and it cannot be that women who are already in pain have to put in an excessive amount of additional effort to be heard by their doctors, in order to avoid detrimental consequences to their health.

 

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References

Bhf.org.uk. (2018). Misdiagnosis of heart attacks in women. [online] Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women/misdiagnosis-of-heart-attacks-in-women [Accessed 31 Aug. 2018].

Calderone, K. (1990). The influence of gender on the frequency of pain and sedative medication administered to postoperative patients. Sex Roles, 23(11-12), pp.713-725.

Ekechi, C. (2018). Time’s Up For Gender Inequality In Healthcare. [online] HuffPost UK. Available at: https://www.huffingtonpost.co.uk/entry/time-is-up-for-gender-inequality-in-healthcare_uk_5a7b572ce4b0a0f48092ead8 [Accessed 31 Aug. 2018].

Fenton, S. (2018). How sexist stereotypes mean doctors ignore women’s pain. [online] The Independent. Available at: https://www.independent.co.uk/life-style/health-and-families/health-news/how-sexist-stereotypes-mean-doctors-ignore-womens-pain-a7157931.html [Accessed 31 Aug. 2018].

Fillingim, R. and Maixner, W. (1995). Gender differences in the responses to noxious stimuli. Pain Forum, 4(4), pp.209-221.

Hadfield, R. et al. “Delay In The Diagnosis Of Endometriosis: A Survey Of Women From The USA And The UK”. Human Reproduction 11.4 (1996): 878-880. Web.

Hoffmann, D. and Tarzian, A. (2003). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. SSRN Electronic Journal.

Lennane, K. and Lennane, R. (1973). Alleged Psychogenic Disorders in Women — A Possible Manifestation of Sexual Prejudice. New England Journal of Medicine, 288(6), pp.288-292.

Maternal, Newborn and Infant Clinical Outcome Review Programme (2015). Saving Lives, Improving Mothers’ Care. [online] Available at: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202016%20-%20website.pdf [Accessed 31 Aug. 2018].

Rogers, P. A. W. et al. “Priorities For Endometriosis Research: Recommendations From An International Consensus Workshop”. Reproductive Sciences 16.4 (2009): 335-346. Web

Trimble, M. (1982). Chronic Pain: Psychosocial Factors in Rehabilitation. Journal of Neurology, Neurosurgery & Psychiatry, 45(12), pp.1172-1172.

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