Does Sexism Exist in Healthcare?

A doctor enters an exam room to find their patient doubled over in pain. Should the doctor’s reaction to the patient’s symptoms vary based solely upon whether the patient in question is a man or a woman? While I would argue most certainly not, the unfortunate truth is that a patient’s gender often plays a role in the doctor’s reaction.

It happens more often than you might imagine. When 27-year-old model Elly Mayday started experiencing lower back pain, her doctors told her to do core-strengthening exercises. It was only persistence on Mayday’s part that led her doctors to discover she was actually suffering from stage III ovarian cancer. When Joe Fassler’s wife arrived at the ER via ambulance complaining of severe abdominal pain, a doctor determined that she had a kidney stone without even doing a physical examination. Hours later a CT scan revealed a potentially life-threatening ovarian torsion, which resulted in the loss of her ovary. Kristie Wilson went to her doctor at the age of 17 with painful stomach cramps, but was told repeatedly the pain was “growing pains or thrush.” After being dismissed three times, her pleas to be referred to a specialist were finally granted and she was diagnosed with cervical cancer. Sadly, despite eventually getting an accurate diagnosis, Wilson died at the age of 21. Could her death have been prevented with more aggressive care?

Unfortunately, it isn’t just instances of acute pain where women seem to receive different treatment than men. In 1997, a woman in the UK went to the National Health Service because she was experiencing “severe and unrelenting” facial pain. It took 15 years of effort on her part to finally get the MRI scan she requested, and when she did it showed she needed surgery that fully resolved the source of her pain. Although solidly diagnosed with two kidney diseases and endometriosis by the age of 25, Ally Niemiec has been refused pain medication in emergency rooms and has often been made to feel as if she were a drug addict or that she was exaggerating her pain.

It’s hard to know whether these specific individual cases are the result of sexist assumptions on the part of the healthcare providers or whether they were just medical errors. But scientific studies have actually proved that there is a definite gender bias when it comes to how pain is treated. A 1990 report found that American women were more likely to be given sedatives for their pain, while male counterparts were given pain medication. A 2008 study published in the journal Academic Emergency Medicine looked at nearly 1,000 people who visited an emergency room. Although men and women reported similar pain scores, women were 13 to 25 percent less likely than men to receive opioid pain medications. In addition, women waited an average of 65 minutes to receive analgesia for acute abdominal pain – while male patients who presented with the same complaints waited only 49 minutes.

In 2001, a University of Maryland study called “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain” concluded that women are “more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients.’ Looks play a role as well, as the study found that women “are more likely than men to have health-care providers assume they are not in pain if they look more physically attractive.” The study also concluded that women are more likely to have their pain symptoms characterized as emotional or psychological in nature, rather than something physical. The researchers concluded that gender biases “have led health-care providers to discount women’s self reports of pain at least until there is objective evidence for the pain’s cause. Medicine’s focus on objective factors and it’s cultural stereotypes of women combine insidiously, leaving women at greater risk for inadequate pain relief and continued suffering.”

After experiencing similar issues in during her mother’s diagnosis – and later her own – patient advocate Katie Ernst has been working to shed light on these issues on her blog Miss Treated. Her mother’s symptoms, which doctors attributed to depression or hypochondria for nearly twenty years, eventually lead to a diagnosis of Sjogren’s syndrome. Ernst herself began experiencing severe bouts of fatigue and lightheadedness at the age of 19. Doctors told her that she was depressed and even, quite shockingly, that “it’s normal for 19 year old girls to pass out.” Approximately 12 years after her initial symptoms, Ernst was finally diagnosed with lupus after her husband accompanied her to an appointment.

Today, Ernst’s blog serves as a place for women to share their stories when they feel a medical professional has mistreated them because of their gender. It also serves as a place to share information about medical, legal, and psychological research on the topic of medical sexism. Ernst maintains an annotated list of articles and studies on the topic (several of which I have linked to above). Ultimately, Ernst hopes her research will help us discover ways to solve the issue of doctors not trusting or believing their female patients’ reports of symptoms – which she believes is at the root of most of the problems we see within the medical profession today. “The most important thing that any doctor can do is to actually listen to and believe in their patients,” Ernst told me. “If I could do something to even slightly move the needle in that direction, I will feel like I’ve really accomplished something.”

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