By Karmen Gill, The Madeira School, McLean, Virginia, USA
A woman comes into the emergency room with chest pain and a heart rate of 220 beats per minute. Her doctor told her it was just an anxiety attack and sent her home with Xanax. But she knew it was more than an episode. After many visits to the doctor, she was diagnosed with endometriosis, a painful disorder where the tissue inside the uterus migrates outside (Billock, 2018).
This is not an isolated incident.
A 50-year-old female lawyer sought out a second opinion on her symptoms of chest pain and decreased endurance (Mieres, n.d.). Her internist told her that these symptoms were solely a result of perimenopause and high stress, but Dr. Mieres realized that she was experiencing uncontrolled hypertension. After a simple stress test and coronary artery calcium scan, Dr. Mieres saw that she had plaque on her arteries, which is a sign of early coronary heart disease. Gender bias plays a large role in the misinterpretation of women’s symptoms and, as exemplified by these examples, there can be serious repercussions on the patient’s wellbeing if they are not recognized.
Without coincidence, the word hysteria, defined as a psychological disorder that causes one to be overdramatic and attention-seeking, originates from the Greek word for “uterus”. Dating back to the second millennium BC in ancient Egypt, women were frequently diagnosed with female hysteria whenever they displayed anxiety or anger (Tasca, 2012). While this diagnosis does not exist today, its impact still taints the quality of healthcare women receive. When women vocalize their pain to their healthcare provider, they are viewed as “paying too much attention to your body”, as a provider told a woman in an emergency room (Billock, 2018).
Symptoms are one of the primary ways of accurately diagnosing a disease or disorder. However, most diseases and symptoms have been studied under the male anatomy, making it more likely for women to be misdiagnosed. Societal norms have also contributed to this bias, where men are taught to be brave and resilient while women are expected to be sensitive and gentle. These stereotypes cultivate the tinted lens through which women’s pain is seen.
One study conducted in 2008 examined the difference in pain treatment that men and women received in emergency cases of acute abdominal pain. Both men and women reported very similar pain scores, but women were less likely to receive analgesic treatment. Only 47% of women were given opiates while 56% of men received opiates. In addition, women had to wait 65 minutes before they received medication while men only waited 49 minutes (Chen, 2008). This is an alarming trend that shows the difference in care that men and women receive for the same pain and symptoms. Change must be brought for both sexes to receive equal healthcare treatment.
However, in low-income countries, gender equality in healthcare remains taboo. A study in India showed that many women did not even have access to healthcare, as demonstrated by the average ratio of male to female patient visits of 1.69 to 1 and ratio of 2.37 to 1 in rural states (Kapoor et al., 2019). As the distance between a hospital and female patient increases, the chances of her receiving healthcare treatment decreases because her family would rather keep her at home than spend additional money on travel. Once again, societal norms and gender discrimination play a large role in the lack of concern for women’s health in India. "The mental conditioning of Indian society has led to women having a very high threshold of patience and silence. Health of a woman is not a priority in our country. No one wants to invest in women's health”, says Ranjana Kumari, women's rights activist and director of the Centre for Social Research in New Delhi (Kalra, 2019).
Women’s health in Africa is arguably the most concerning. Poverty among women, economic disparities, and sexual and gender-based violence are a few of the issues standing in the way of improving African women’s health. Female genital mutilation is one of the largest concerns threatening the wellbeing of women, especially their reproductive health. The World Health Organization has implemented advocacy and support initiatives in Africa to mitigate these disparities. However, in order to make significant advancements in African women’s healthcare, the common mentality that women are being “selfish” by considering their wellbeing needs to be rectified (WHO, n.d.).
Strides in bringing equality in health care have been made by many professionals, including specialists at Katz Institute of Women’s Health. Dr. Grossman is working on integrating the center’s programs to consider all aspects of a female patient’s life—medical history, symptoms, nutrition, and lifestyle (Mieres, n.d.). Additionally, Dr. Mieres is working on changing the curriculum at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell to emphasize that a one-size-fits-all approach to treating patients is especially harmful towards female patients.
Though the healthcare system is gradually progressing towards equality, women need to take matters of their health into their own hands. The idea of being a “good patient”, one who refrains from complaining or not sharing all symptoms, should not be an obstacle. If a concern is not heard, getting a second opinion may help resolve lingering worries and find an accurate diagnosis. Most importantly, building a rapport between a patient and doctor will strengthen the patient’s quality of healthcare. As Dr. Mieres says, “relationship with your doctor is based on partnership not paternalism”. With four million more women in America compared to men, it is vital to address these gender biases against women (Statistic Times, 2019). "Improving women's health matters to women, to their families, communities and societies at large," says Dr. Margaret Chan, former director-general of the World Health Organization. “Improve women’s health, improve the world” (CNN, 2009).
References
Chen, E. H., Shofer, F. S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. L., Sease, K. L., & Mills, A. M. (2008). Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain. Academic Emergency Medicine, 15(5), 414-418. https://doi.org/10.1111/j.1553-2712.2008.00100.
Gender Ratio in the United States. (2020, July 13). Statistic Times. Retrieved June 18, 2021, from https://statisticstimes.com/demographics/country/us-sex-ratio.php
Kalra, R. J. (2019, August 21). Access to health care a distant dream for most Indian women. DW News. Retrieved June 28, 2021, from https://www.dw.com/en/access-to-health-care-a-distant-dream-for-most-indian-women/a-50108512
Kapoor, M., Agrawal, D., Ravi, S., Roy, A., Subramanian, S. V., & Guleria, R. (2019). Missing female patients: An observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India. BMJ Open, 9(8), e026850. https://doi.org/10.1136/bmjopen-2018-026850
Kiesel, L. (2017, October 9). Women and pain: Disparities in experience and treatment. Harvard Health Publishing. Retrieved June 18, 2021, from https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562
Mieres, J. (n.d.). Gaslighting in women's health: No, it's not just in your head. Northwell Health. Retrieved June 18, 2021, from https://www.northwell.edu/katz-institute-for-womens-health/articles/gaslighting-in-womens-health
Nabel, E. G. (2000). Coronary Heart Disease in Women — An Ounce of Prevention. New England Journal of Medicine, 343(8), 572-574. https://doi.org/10.1056/NEJM200008243430809
Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). "Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Research and Management, 2018, 1-14. https://doi.org/10.1155/2018/6358624
Tasca, C., Rapetti, M., Carta, M. G., & Fadda, B. (2012). Women And Hysteria In The History Of Mental Health. Clinical Practice & Epidemiology in Mental Health, 8(1), 110-119. https://doi.org/10.2174/1745017901208010110
WHO: Women's health an 'urgent priority'. (2009, November 11). CNN. Retrieved June 18, 2021, from http://www.cnn.com/2009/HEALTH/11/11/women.health/
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Article Thumbnail:
Lau, Lien C. “Pain .” Flickr, 1 Jan. 2005, www.flickr.com/photos/38479816@N04/3825822831.