How Gender Bias Affects Medical Care For Patients

Content Warning: This post will discuss subjects such as sexism, discrimination, and poor medical treatment that could possibly be triggering for some with past medical trauma. My intent is to educate, not to harm.

 

Yesterday, I stumbled upon this article via Twitter, Women ‘Catastrophize’ About Pain More Than Men. I’m almost hesitant to write about this article in fear of adding some sort of legitimacy to it, but it, unknowingly, shines a light on a major issue plaguing our society: gender bias in medicine. This is a bias that affects both men and women negatively.

The bias that seems to be so prominent in the medical field is that women are overly dramatic, especially where pain is concerned. I have experienced this first hand time after time after time. The article above highlights this perception while pretending to be a research based article. However, they don’t link to any sources and, other than one or two quotes, don’t show any science to back up this idea that women ‘catastrophize’ about their pain. Therefore, instead of responding only with my own experiences (although I will definitely include some) I am also going to support what I’m saying with peer reviewed journals or articles from reputable sources. Pat Anson, author of “Women Catastrophize About Pain More Than Men,” please take note of how it’s done.

First, lets talk about this term catastrophize. It’s a term used to characterize a patients negative attitude towards events or feelings. Basically, it’s exactly what it sounds like: making everything a catastrophe. It’s used in relation to pain to describe someone who thinks negatively about their pain. According to the research paper Pain Catastrophizing: A Critical Review, the idea of pain catastrophization was introduced by Albert Ellis in 1962 and Aaron Beck in 1979. Why do those dates matter? Well, according to the paper Women and Hysteria in the History of Mental Health 1980 is the year when the official diagnosis of “hysteria” was removed from the DSM-III (the psychiatric journal of mental disorders).

The terms hysteria and hysterical have made their way into our mainstream vocabulary, but very few people know the history of the term. Hysteria was a medical diagnosis based purely on the fact that a woman has a uterus which dates back to Ancient Egypt and prevails through the 20th Century (WHHMH). I’m sure you’ve heard of the medical procedure a hysterectomy? Did you know that they were originally performed as a treatment to hysteria since they were believed to be the cause of any and all medical maladies that doctors didn’t understand? Hysteria treatments have ranged from strange to horrifying, including: using bowls of perfumed water to coax the uterus back to it’s rightful place, suggestions of marriage and sex, actual sexual simulation and/or penetration by male doctors, exorcism, and being accused of witchcraft which typically meant a death sentence (WHHMH). Symptoms varied and were vague. They could include: fainting, anxiety, depression, abdominal pain, infertility, so on and so forth.

Catastrophizing is the contemporary ‘hysteria.’ It is a vague catch-all that is used to dismiss a woman’s experience. Women are constantly taught to doubt themselves, even when it comes to knowing their own bodies. This has led to women often receiving sub-par healthcare and having to overcome more obstacles than males to receive the same treatment.

Don’t believe me? That’s ok, you don’t have to take my word for it. That’s why I did research (looking at you Pat Anson)! According to an often cited peer-reviewed research journal, The Girl Who Cried Pain, research indicates that “while women have a higher prevalence of chronic pain syndromes and diseases associated with chronic pain than men […] women’s pain reports are taken less seriously than men’s, and women receive less aggressive treatment than men for their pain” (pg 21).

It’s not my intention to be snarky, but I’m pretty sure that’s the exact opposite of what Pat’s article states: “For women, pain catastrophizing was strongly associated with having an opioid prescription, even when there were relatively low levels of pain.” Just for some perspective, “The Girl Who Cried Pain” was a review of multiple different studies looking into pain, gender bias, and medical treatment. Pat’s mentions one study by name but doesn’t even link to the source. Ok, fine…maybe I did intend to be snarky.

Pat’s article also included this quote from Yasamin Sharifzadeh: “If physicians are aware of these gender-specific differences, they can tailor their treatment,” she said. “When treating chronic pain patients — especially women — they should analyze pain in its psychological aspect as well as its physical aspect.” This is not only a ridiculous and unnecessary comment, but it is also incredibly wrong as there’s a whole bunch of research to support the opposite. An article from the Cleveland Clinic states that women are more likely than men to suffer from chronic pain conditions such as: osteoarthritis, fibromyalgia, irritable bowl syndrome, headaches, migraines, fractures, and more (Why Are Women More Likely to Suffer From Chronic Pain).

My loyal fans, assuming I have any, will remember that I have multiple chronic illnesses, the most prominent being POTS (a form of dysautonomia) and Ehlers Danlos Syndrome Hypermobility Type. According to Dysautonomia International, approximately 80% of POTS patients are female. This journal article on Ehlers Danlos Syndrome states that more than 90% of patients with the hypermobility type of EDS are female. Now, these numbers could be somewhat skewed by the fact that “men with chronic pain are more likely to delay seeking treatment” which is hypothesized to be due to the gender norm that men have to be tough which means dealing with your pain, however, once they do seek treatment they “generally receive a more aggressive response from health-care providers” (The Girl Who Cried Pain).

“when women are consistently refused full work-ups and adequate care because it is assumed that they are just ‘catastrophizing’ or being melodramatic, people die. Women die. “

One researcher came up with a hypothesis for this difference in treatment called “Yentle Syndrome” (ibid). The results of several different studies support this hypothesis as “physicians were found to consistently view women’s (but not men’s) symptom reports as caused by emotional factors, even in the presence of positive clinical tests” (ibid). Read that sentence again, because it’s an important one. Now, understand that this does not mean that men never have to deal with disbelieving doctors. I have multiple male friends in my spoonie network that have dealt with this time and time again. However, it does show that there is a systemic problem with gender bias against women that is critically harming their health.

Almost every visit to the ER comes with a shot of Ativan (an anti-anxiety medicine) for me. In fact, it typically is given to me before any tests are done, other than checking vitals, and before I’ve even spoken to the doctor. There is something incredibly wrong with a doctor administrating medication to a patient before fully evaluating them or even speaking to them. This is not to say that anxiety isn’t a serious problem that needs to be treated as well, but when women are consistently refused full work-ups and adequate care because it is assumed that they are just ‘catastrophizing’ or being melodramatic, people die. Women die.

This bias has affected not only the treatment I receive, but how I approach that treatment. I stopped wearing make-up to any of my doctor’s appointments with men because I have had them tell me that I look too pretty to be sick. Research has shown that I’m not the only one that happens to. When I go to the urgent care or ER, I almost never tell them that my pain is above an 8, no matter how painful it is. Why? Because I’ve seen the eye rolls when I say ’10’ through clenched teeth while doubled over in pain. I’ve heard the sighs of disbelief. And I’ve received the all-too-common “it’s just anxiety, you need to calm down.” Then, to add insult to injury, if I push back and demand to be taken seriously I get: “see, you’re all worked up. You need to calm down, just go get some rest.”

If you have never been in that situation, then it might be hard to comprehend the damage such an experience does to a persons morale. To this day I question myself constantly over whether my pain is real or made-up. Before I go to the ER, I almost always ask Matt if he thinks that I really need to go or if I’m just being too dramatic. His response is always the same, “you know your body, if you say it’s that bad then it’s that bad.” Why is it so hard for doctors to understand that concept?

One of the largest flaws in any kind of ‘catastrophizing’ or ‘hysteria’ hypothesis is that, as of right now, pain cannot adequately be measured in any objective form. Pain is always subjective, always. Doctors have no way to accurately measure how much pain you are in, they have to rely on what you tell them. “The Girl Who Cried Pain” confirmed this fact by stating: “because diagnostic techniques are not available to “accurately” measure pain and because pain perception is affected psychological and cultural factors, patients self-reporting remains the basis for diagnosis” (pg 18). If the main basis for a diagnosis is the patient’s experience, then what happens for the patient when the doctor refuses to believe their experience? Well, typically, they suffer, they get sicker, or they even die. This seems to be a gross breach of the well-known Hippocratic oath…although, to be fair, Hippocrates was one of those fellas that believed being a woman was in itself a medical condition.

To be honest, I could talk about this all day. There’s an abundance of evidence, research, hypotheses, and personal stories that support the harm of gender bias in medicine. There’s also lots of theories as to why the bias exists, why men delay getting treatment, why women are more vocal, why women are more likely to develop chronic pain disorders, and so on. I’m even tempted to tackle the seemingly sudden appearance of women’s disorders that many think are evidence of our society poisoning us or whatever, but I believe is more indicative of how women’s health issues have been ignored since the dawn of time. I mean, women were being diagnosed with hysteria in Ancient Egypt for frequent fainting spells….sounds a bit like POTS to me! But, I will save those fights for another day.

Oh, Pat. I hope that this blog has helped to show you the errors of your way. Not that I expect a huge amount of journalistic integrity from an article on painnewsnetwork.org, but if I can do it, then so can you. Fellow spoonies, spoonie supporters, women, loved ones of women, and everyone (because this is humanity’s problem), I hope that this article was helpful for you. I hope you maybe learned something you didn’t know before. Or maybe got some validation for your struggles. And I hope that you’ll share this far and wide because it’s time for this deadly injustice to end.

Do you have an experience with a disinterested doctor you’d like to share? Leave me a comment!

 

And here are some other, but by no means all, articles discussing this problem that I didn’t end up using in my post:

http://www.healthline.com/health-news/gender-bias-against-female-pain-patients#3

https://www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/

 

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SaideeWynn

I am a mother, partner, teacher, daughter, writer, and blogger. I'm working on turning my private hobby into a public one, whether the public asked for it or not. I have a BA in theatre and a Master's in Education (with a Montessori integration), making me a highly overqualified internet ranter.

One thought on “How Gender Bias Affects Medical Care For Patients

  • November 7, 2017 at 12:56 am
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