UK: the Guardian:Women dying unnecessarily from heart disease

Healthcare professionals and the public mistakenly believed that women’s risk of CVD was lower than men’s, the statement said. “Myths and unconscious biases within clinical practices and societal perceptions further obscure the reality that heart disease does not discriminate by sex,” it said.
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I'm sure I read a few years ago that in the USA heart disease in its various forms was actually causing more deaths in women than men. But patients and doctors all assumed that it killed many more men than women.

I don't know if the figures have changed since I read this.
 
I've posted a few articles here on how men and women's symptoms present themselves very differently in heart disease.

One research I can't find at the moment that says gender of the ER doctor might affect female patients’ chances of survival. Research shows women are also twice as likely as men to die within six months of serious heart attack.
 
“Myths and unconscious biases within clinical practices and societal perceptions
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Some of those biases are unconscious. Most are definitely conscious. They're even taught at medical school, encouraged within the culture of health care, voiced out loud and put in writing. They're very overt, in fact. More often than not they're said in places and circumstances where they think the general public doesn't notice, but the Internet has changed that. Now there are decades of those easily available, and more of it is produced every single day. But point it out and it's defended because "it's the truth". The same thing bigots say. Not coincidentally. After all, people from X are obviously superior to the uncultured swine from Y. It's just a fact, everyone knows it.

A big reason why they hate the Internet where it relates to their job. It's still a convenient thing to blame their failures on, but then too many go on and share it on public forums, or their own work, and it just exposes the whole thing. Not really different than the protestant split over the secretive processes of the Catholic church. Times change, but humans don't.
 
rvallee said:
A big reason why they hate the Internet where it relates to their job.
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Today on r/medicine:

Seriously though, where do all these comments come from? Of course there are shitty doctors, just like shitty lawyers, engineers, chefs, etc. But holy fuck you would think me, you, and basically 90 percent of the people on this subreddit are almost psychopathically non empathetic based on reddit comments.
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Locked post, because of course.

And remember the #1 (officially #2, but whatevs) rule there is "No personal stories or situations. No requests for medical advice or information."

Nevertheless the current top post is —

I think we all (in the medical community) internalize stereotypes that have interfere with our judgment to a certain extent. I developed cauda equina after a back injury, pain was so bad I had to kneel during rounds. Fellow said this is chronic pain which we all know is psychologic. An attending encouraged me to smoke marijuana to deal with my chronic pain issue. I internalized these stereotypes as well and ignored the red flags until it was almost too late. It took my own permanent neurologic injury to realize how harmful biases are in the medical field, and for me to take my own patients more seriously.
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I've been reading the replies to that thread posted by @SNT Gatchaman immediately above. These are two of the best I've read.

Unfortunately, I don't know how to copy replies from Reddit without losing all the formatting.

STEMpsych LMHC - psychotherapist 48 points 13 hours ago

Are there legions of doctors that exist somewhere who just tell all patients that they're faking, or whatever else the complaints online call out???

Not all of them. The female ones. Apparently.

This is your friendly reminder that it's standard of care not to provide any anesthetic for a colposcopy, a procedure where a literal chunk of flesh is carved out of part of your reproductive system, and that until a month ago, it was not standard of care to provide anesthetic for IUD insertion despite widespread attestation to it being agonizingly painful.

A physician doesn't have to be a bastard or openly antagonistic to women to routinely torture women and disregard their suffering. A physician doesn't even have to be male. One of the most eye-opening experiences of my Reddit life was being a fly on the wall over in r/residents, listening to a bunch of women obgyn residents discuss, "Hey, uh, so why don't we use any sort of anesthetic for colposcopies?"

But, of course, there are physicians (including women physicians) who do have contempt for women patients and their pain. It can be very quiet and not announce itself. It can just manifest in warmly patronizing "reassurance" that nothing is really wrong, delivered in advance of any assessment, imaging, or testing whatsoever.

Heck, maybe I do it too.

Indeed, maybe you do.
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HoldUp--What NP 50 points 14 hours ago

It's legitimately wild to me that instead of believing the hoards of people, especially women, in society who say they've had these experiences, your first instinct is to ask other doctors with a note of "well I don't know anybody who would do that." Yes you do, you absolutely do. Of course nobody ever thinks they're being dismissive of legitimate claims because they think they're right.

If we had a couple of hours to chat I could tell you plenty of stories. Some of my own, some of my mother's from the years I spent as her caregiver before her "anxiety" (fucking pulmonary fibrosis) killed her.

And many of these are from reputable doctors, ones with good reputations who by all accounts are otherwise great.
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SNT Gatchaman said:
Today on r/medicine:



Locked post, because of course.

And remember the #1 (officially #2, but whatevs) rule there is "No personal stories or situations. No requests for medical advice or information."

Nevertheless the current top post is —
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It's a bit wild how they're noticing how there are no structures in place to make such complaints, but can't connect the dots as to why this is the reason those are mostly voiced on public forums like newspapers and social media. With patients, there are loads of factors that come into play for why the offending clinician isn't directly told those things, mostly having to do with it being pointless since it never changes anything. But they usually are told. Just not in the same terms as people use later on. Because offending a physician is a great way of degrading your own future care, and most people know this. The power imbalance is total, and yet it's MDs who seem to feel the most powerless here.

The thread overall isn't that bad. It's basically ignorant of everything that doesn't happen during a consult, but it's baffling that the thread got locked where there is in fact quite a lot of agreement that this is a problem, although vastly understating it and its real-life consequences.

But what they're really missing out here is that the problems lie in the systems, not in the individuals. The individuals comply with the system's demands, and they are part of the problem in the sense that those systems will only change when those who work in it make it change. Systems and culture. Bureaucracies can be so much more harmful and just as psychopathic as vengeful mobs, especially when they are pretty much immune from legal repercussions.
 
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rvallee said:
It's a bit wild how they're noticing how there are no structures in place to make such complaints
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Another thing I've noticed is that if a doctor makes a diagnosis (that is, in reality, a misdiagnosis) he/she assumes that since the patient rarely comes back they (the doctor) must have been right when, of course, such perfection rarely exists.

Why is there no standard method of letting doctors know that their original diagnoses was wrong?
 
Another article on women and the heart :

Title : 8,000 UK women die due to unequal heart attack care
Link : https://www.itv.com/news/2018-11-22/8-000-uk-women-die-due-to-unequal-heart-attack-care

More than 8,200 women in England and Wales could have survived their heart attacks had they simply been given the same quality of treatment as men, new research has found.

Researchers at the University of Leeds said the actual number of lives lost to unequal care is likely to be much higher, as they did not include all hospital admissions which occurred over the 10-year study period.
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I tried to find the study the article was based on, but couldn't find it.
 
It might be

Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies’ consensus document
Upasana Tayal; Graziella Pompei; Ian Wilkinson; Dawn Adamson; Aish Sinha; David Hildick-Smith; Richard Cubbon; Madalina Garbi; Thomas E Ingram; Claire L Colebourn; C Fielder Camm; Tomasz J Guzik; Lisa Anderson; Stephen P Page; Eleanor Wicks; Petra Jenkins; Stuart D Rosen; Stavros Eftychiou; Eleri Roberts; Helen Eftekhari; Heather Probert; Aynsley Cowie; Raj Thakkar; Jim Moore; Colin Berry; Gaby Captur; Aparna Deshpande; Sarah Brown; Roland Malkin; Mary Harrison; Claire Lawson; G Andre Ng; Vijay Kunadian

Despite significant progress in cardiovascular pharmacotherapy and interventional strategies, cardiovascular disease (CVD), in particular ischaemic heart disease, remains the leading cause of morbidity and mortality among women in the UK and worldwide.

Women are underdiagnosed, undertreated and under-represented in clinical trials directed at management strategies for CVD, making their results less applicable to this subset. Women have additional sex-specific risk factors that put them at higher risk of future cardiovascular events. Psychosocial risk factors, socioeconomic deprivation and environmental factors have an augmented impact on women’s cardiovascular health, highlighting the need for a holistic approach to care that considers risk factors specifically related to female biology alongside the traditional risk factors. Importantly, in the UK, even in the context of a National Health Service, there exist significant regional variations in age-standardised mortality rates among patients with CVD.

Given most CVDs are preventable, concerted efforts are necessary to address the unmet needs and ensure parity of care for women with CVD. The present consensus document, put together by the British Cardiovascular Society (BCS)’s affiliated societies, specifically portrays the current status on the sex-related differences in the diagnosis and treatment of each of the major CVD areas and proposes strategies to overcome the barriers in accessing diagnoses and treatments among women.

This document aims at raising awareness of the scale of the current problem and hopes to stimulate a multifaceted approach to address sex disparities and enable future comprehensive sex-and gender-based research through collaboration across different affiliated societies within the BCS.


Link | PDF (Heart) [Open Access]
 
Story also covered in today's edition of The Times (London):

It’s not just heart disease — other conditions that are often missed in women
Brain tumours, dementia and autism are among the conditions for which women are more likely to be given an incorrect diagnosis

By now, it’s surely no secret that women are more likely to be misdiagnosed or dismissed by medical professionals than men. According to the Women’s Health Strategy for England in November 2022, 84 per cent of women have felt a doctor wasn’t listening to their concerns, while 57 per cent feel they have been given the wrong diagnosis.

A report by the men’s health platform Manual found that Britain has the 12th-highest female gender health gap in the world thanks to “the misdiagnosis of women’s symptoms”. In its league table of the top 66 countries with a male health gap, the UK didn’t feature.

Paywalled:
https://www.thetimes.com/life-style...nosis-women-other-health-conditions-v97pqs3kk

Archive:
https://archive.ph/qAcSB
 
Perhaps a general gender bias thread might be an idea to collate experiences .
Also how different ( if at all ) is the male experience of healthcare provision if diagnosed with a " female" disease

Thread from X which just reinforces that generally bias is not an unusual aspect of care ( lack of )

https://twitter.com/user/status/1856451506351775757


“If somebody doesn't help me, I'm going to die," she recalls wailing, watching doctors and nurses pass her by.

"Somebody said to me, 'I don't know what you expect me to do,'" she said. "'You're a healthy 21-year-old young female.'"

This is exactly what happened to me at 24…

This happens far too often. Some of the most dangerous words in medicine are:

“You test results are normal”
“You’re young and healthy”
“What do you want me to do?”

I heard these words over and over while dealing with a severe internal bleed after a hysterectomy /2
I had been sent home after the surgery despite not feeling “right”. I remember pleading with them to keep me longer and then telling me “you’re young and healthy you will be fine”.

A few days later it was obvious I wasn’t “fine” /3

.....
Lots of similar comments - in this case treatment provided after a physically large partner accompanied her and loudly refused to leave until something was done . She was subsequently airlifted to a larger facility for emergency surgery with 50/50 odds ..
 
Arnie Pye said:
Sexism in the general population is rife apparently. I doubt doctors are exempt...

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This is the stuff I mentioned in the Who is Simon Wessely? thread, where I linked to someone who made a graphic for how the psychobehavioral model of chronic illness is basically an extension of this "your body, my choice" thinking.

Physicians are definitely not exempt. In fact pretty much have it down to a science, but this isn't applied only to women, it's a self-entitled culture devoid of any real accountability that is the real problem. Bad behavior is rarely punished, in fact in some cases it's mandatory.
 
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