Why don't doctors trust women? Because they don't know much about us

[Mij]

This article is 6 years old. I don't see it posted here.

I discovered that there are 10 chronic pain conditions that predominantly affect women which have very similar symptoms; and that once a person has one, they’re more likely to accumulate others.

Endometriosis, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, painful bladder syndrome, migraine headache, chronic tension-type headache, temporomandibular joint disorders, chronic lower back pain and vulvodynia affect at least 50 million US women alone.

I discovered that some of these pain conditions have a high rate of co-occurrence with autoimmune conditions including rheumatoid arthritis, lupus, Sjogren’s syndrome and thyroid diseases.

You know what else I discovered? That these conditions are all beset by delayed diagnosis; that a high proportion of women and gender-diverse people eventually diagnosed with these conditions will first be told they have a mental health condition, or are too concerned about their health.

You know what else I discovered? That many of these conditions can be well-managed if caught early.

Why are women still being treated as hysterical, overly emotional, anxious and unreliable witnesses to their own wellbeing?

Why do doctors still treat their patients who are female, people of colour or gender-diverse differently to their white male patients?

Why don’t they trust us?

The answer turns out to be quite simple. They don’t really know much about us.

 

[Trish]

I have only read the short quote above, but surely quite a sizeable proportion of doctors these days are women, and quite a lot are people of colour, so why the assumption that they don't know much about us?

 

[Mij]

The article goes on to say

"Women weren’t included in clinical trials until the 1990s. While we make up 70% of chronic pain patients, 80% of pain medication has been tested only on men. Even in preclinical trials with cell lines and rodents, males have been favoured over females. Researchers have justified this bias by claiming that oestrous cycles in female rodents – and menstrual cycles in human women – would potentially corrupt results. If that were so, wouldn’t it be quite important to find out before selling the drug to women?"

I had an endometrial biopsy done by a female gynecologist last year and was not given any pre-biopsy medication. She mentioned that it affects the vagus nerve and that I "might feel a little discomfort'. I would rate the pain at a scale of 10 (0-10) Why don't they provide semi-sedation or put the patient out for this procedure? Would they treat a male patient this way for a procedure that involves excruciating pain?

 

[Jonathan Edwards]

Would they treat a male patient this way for a procedure that involves excruciating pain?

Yes, they do, all the time.


The article is full of factual errors and biased claims - just as bad as any bias it seeks to unveil.

Men are treated as badly or even worse than women if they complain about things that do not seemto showup on tests.

When I worked for Ted Huskisson, who did most of the painkiller trials in UK rheumatology in the 1970s, virtually all the patients were women. It is just nonsense to say otherwise.

 

[MrMagoo]

It’s institutional/structural misogyny, that’s why.

 

[Yann04]

There definitely seems to be a structural bias towards conditions majoritarily affecting non-male populations. (women and non-binary).

But I have to say as a man with Me/cfs i havent got the impression they have any clue what theyre doing or compassion towards me either.
Perhaps it would be even worse if I was female. I can’t imagine how horrid that would be.

 

[Jonathan Edwards]

There definitely seems to be a structural bias towards conditions majoritarily affecting non-male populations. (women and non-binary).

I just don't see that, having spent my life working on a disease that mostly affects women. I find it hard to see where bias would come in there - it does affect more women.

And as pointed out, most doctors are women now anyway. And when it comes dismissing people they seem to be some of the worst. I worked with both male and female colleagues and the females were at least as likely to diagnose problems as psychological.

 

[Utsikt]

Women can still be biased against women.

 

[jnmaciuch]

There definitely seems to be a structural bias towards conditions majoritarily affecting non-male populations. (women and non-binary).

But I have to say as a man with Me/cfs i havent got the impression they have any clue what theyre doing or compassion towards me either.
Perhaps it would be even worse if I was female. I can’t imagine how horrid that would be.

Having a poorly understood chronic illness will automatically put you at the bottom of the barrel regardless of gender, but yeah being a woman definitely adds an extra layer on top of it. It's like I'm starting off every single interaction with the specter of the neurotic young woman hanging over my shoulder and every single thing I say gets (mis)interpreted through that lens.

I'm not having a discussion with my doctor, I'm immediately being placated. I can say that a recent switch in medication worsened my symptoms to the point that I might have to drop my classes, and what gets put in my chart is "anxious about doing well in school". I ask one question about a new medication and get talked to like I'm a child. Multiple doctors have felt entitled to scold me for having too high expectations when I told them that SSRI #4 didn't seem to do anything.

I also learned pretty quickly not to let doctors catch on that I have a biomedical background and know exactly what they're talking about because it can sometimes lead to me getting worse care. And it all operates completely below the awareness of any doctor, of course. They'll all walk out of those appointments earnestly believing that they didn't treat me any differently.

Women can still be biased against women.

Yes absolutely, women doctors were often as bad about this as the men and I've never seen that as an argument against gender bias in medicine. Women doctors pick up the same deeply ingrained cultural narratives as everyone else--being a woman might make a doctor more likely to choose to critically examine their own biases and change their behavior, but certainly doesn't guarantee anything.

 

[Jonathan Edwards]

It's like I'm starting off every single interaction with the specter of the neurotic young woman hanging over my shoulder and every single thing I say gets (mis)interpreted through that lens.

And what controlled evidence do you have for it being any different from having the spectre of being a neurotic old man hanging over you? My tropical sprue was diagnosed as 'functional'. My prostate cancer was treated as 'a bit too much worrying maybe'. My paroxysmal supraventricular tachycardia was treated by my cardiological colleague as a sign of the wimpishness of rheumatologists.

I can't see how women can tell that the situation is different for them, since they have never been sneered at as worried well men.

To me this article is a very good example of why crying wolf gets nobody anywhere. It confirms the very prejudice it sets out to dispel.

 

[jnmaciuch]

And what controlled evidence do you have for it being any different from having the spectre of being a neurotic old man hanging over you? My tropical sprue was diagnosed as 'functional'. My prostate cancer was treated as 'a bit too much worrying maybe'. My paroxysmal supraventricular tachycardia was treated by my cardiological colleague as a sign of the wimpishness of rheumatologists.

I can't see how women can tell that the situation is different for them, since they have never been sneered at as worried well men.

To me this article is a very good example of why crying wolf gets nobody anywhere. It confirms the very prejudice it sets out to dispel.

Let me schedule an appointment first so I can at least get a prescription out of it.

 

[Utsikt]

And what controlled evidence do you have

Seems like there have some studies looking at both real life data and imaginary cases.

https://aacnjournals.org/ccnonline/article/32/6/8/3242/Is-There-Gender-Bias-in-Critical-Care

I haven’t checked the studies at all, but if the descriptions here are right it would indicate some bias against women.

There’s also this review of mostly simulated cases for med students, with 8/9 showing bias against women when it comes to pain.

Medical student perceptions of gender and pain: a systematic review of the literature - BMC Medicine

Background Gender bias exists in healthcare and affects how pain is assessed and managed. This bias affects patient outcomes and their trust in healthcare professionals. We also know that future clinicians develop their attitudes early in training. Medical school is therefore an opportunity to...

bmcmedicine.biomedcentral.com

Or this on post-operative pain and pain management:

A Systematic Review of Race, Sex, and Socioeconomic Status Differences in Postoperative Pain and Pain Management - PubMed

Optimal postoperative pain relief continues to be a challenge for individuals who self-identify as racialized minorities, females, and those of lower SES. Standardization of care may help reduce disparities in postoperative pain management.

pubmed.ncbi.nlm.nih.gov

 

[Jonathan Edwards]

Seems like there have some studies looking at both real life data and imaginary cases.
https://aacnjournals.org/ccnonline/article/32/6/8/3242/Is-There-Gender-Bias-in-Critical-Care
I haven’t checked the studies at all, but if the descriptions here are right it would indicate some bias against women.

There’s also this review of mostly simulated cases for med students, with 8/9 showing bias against women when it comes to pain.

Isn't this exactly the sort of garbage questionnaire research we get annoyed by every day on here?
Might there not be all sorts of confounding aspects to such studies?
If a shedload of people want to prove a point because it is trendy they will find data somewhere.

What about when I had renal colic and I pointed out to the nurse that the entonox machine was not delivering any gas. She pretended it was, because she had been told to, despite it being switched off, presumably because someone said I was just being hysterical. She was too junior to realise that I knew perfectly well what was going on.

 

[Utsikt]

Isn't this exactly the sort of garbage questionnaire research we get annoyed by every day on here?
Might there not be all sorts of confounding aspects to such studies?

I think they created imaginary cases and only changed the gender to assess how gender impacts the assessments by the doctors or students. That seems pretty controlled to me? How that translates to what they do in practice is unclear, but why would it be much different?

Of course the studies asking about perceptions of bias have the usual flaws.

The register studies on overall rates of procedures or medication use might have some use, especially for the conditions where there is no reason to expect differences between the genders.

What about when I had renal colic and I pointed out to the nurse that the entonox machine was not delivering any gas. She pretended it was, because she had been told to, despite it being switched off, presumably because someone said I was just being hysterical. She was too junior to realise that I knew perfectly well what was going on.

It might be that healthcare in general has massive issues, but that it’s on average a tad worse for women?

 

[V.R.T.]

While I don't want to diminish anything that women go through, my experience has been that the minute you express what doctors consider undue concern about your health, or suffer from an affliction they cannot immediately diagnose, you lose a good proportion of whatever privilege being a man might have afforded you. One of the things about masculinity as a concept is that it must be performed at all times. And part of that is pretending never to feel unwell or be in pain, or at least play it down constantly, and push and push and work as hard as you possibly can. If you don't or can't do this you are labelled as weak, anxious, lazy, hypochondiac etc etc.

I have been gaslit, lied to, inappropriately diagnosed with psychological conditions by a GP based on one appointment, belittled, patronised, harangued and prescribed inappropriate medications ever since I first began to have health issues at 19 and stepped outside the sphere of 'well'. Every conversation I have ever tried to have with a GP since then has made me feel like I am under suspicion of something I can't quite put my finger on.

My partner has been on the receiving end of some heinous treatment by doctors too, and some of that did seem rooted in misogyny. Many of my female friends have stories of health conditions being dismissed. But the problem with medical culture goes beyond sexism. It is the entire ethos and the way they are taught to view patients. The rot goes very deep.

 

[Turtle]

When specialists treat men and women in such awful ways are they even trained in communication?
Is it still: the med student has learned a lot and then sees the first patient and reports to the supervisor?
Or are they using video or other media now? What about role play?
My diabetes nurse was trained way better in patient communication than any doctor I've met.

 

[MrMagoo]

There definitely seems to be a structural bias towards conditions majoritarily affecting non-male populations. (women and non-binary).

But I have to say as a man with Me/cfs i havent got the impression they have any clue what theyre doing or compassion towards me either.
Perhaps it would be even worse if I was female. I can’t imagine how horrid that would be.

It’s the same except you get random extra advice about having a baby or losing weight

 

[MrMagoo]

And what controlled evidence do you have for it being any different from having the spectre of being a neurotic old man hanging over you? My tropical sprue was diagnosed as 'functional'. My prostate cancer was treated as 'a bit too much worrying maybe'. My paroxysmal supraventricular tachycardia was treated by my cardiological colleague as a sign of the wimpishness of rheumatologists.

I can't see how women can tell that the situation is different for them, since they have never been sneered at as worried well men.

To me this article is a very good example of why crying wolf gets nobody anywhere. It confirms the very prejudice it sets out to dispel.

That’s because you’re a man.
Have you ever been advised to have a baby to resolve a medical concern?
It’s not a race to the bottom, medical care is woeful but we also know it’s worse for women, and for people of colour and the disabled. There are a wealth of studies, a recent one on how women of colour are more likely to die in childbirth in the NHS than white women. And be given less drugs.

Recently the NHS has made an effort to show things like rashes as the present on non-white skin because it looks different. If you were black then unless you were lucky enough to have a dr with experience certain skin presentations could be missed because they look different.

This isn’t a “medical” trial study it’s a sociological one, and there are many should you wish to look further into the statistics, since it’s not an area you’re familiar with.

 

[jnmaciuch]

While I don't want to diminish anything that women go through, my experience has been that the minute you express what doctors consider undue concern about your health, or suffer from an affliction they cannot immediately diagnose, you lose a good proportion of whatever privilege being a man might have afforded you. One of the things about masculinity as a concept is that it must be performed at all times. And part of that is pretending never to feel unwell or be in pain, or at least play it down constantly, and push and push and work as hard as you possibly can. If you don't or can't do this you are labelled as weak, anxious, lazy, hypochondiac etc etc.

I have been gaslit, lied to, inappropriately diagnosed with psychological conditions by a GP based on one appointment, belittled, patronised, harangued and prescribed inappropriate medications ever since I first began to have health issues at 19 and stepped outside the sphere of 'well'. Every conversation I have ever tried to have with a GP since then has made me feel like I am under suspicion of something I can't quite put my finger on.

My partner has been on the receiving end of some heinous treatment by doctors too, and some of that did seem rooted in misogyny. Many of my female friends have stories of health conditions being dismissed. But the problem with medical culture goes beyond sexism. It is the entire ethos and the way they are taught to view patients. The rot goes very deep.

I understand the point you’re making, though I think it’s worth clarifying the specific dynamics here because this ends up being one of the most common misunderstandings whenever gender bias is brought up in relation to things men also experience.

It’s not that masculinity protects against ableism/medical neglect or that the privileges of masculinity go away once you’re perceived as disabled—those things are always going to have their full impact regardless of gender. Its that masculinity confers the privilege of not having to deal with the specific ways that this ableism intersects with and gets compounded by bias against women.

So men will often chime in to say things like “well I get disregarded and treated as incompetent by doctors too” but the point is that when men experience those things, it’s rarely if ever on account of being a man. And the vast majority of reasons why a man would get disregarded (such as being disabled, racism, or just regular doctor misanthropy) are also things that women experience in conjunction with being disregarded in the way that women are.

For what it’s worth, woman also face the exact same expectation to constantly push through pain and never show that anything’s wrong—when they do express pain or illness, it’s not something that is “allowed” on account of them being a woman. It’s just a wholly negative thing that is expected more of women by default because they are already viewed in the negative light of being less able to handle adversity. “Be a man” only has meaning as a phrase because the implication is that it’s shameful to be weak and fragile like women.

So yes, the medical system is completely broken and men are hardly getting a rosy experience even if they’re not disabled. Their experience is just one that isnt also colored by bias against women. We’re scraping the bottom of the barrel anyways when it comes to medical treatment for poorly understood chronic illnesses, so in some respects it might not seem like a huge difference—but any woman with a chronic illness will tell you that being a woman does change important aspects of how that experience plays out.

 

[Snow Leopard]

"Women weren’t included in clinical trials until the 1990s. While we make up 70% of chronic pain patients, 80% of pain medication has been tested only on men. Even in preclinical trials with cell lines and rodents, males have been favoured over females. Researchers have justified this bias by claiming that oestrous cycles in female rodents – and menstrual cycles in human women – would potentially corrupt results. If that were so, wouldn’t it be quite important to find out before selling the drug to women?"

I've seen this claim a lot in the media over the last 10 years by lazy journalists, the problem is that it simply isn't true. The medications predominantly prescribed to women have had trials that have had participants that are predominantly or entirely women and this has been true for decades.

The rat research line is also irrelevant because rat models translate poorly to human hormone dynamics anyway - the research needs to be confirmed in humans anyway. The best evidence for bias against women is the balance of research funding itself, and the actual experiences of women in medical practise. The fact that experiences still aren't systematically measured is because the medical field simply doesn't want to know how badly they are really doing. If they measured those experiences they'd know how much more they are failing women.