The Problem of Gender Bias in Medical Diagnosis
The old stereotype that men are doctors and women nurses seems to belong to another time, but when we look at the statistics, the categories still ring true. Despite 77% of the NHS workforce being women, only 5% of them work as doctors or dentists, compared to 22% of the male workforce holding one of these roles.
Of these, only 34% of specialist medical positions are held by women, although the number of female specialists in training is steadily growing. What this means in practice, is that although women make up over half of the population, when in need of specialist care, it’s likely we will be seen by a male doctor.
On the surface, this doesn’t seem like much of a problem, but only because we like to think of doctors as benign, infallible, and unbiased professionals, operating within the strict guidelines of objective medical science. Unfortunately, there are two things wrong with this view.
Firstly, doctors are human just like the rest of us. They don’t practice medicine in a vacuum, and are just as prone to unconscious and conscious bias as we are. Secondly, medical science has a long history of both misunderstanding and mistreating female patients, and delays in diagnosis for women are startlingly common.
“There are a lot of hills in Sheffield”
It’s October 2016. I am 25-years-old, and sitting in a waiting room at my local hospital, waiting to see an ENT. It’s been one year and seven months since I had a whiplash injury and started experiencing chronic pain, pressure in my left ear, altered sensations, and slurred speech. It’s been eight months since the chronic dizziness and vertigo attacks began, following a chiropractic correction I should never have attempted.
The hospital is loud. The strip lighting is making my head pound, and the car journey here means I am teetering on the edge of a vertigo attack. Every noise echoes in my skull and makes the edges of my vision quiver, and I have to tilt my head to stop everything from jumping. The sound of my own voice causes me pain, and if I speak too much I’m likely to lose my equilibrium entirely — and I really don’t want to vomit in public.
But this appointment could change everything. I’ve been sent here by a neurologist I was referred to five months ago. He wants to make sure everything’s fine with my ears, and I know for a fact there’s something wrong with my left ear, or at least the nerves around it, so I’m hopeful that finally, finally, someone might diagnose me.
“So, what seems to be the problem?” The ENT asks, as I gingerly sit in front of him.
And here I go. I’ve got really good at describing the minutae of my symptoms over the last year and a half. I focus on the vertigo and dizziness first, emphasising how everything seemed to go wrong after the whiplash, and suggesting that my joints have always been weak and painful so perhaps this is related? Next, I tell him about how I’ve had to quit work, that I can’t leave my house unaided, that every waking moment is a battle to remain upright, that I can’t sleep because the vertigo wakes me up, and nothing I do seems to bring any relief.
I don’t talk about this stuff a lot. I haven’t allowed myself to, so by the end of my speech I feel a lump forming in my throat, but I am adamant I won’t be seen as an ‘hysterical woman’. Finally, I manage to suggest that perhaps the whiplash injury damaged my inner-ear, or the nerves and muscles in my neck, and maybe he could order a scan to check? By the time I’m finished, the room is swaying and the edges of objects are out of focus, but I’ve said my piece and I’m happy.
That is, until he sits back in his chair, flips idly through my medical file, and says:
“Well, there are a lot of hills in Sheffield.”
For a moment, I’m not sure I’ve heard him correctly. Surely, he can’t be suggesting what I think he’s suggesting? That the debilitating symptoms I’ve just described exist simply because I live slightly above sea level? But he’s looking at me completely calmly, so I ask him, just as calmly, what he means.
He launches into a ten-minute explanation about changes in air pressure, and how some people are affected more than others, and that because there’s no hearing loss it couldn’t possibly be anything else. I feel like someone has punched me in the stomach. All I hear as he speaks is the none-too-subtle implication beneath his words: Your symptoms can’t be that bad. You’re faking it. You’re wasting my time.
When he finishes his explanation, I sit and stare at him for a long moment, and when I speak my voice is both too loud and seems distant.
“So, you’re not going to request a scan then?”
He repeats that there’s no hearing loss, suggests I do more exercise, and tells me that women often mistake anxiety for something ‘sinister’, so I shouldn’t worry too much. When I leave his office I’m too numb to cry, but I spend the rest of the day sitting in my living room watching the walls move, and trying not to think about the months I’ll have to wait to see a different doctor.
A common story
You might think this story has been exaggerated, or that it is, at the very least, an outlying example of poor medical care from one individual. But this is merely one example of the kind of dismissive attitude I’ve faced from specialists over the last three years, and my case is far from unusual.
From medieval ideas about wandering wombs, to advice as late as the 1970s that a woman who leaves her abusive husband must be suffering from a mental illness, history is riddled with the misdiagnosis and mistreatment of women. Of course, race and poverty also feed into healthcare bias, and men are poorly served in regards to mental healthcare, but women seeking diagnosis for physical illness are all too frequently dismissed, and actively harmed by medical bias.
A recent study by the British Heart Foundation found that women have a 50% higher chance of receiving a false diagnosis following a heart attack, in part because the severity of their symptoms is not immediately believed, and they are more likely to be told they’re having a panic attack.
Numerous clinical studies have found that women obtain dialysis later than men, that doctors are more likely to assume chronic pain in women is caused by emotional distress — even when clinical tests prove otherwise — and that women having a stroke are 30% more likely to be misdiagnosed in an emergency room.
In her essay The Girl Who Cried Pain, Leslie Jamison argues that women are “more likely to be treated less aggressively in their initial encounters with the healthcare system, until they ‘prove they are as sick as male patients,’” leading to delays in both the acute and long-term treatment of pain.
For chronic illnesses, and in particular, autoimmune illnesses, the statistics are even worse. For reasons that are still unclear, around 75% of people affected by autoimmune illnesses are women, but it takes an average of five different doctors and 4.6 years for us to receive a correct diagnosis. Anecdotal evidence suggests that a large number of these women are told their symptoms are all in their head, and so prescribed anti-depressants rather than further tests.
It is, similarly, no coincidence given the attitude of the medical profession towards female pain, that it takes between 7 and 8 years for a woman to be diagnosed with endometriosis. Neither should it be surprising that, when almost all sufferers of fibromyalgia and chronic fatigue syndrome are women, until the last ten years the medical profession denied these conditions even existed outside of mental illness.
The importance of recognising bias
It seems clear that women are often poorly-served by a profession that has traditionally dismissed, ignored, or misunderstood our pain. However, the issue of medical bias is a complex one. The steady increase in women entering the medical field as specialists will, we might assume, go some way to encouraging a fairer consideration of our symptoms, and greater understanding of the stark differences between our healthcare experiences and men’s.
But it won’t solve the whole issue.
The medical world may have prided itself on its objectivity throughout history, but we need to be aware that this has never been the case. Until we recognise this, nothing will change. An emerging body of research now seems to prove that if you’re a woman, you are more likely to experience bias in healthcare, and this is compounded if you are also a Person of Colour, transgender*, poor, or fat.
Until all specialists are trained to focus more on what the patient is saying, rather than on who is saying it, we will continue to suffer from the effects of delayed treatment and medical gaslighting; regardless of whether or not there are a lot of hills in Sheffield.
- *I wasn’t able to find many details on the experiences of trans men and women accessing care, but I would be interested in learning more about it.
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