The Invisible Killer
How medical bias leads to poorer outcomes for women and minorities
“Men don’t go to doctors unless something really bad is happening.” This is a common refrain among friends and family who are often frustrated with their loved ones’ refusal to get timely treatment. They believe that if a man is at the doctor, it must be serious. They also believe that men must disproportionately have worse outcomes in the US medical system because they don’t seek timely treatment. However, it ends up these beliefs are rooted in social misconceptions.
First, let’s address some of these common misbeliefs:
- More women enter the healthcare system than men: This isn’t necessarily true (it depends on the issue being treated). Also, studies generally control for the number of women vs. men who actually enter the healthcare system. Even so, the health and treatment outcomes for women are worse than men.
- Doctors believe men are more serious, and treating them more seriously is a good thing: If doctors are treating male patients more seriously than female patients based upon the belief that “men only see doctors when something really bad is happening”, that’s actually the definition of bias. That would mean doctors are either implicitly or explicitly assuming they know their patient’s intent and the condition’s severity before they’ve even had an opportunity to treat them.
- Men defer treatment more than women: Not so! Our cultural discourse here is different than the data. When it comes to some conditions like heart attacks, studies show that women may actually defer treatment. So, it’s a false assumption that men are always the ones to put off going to the doctor. It depends upon the health issue.
- Women are treated as seriously — or more seriously — than men: Unfortunately, women often receive worse care because their concerns are dismissed as “all in their head”, anxiety, emotionality, or hysteria. This is rooted in sexism. Other dismissal can be due to general practitioners’ lack of experience with female-specific issues. As explained in this ThinkProgress piece: “The issue extends beyond the female reproductive system. There’s a particularly well-documented gender gap in the treatment of pain. Even though women are more likely to suffer from chronic pain […] they’re less likely than their male counterparts to receive appropriate treatment for it.”
To go a bit more in-depth: medical bias is such an issue that it’s now often discussed in medical school training. When healthcare bias is discussed, and it’s not just gender bias that’s the issue, but racial bias. As noted in the New England Journal of Medicine (emphasis mine):
Despite physicians’ and medical centers’ best intentions of being equitable, black–white disparities persist in patient outcomes, medical education, and faculty recruitment. In the 2002 report Unequal Treatment, the Institute of Medicine (IOM) reviewed hundreds of studies of age, sex, and racial differences in medical diagnoses, treatments, and health care outcomes. The IOM’s conclusion was that for almost every disease studied, black Americans received less effective care than white Americans. These disparities persisted despite matching for socioeconomic and insurance status.
A doctor wrote about racial bias in medicine in the Scientific American, and the details are pretty shocking:
Two studies performed in emergency rooms showed that doctors were far more likely to fail to order pain medication for black and Hispanic patients who came in with bone fractures. Doctors are less likely to diagnose black patients with depression yet more likely to diagnose psychotic disorders such as schizophrenia. Hispanic HIV patients are twice as likely to die as white HIV patients, and black HIV patients are less likely to get antibiotics to prevent pneumonia. There is, however, one procedure that doctors are more likely to perform on black patients: amputation.
There’s also that much of the medical research done and information propagated assumes “male” by default. For example, the common recognizable signs for a stroke that are propagated are the male stroke symptoms. Female stroke symptoms can be very different. Same thing for heart attacks:
The fact that women’s heart attacks are less likely to adhere to the “textbook” model is not exactly an accident, since the textbook was, quite literally, written based on what men’s heart attacks look like.
This can have drastic, life threatening consequences. For female patients, the risk is that patients may not recognize symptoms, even when they’re at risk:
Many of the interviewees in the Yale study, even those who had a family history of the disease, underestimated how much they were personally at risk, often figuring that they were too young to be having a heart attack.
They also had a fairly stereotypical idea, gleaned mostly from popular media, of what it would feel like: the sudden onset of chest pain and shooting left arm pain that marks the “Hollywood heart attack.”
So when they began to experience symptoms like jaw pain, upper back pain, a feeling of indigestion, nausea, and fatigue — the “atypical” signs that women are more likely than men to get — they tended to attribute them to other health problems.
For doctors, the issue is that medical community misinformation can lead to misdiagnosis or dismissal of concerns. If your doctor doesn’t know the difference between male and female heart attack symptoms, how can they properly treat their patients? And if they aren’t aware that women are a higher-risk group, will they appropriately respond to female patients?
Although more women than men have died each year from cardiovascular-related causes since 1984, fewer than one in five doctors — primary care physicians, OB/GYNs, and even cardiologists — surveyed in a 2005 study knew that.
Medical bias is a very real issue, whether you’re talking about sex, gender, race, or even body size (healthcare bias against obese patients is also a life-threatening issue.) It adds up to tragically poorer health outcomes and preventable deaths for many groups.
And when it comes to female patients, research is clear: they’re treated less seriously, even once they’re at the doctor. They have worse health outcomes, and doctors are less well-informed about their unique symptoms and health conditions. It’s a widespread issue, and the medical community has a long way to go until equity is achieved.
Kimberly is a freelance writer and photographer. She has been on the receiving end of healthcare bias in the emergency room, and it was a very sobering experience. The rest of the time you’ll find her traveling and eating.
Leave a tip ❤ | FB | Instagram | Twitter | Plethora-Etc.com
