A healthcare system based on gender bias.
An exploration of the experiences of female patients and professionals in healthcare.
Gender bias in healthcare occurs when both genders are not offered equal quality treatments and care for the same medical complaints or when variable manifestations of disease are not considered based on sex. Increasingly, researchers and clinicians are recognising the importance of accounting for sex as an important biological variable. Yet the diagnosis and treatment of health problems is largely based on male-centred research which lacks inclusion of women in fear that their hormone fluctuations and reproductive cycles will affect the results(1). Even when women are included, a large number of studies fail to report their findings by sex, leading to the question are these discoveries safe and effective for women?
The underrepresentation of women in chronic pain studies is just one of the examples sparking discussion of gender bias in healthcare research. Women dominate most diagnoses of chronic pain(2). Yet 80% of studies on chronic pain used only male mice or human men(3). The problem arises in the assumption that women’s biology and experience of pain are the same as men. However, studies have shown that women have a greater sensitivity to pain and perceive pain differently to men. In addition, the sexes are often treated differently for pain, leading to disparities in pain management. It is unsurprising that many of the chronic pains conditions for which we do not have treatments for are more common in or exclusively affect women, such as endometriosis and polycystic ovarian syndrome. This may be a result of the lack of investment we need to fully understand women’s health. One-third of women will suffer from a reproductive or gynaecological problem in their lifetime yet only 2.5% of publicly funded research is designated to reproductive health (4,5).
In practice, this ingrained gender bias in healthcare research has resulted in a dismissive and overlooked attitude towards women. Women have reported being described as hysterical, emotional and fabricating pain by healthcare professionals when discussing chronic pain issues (6,7). They have described “(…) how hard they have had to work to be taken seriously, believed, and understood in medical encounters”(7). Unfortunately, I have seen such gender bias firsthand in clinical practice: a woman writhing in pain from cervical cancer, was blamed by the team caring for her, for not attending her latest smear test. Meanwhile, down the corridor a male counterpart is rewarded for his ‘bravery’ for coming to see the doctor about his testicular pain.
The gender bias in clinical practice does not stop with the patients. With female doctors, too often being referred to as ‘lady doctors’. Yet 45% of doctors in the UK are female; with this expected to rise, with 53.4% of medical students being female(8,9). So, I ask myself, am I being difficult if I challenge patients when they use such a term? Maybe they don’t mean any offence, but also is accepting such inadvertent sexism contributing to a system of gender bias? My own experience of gender bias involves regularly being mistaken for a nurse despite introducing myself as a medical student. However, my male peer with the same introduction is referred to as a doctor. Such unconscious biases represent how deeply the gender biases in medicine are ingrained. There have been moments when I have been interrupted by an irrelevant comment about appearance or misogynistic joke, but this is just further evidence of a much larger problem. And that is the insidious misogyny which is evident in our culture.
It is important to note that efforts are being made by the scientific community to counteract neglect of women in healthcare. For example, women are now routinely involved in clinical studies, and we are beginning to explore the differences in the ways that men and women explore the disease. Developing awareness around gender norms is important, both in research and clinical practice, in order to counteract the gender bias in healthcare and to support healthcare professionals in providing more equitable care to meet the needs of all patients(7).
You may be thinking, what can I do as a student to help cease gender bias in the healthcare system? You may feel that this problem arises systemically and is out of your control. However, there are steps we can take as individuals to work towards the advances in women’s health we need. Firstly, start to think about women’s health in the same way you think about other causes that are important to you. Read up, share posts, and start discussions with friends and colleagues. Most importantly, if you find yourself in a healthcare setting, ask the doctor who cares for you or a loved one — is this disease or treatment different in women? Whilst the doctor may not know the answer yet, if asked, they will go looking and the conversation into women’s health will start to open up.
If this topic is of interest to you, come along to our upcoming ‘Sexism in Medicine’ panel discussion:
Sexism in Medicine
Mon 23 Mar, 6–8pm (we’ll bring pizza!)
LUBS Maurice Keyworth 1.06
This event is a panel discussion aiming to discuss this sexism and when, why and how it should be challenged with practical ways to do this.
Find out more here. https://www.luu.org.uk/union-events/2020/march/sexism-in-medicine-230320/
(1) https://www.popsci.com/surprise-researchers-think-women-are-being-excluded-from-clinical-trials/
(2) Thomtén, J. (2012). Pain among women: Prospective population studies from a biopsychosocial perspective on pain. Mid Sweden University, Östersund.
(4) https://www.gov.uk/government/news/survey-reveals-women-experience-severe-reproductive-health-issues
(5) http://www.ukcrc.org/wp-content/uploads/2015/08/UKCRCHealthResearchAnalysis2014-WEB.pdf
(6) D. E. Hoffmann and A. J. Tarzian, “The girl who cried pain: a bias against women in the treatment of pain,” Journal of Law, Medicine & Ethics, vol. 28, no. 4, pp. 13–27, 2001.
(7) A. Werner, L. W. Isaksen, and K. Malterud, “‘I am not the kind of woman who complains of everything’: illness stories on self and shame in women with chronic pain,” Social Science & Medicine, vol. 59, no. 5, pp. 1035–1045, 2004.
(8) https://www.bmj.com/bmj/section-pdf/959692?path=/bmj/360/8138/Careers.full.pdf
(9) http://www.medicalwomensfederation.org.uk/about-us/facts-figures
(10) Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Research and Management, 2018, 14. https://doi.org/10.1155/2018/6358624
