Sexism in Medicine

PREMIUM CONTENT for MEMBERS ONLY

Please login to view this content , or sign up for an account

For many women, the dismissive phrase, “It’s just in your head,” is an all too familiar response during medical visits. Gender bias remains a common concern even in today’s evolved medical world. The stereotype of women being overly anxious, stressed, or hysterical has long been used to dismiss their concerns when seeking medical care. Their pain and symptoms are more likely to be written off as anxiety, causing women to be more likely to be misdiagnosed or take longer to receive a proper diagnosis. Not only does this create more shame when a woman tries to advocate for herself, but a misdiagnosis can have serious, and even fatal, consequences.

“Female patients’ pain and symptoms are more likely to be written off as anxiety, causing women to be more likely to be misdiagnosed or take longer to receive a proper diagnosis.”

Dr. Elizabeth Comen is breast cancer oncologist and women’s health specialist at NYU Langone Health’s Perlmutter Cancer Center. She wrote the book “All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters” that largely discusses the ways in which medicine disregards women’s health. In her book she writes about the history of women’s health being minimized, stating that women were thought to just be “small men.” This thinking demonstrated a clear lack of knowledge and disregarded female biology. Dr. Comen was inspired to write her book based on her experience as a doctor treating female patients. She observed the different experiences women have when receiving health care, and how these experiences are disproportionate to those of men.

Women have been historically neglected excluded when receiving health care. For a long time, women who were facing serious physiological problems were often overlooked and thought to be “hormonal,” therefore making their symptoms irrelevant. These ways of thinking are extremely damaging, and Dr. Comen writes that this level of dismissal was also happening towards white women who were privileged. The treatment towards women of color or women facing poverty, was even worse. Keisha Ray, PhD, is an associate professor at McGovern Medical School. She talks about her experience in receiving care as a black woman, stating the lack of compassion and care feels more exaggerated, as she is faced with both racial and gender discrimination.

Even Dr. William Osler, one of the “Big Four” founding professors of John Hopkins Hospital and a leader in modern medicine, was under the idea that medical symptoms were all just in a women’s head. He believed that women who were experiencing symptoms of heart attacks were actually experiencing neurosis-induced symptoms that masked itself as a disease. Today, 44% of women will develop heart disease and about one in five women will die from it. Yet, women still are often being dismissed for their symptoms, especially those that are thought to be atypical such as jaw and back pain. Since doctors are not seeing these atypical symptoms in their male patients, they may be less likely to take it seriously when reported.

Furthermore, Irritable Bowel Syndrome (IBS) is more common in women than men and the research now shows that hormonal differences can play important roles in the pathophysiology of IBS. A study showed that women seeking care for abdominal pain were more likely to have their symptoms be dismissed or minimized compared to men. Abdominal pain and other symptoms related to IBS can take a serious toll on an individual’s wellbeing and quality of life. When these symptoms are dismissed in women or they are misdiagnosed, it can create a serious burden to their daily lives.

“…a study showed that women seeking care for abdominal pain were more likely to have their symptoms be dismissed or minimized compared to men.”

With the dismissal of symptoms and misdiagnoses, healthcare can feel all too overwhelming for women. It becomes difficult for them to advocate for themselves, and they are more likely to feel shame. Dr. Comen even reports that her patients who are women will become apologetic. One of her patients who was moments from death even apologized to Dr. Comen for sweating on her. She has found the need to apologize to be a constant pattern throughout her female patients. They apologize for seeking care, advocating for themselves, and even for being sick. Beyond the shame they feel for being sick, Dr. Comen also writes that they feel shame towards their symptoms, such as the pain they are experiencing or even how disgusting something may appear.

Many women have experienced feeling invisible, ignored, and defeated in a health care setting due to the injustices of being dismissed or misdiagnosed. The male model has been the gold standard for diagnosis and treatment, leading to misrepresentation of women in medicine. It was not until 1986 that the National Institutes of Health (NIH) established a policy to encourage researchers to include women as participants in their studies. While this policy helped, it took another 7 years to make this a federal law.

Major progress in the area of women’s health has been achieved through the activities and policies of the NIH Office of Research in Women’s Health (ORWH). Established in 1990, the Office of Research on Women’s Health serves as the focal point for women’s health research at the National Institutes of Health. For over thirty years, ORWH has worked across the NIH and beyond to advance our understanding of sex and gender as influences in health and disease, support women in biomedical careers, and stimulate research to improve the health of women. Under the leadership of Drs. Mayer and Chang, UCLA has been successful in receiving uninterrupted NIH funding for studying sex-related differences in brain gut interactions in patients with IBS over 15 years.

In addition to these changes in medical research, more doctors are now working to intentionally make improvements in the experience that women have in a medical setting. Instead of minimizing their symptoms and writing it off as anxiety, they are working to understand the other possibly diseases that may be responsible for their set of symptoms.

“The male model has been the gold standard for diagnosis and treatment, leading to misrepresentation of women in medicine.”

Yet, Dr. Comen states that an essential part of women receiving health care is to be able to trust their own knowledge of their bodies and know that they can advocate for themselves. She writes that a women seeking health care for a medical issue should not just be concerned about what they think will be most well received by their practitioner, but rather what they are truly worried about. She even recommends bringing a close friend or family member along if someone is feeling ignored or dismissed by their doctor.

With that said, if a doctor is dismissive of symptoms, it is always acceptable to find a new one who provides a space of respect of understanding. Every patient, no matter their gender, deserves to have a positive experience when receiving medical care and to feel that there is mutual respect between them and their doctor.

Amanda Johnson is a recent graduate from the University of Southern California where she received her degree in Psychology. In addition to her university studies, she earned her Integrative Nutrition Health Coach certification from the Institute of Integrative Nutrition (IIN).

This article was reviewed and approved by Emeran Mayer, MD