By Bhumika Hooda
Abstract
Gender bias and healthcare disparities are known factors that cause misdiagnosis in women. For instance, symptoms of heart attacks in women may differ from those in men; unfortunately, many healthcare providers are not trained to recognise these differences. Additionally, women’s pain is often dismissed or not taken seriously, leading to delays in diagnosis and treatment. In this article, we will broadly explore the causes of this “pain gap” and the lack of seriousness towards women’s medical complications, along with viable solutions to these problems.
Introduction
In a concerning discovery, it was established that despite a higher mortality rate among women due to heart attacks compared to men, they are 50% more likely to be misdiagnosed in cases with cardiovascular concerns. On the same note, although stroke stands as the third leading cause of death in women, it is misdiagnosed nearly 33% of the time. These numbers represent a fraction compared to all the other health complications. Yet, these staggering discrepancies in medical misdiagnosis put almost half of the population at an increased risk of facing severe health complications and possible death. These figures are indicative of gender bias, a pervasive issue in the medical industry, wherein one gender receives preferential treatment over the other. This bias is based upon deep-rooted, albeit wrong, beliefs such as women are more overly emotional, that they overreact and that they want to draw more sympathy for themselves.
Anushay Hossain, in ‘The Pain Gap: How Sexism and Racism in Healthcare Kill Women‘, highlights how misogyny and racism persist in the healthcare system, leading to the neglect of severe health issues in women. Anne’s complaints of long-term strange sensations along her face and body and blurred vision were laughed off by her doctor, and she was refused any neurological examination. It was after she lost consciousness that she was directed to an MRI, which revealed a brain tumour. Similarly, Diane was mocked when she expressed concerns about abdominal cramps, and the doctor called it a “mild inconvenience”, which was later diagnosed as uterine cancer. For 15 years, Angelica was told she had “anxiety attacks” in response to her palpitations until a nurse took pity and checked her blood pressure, which confirmed her chronic cardiovascular disease. Countless stories exist of women’s pains and symptoms being dismissed by the healthcare system for years on end and only to be taken seriously after irreparable damage had occurred.
Misdiagnosis is flared through unreasonable stereotyping and under-representation in research, resulting in knowledge gaps related to physiological factors and symptom attribution (e.g., the “classic” symptoms of heart attack, modelled after men, may be overlooked when women experience variation). The most significant feat to defeat remains the insufficient inclusion of women as subjects in medical trials and studies. Since the study sample is homogeneous, the solutions and outcomes are one-size-fits-all. Additionally, people of colour belonging to minority communities are also victims of under-representation in clinical tests and trials.
Why Does this Happen?
The roots of this problem lie in the logically unfounded stereotyping of women. Women have always been seen as hysterical and prone to “overreaction.” Hysteria was a common diagnosis among women to denote physical symptoms having psychological causes. Even today, it is understood as an uncontrollable emotional reaction attributed to women. It is the historical equivalent of saying, “It’s all in your head” to women suffering definite symptoms of underlying disease. For the longest time, Hysteria was exclusively associated with women, and the word itself originates from the Greek word for “uterus”. Almost all major somatic diseases were diagnosed as Hysteria in women. This bias, which trivialises women’s pains and problems and attributes them to something imagined or exaggerated, still exists in the medical industry.
Historically, women’s pain is often seen as having emotional rather than physical origin. This leads to a lack of seriousness in acknowledgement of women’s pain. This issue is compounded by societal expectations that women should endure pain silently, which is viewed as a testament to their strength. Additionally, women’s pain is often not accorded the same level of seriousness as men’s, indicating the fetishisation of women’s pain. This perception extends to medical procedures like IUD insertion, where the discomfort and pain of the patient are often overlooked. Various patient stories express how such a necessary procedure is almost unbearable due to the lack of better accommodation of the experience of patients, who are primarily females. In one instance, a woman undergoing the IUD procedure complained repeatedly of tremendous pain, but her concerns were disregarded. She eventually passed out on the table only to be awakened by a nurse urging her to hurry up and change her clothes as the room was needed for another patient. The woman described this incident as hurtful, embarrassing and violent.
The second impediment is the lack of representation of women in clinical trials. This problem is not confined to the medical industry but is true for almost every sector. A study conducted between 2011 and 2015 analysed cardiovascular care provided to women in Indian Hospitals. Despite having severe symptoms like high blood pressure, body pain, and numbness, women were frequently misdiagnosed. Consequently, deaths related to cardiovascular disease are notably higher in India, a trend attributed to the lack of female representation. The models used in studies and medical trial runs are predominantly centred around men, mirroring what is taught in medical schools. Therefore, the initial instinct of the doctors is to disregard varied symptoms that deviate from those commonly observed among men. Despite the glaring physiological difference between the male and female body, this practice persists.
For example, one of the blood tests conducted for detecting cardiac problems in Indian hospitals is affected by the test’s sensitivity to female hormones, which is often overlooked during test result interpretation. The troponin assay biomarker, used to detect heart disease, cannot be read the same way for women as it is for men. This may lead to misdiagnosis for female cardiovascular patients. Another example is the sleep aid drug Zolpidem, which had been in use for 20 years before researchers realised that men metabolise the drug faster, necessitating a lower dosage for women. It was only in 2016 that the US National Institute of Health (NIH) mandated the consideration of sex as a biological variable in studies.
The Way Forward
The first step should be to acknowledge the existence of bias. Medical professionals should be infused with greater empathy towards women to reduce the “pain gap” and “trust gap” that persists. For women experiencing chronic and severe problems, the difficulty lies in maintaining a stoic disposition to avoid being labelled “hysterical.” For females experiencing non-urgent issues requiring an extended diagnostic process, like diabetes or cancer, preserving your reputation as a trustworthy patient appears to be the most challenging part, at least until the mystery is solved. The fundamental understanding should be that women should be believed.
Policy initiatives akin to those implemented by NIH should be introduced. Further studies should be encouraged where females are adequately represented. There is a necessity to scrutinise this discrimination, as it is sometimes a multidimensional problem requiring a holistic and intersectional approach, addressing both sexist and racist angles. Another exemplary action would be to encourage more female participation in the industry. Providing more professional space to women might help raise awareness and empathy towards women’s experiences.
Personal Advocacy is an additional critical step to pursue, and it can only be fulfilled if one has enough knowledge about several diseases to which women are prone. There has been a rise in awareness about several issues, such as endometriosis and other uterine problems, through social media platforms. However, access to knowledge is also limited to only a small section of women. In dire situations, it is always better to inform a friend or a family member about your situation and ask them to advocate for your cause in front of the doctor. However, there is only so much people outside the field can do. Medicine is a separate and specialised field which requires structural changes from within. “Medicine is working to revolutionise its practice and protocols, but there is a long legacy to quash when it comes to women’s bodies and minds.”
Author’s Bio
Bhumika Hooda is pursuing her five-year B.A.LL.B. law degree at Jindal Global Law.
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