Systematic discrimination against women in healthcare: misdiagnosed, mistreated and in pain.

The article is researched and written by Aisha Al-Qahtani and Anneliese Levy

You have probably heard of the various biases in scientific research: from publication bias to outcome bias, but what about sex and gender-bias? Both history and data prove that there is prejudice against women in the field of science, particularly medical science and its practice.

Historically, medical research has focused on male health. Women were often excluded from clinical trials, in order to obtain consistency of treatment effect and reduce potential risks to pregnant women, fetuses and teratogenic effects to future pregnancies. Sex and gender bias continued, even after research reported sex differences in diagnosis, treatment response, drug metabolism, and surgical outcomes.

For example, several studies have reported gender differences in the management of patients with cardiovascular disease. Women have been shown to be less likely than men to receive major cardiovascular diagnostic procedures and “’less aggressive treatment strategies” and are again under-represented in clinical trials.  

While more women are now included in women in medical trials, a male focus may still be create systematic discrimination against women in healthcare.

As well as overlooking potential biological differences between the male and female sex, studies often fail to consider gender-related issues that could impact on treatment approaches and outcomes. Such as psycho-social, cultural, and environmental factors.

Why do women get misdiagnosed by health professionals?

Women may face delay and misdiagnosis in a number of conditions, including stroke, heart attacks and brain tumour amongst others. There isn’t only one answer to why delays and misdiagnosis happens: this is a complex area.

Historically, judgement is often built into the words used to describe ‘women’s ailments’ belying a belief that women are essentially victims of their own biology. For example, the word "hysteria" originates from the Greek word for uterus, hystera. So hysteria was mainly viewed as a female-only diagnosis.  Hysteria was was classified as a mental disorder until 1980, but before that it was considered a physical malady, first described medically in 1880 by Jean-Martin Charcot. Women were subjected to unethical and distressing “medical” treatments as a result of this. It seems that ‘hysteria’ was a catch-all phrase for any unexplained or difficult to define physical or mental health issue in female patients.

This cognitive bias on the part of medical providers against women and their health may have persisted in some cases. A 2018 research review found that health providers are more likely to perceive women with pain as hysterical, complaining and fabricating their pain, as if it is “all in her head.” Women with chronic pain may be assigned psychological rather than physical pain causes.

Unfortunately, there is also still a lack of scientific knowledge about many female specific conditions.

For example, a female specific condition which effects 5-10% of women of reproductive age globally is endometriosis. Yet, on average, it takes 7.5 years from the onset of symptoms to get a diagnosis, and the treatment is prolonged. Causing severe pain to women, and effecting fertility.

What can health communicators do?

How can we ensure that women’s voices are heard, and that they are able take an active role in healthcare, whilst also educating health providers to ensure they are able to get their medical needs met? This is a huge area, but there are few initial steps that could be helpful:

·       Encourage women to document and track their symptoms. For example, early research shows that symptom monitoring for menopausal women may help in healthcare settings and improve patient-doctor communication and treatment adherence.  If women’s symptoms are on record, there may be a higher chance they will get the right treatment.

·       If you are developing health content think about how you can include the views and experiences of women in your work. Anneliese knows from experience that women are actually well-represented in the user research she does. However, it’s also important to take an intersectional approach, and consider the axis of other characteristics such as ethnicity, sexuality socio-economic status and their interaction with gender and health inequalities. One way to do this is to widen your pool of research or user involvement participants and aim for representation from all different groups of women.

·       As a health communicator or health provider are you considering different ways for women to participate or to access services? A recent report from Trilliant Health found that 60 percent of telehealth users in the United States are female. Being able to access healthcare remotely may be useful to women, traditionally more likely to be juggling caring responsibilities. Anecdotally, speaking with a medical professional remotely from the possible privacy and security of your own home could mitigate some of the potentially oppressive power dynamics of having to talk about your health problems in a hospital or doctor’s office. Although it’s obviously not possible to always avoid this, so training for healthcare professionals is also vital.

 Looking to the future

The good news is that the UK Government launched it’s vision for the Women’s Health Strategy in December 2021. The research that underpinned this report found that taboos and stigmas are still evident in areas of women’s health which impacts on experience and level of care, such as the feeling we’re not being listened to. However, the vision report does begin to address the need for healthcare professionals to receive better education and training on women’s health conditions. Here's hoping that the full strategy, set to be published in spring 2022, will set out a clear pathway for this to happen.