Imagine waking up one morning and finding your significant other on the floor of your bathroom in excruciating pain. This is what happened to Joe Fassler early one Wednesday morning. Worried at finding his wife in this state, he called an ambulance.
Upon arriving at the hospital in horrible pain, the nurses and staff told him that his wife would have to “wait her turn.” Other nurses told his wife, “You’re just feeling a little pain, honey.” After waiting for some time, a nurse came over and checked her blood pressure. She was in so much pain she wasn’t able to stay still enough to get an accurate reading, so the nurse told her, “You’ll have to sit still, or we will have to start over.” Then she was strapped in a plastic bracelet to get an accurate reading. After waiting for over an hour, another medical personnel came by and gave her medication for kidney stones without even properly diagnosing her. Several hours later, she finally got a CT. It was discovered that she actually had ovarian torsion: when the ovary twists in on itself. The male doctor treating her didn’t even physically examine her before giving her standard care for a kidney stone issue.
Gender bias in medicine is a topic that has been brought up more numerously and profoundly over the past couple of years. More specifically, the topic of how a patient is treated medically, based on their gender, is a subject that has been more forwardly addressed in recent years. The topic of gender bias has almost always been an underlying issue in medicine but hasn’t always been a point of acknowledgement. So how does gender bias in medicine affect the treatment of patients?
What is Gender Bias in Health Care?
According to the Legal Information Institute of Cornell Law School, “Gender bias refers to a person receiving different treatment based on the person’s real or perceived gender identity.” When the topic of gender bias is addressed in a medical setting, Katarina Hamberg from Umea University says that it is usually in reference to “either an unintended, but systematic neglect of either women or men, stereotyped preconceptions about the health, behavior, experiences, needs, wishes and so on, of men and women, or neglect of gender issues relevant to the topic of interest.” To sum up both definitions of gender bias, it is when one gets different treatment, either intentionally or unintentionally, because of their gender. One patient being treated differently by a physician than another patient, solely based on gender, can be very frustrating.
Negative Impacts of Bias in Medicine
Gender bias in medicine can be discouraging for a lot of patients because they can feel like they are not really being listened to or taken care of properly. This has been found to be especially true for female patients. Emily Paulsen from Duke Health states that, “One in five women say they have felt that a health care provider has ignored or dismissed their symptoms, and 17% say they feel they have been treated differently because of their gender—compared with 14% and 6% of men, respectively.” This statistic emphasizes the fact that more female patients have reported feeling the effects of gender bias in the medical field than male patients.
Not only are there more reported women who are affected by gender bias in the health care field, but studies also show that women’s perceptions of gender bias are correct. When compared to males, Paulsen says “Women who present with the same condition may not receive the same evidence-based care. In several key areas, such as cardiac care and pain management, women may get different treatment, leading to poorer outcomes”. Just being a woman walking into a hospital setting means you might not receive the best care compared to men.
How is this fair? Why should the gender of a patient affect the level of care they are getting? A new study conducted by Arthur Barsky, Heli Peekna, and Jonathan Borus published by the The National Institutes of Health shows that “women generally report more bodily distress and more numerous, more intense, and more frequent somatic symptoms than men.” This means that women and men can present different symptoms for the same illness. So if patients, specifically female patients, leave hospitals feeling like they were mistreated or improperly diagnosed, why would they want to come to hospitals for help?
Feeling ignored or dismissed is one thing, but studies are proving that women’s poorer health outcomes cannot be ignored, especially when it comes to pain management. According to Paul Musey Jr. et al. published by the NIH, “Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care.” Along with this, the Center for Disease Control and Prevention said that, “Even excluding pregnancy-related visits, women were 33 percent more likely than men to visit a doctor.” From these statements, we can understand that pain is the most common reason for emergency department visits and that women are more likely to visit the ED than men. This means the number of female patients who experience gender bias in medicine is far greater than when compared to males because women are much more likely to visit the ED or doctor than men. Because female patients are so much more likely to visit the ED, it is reasonable to conclude that they receive worse medical care than male patients due to gender bias.Not only do women experience more gender bias than men in health care, but now new studies show that women feel more pain on a higher scale than men. Musey Jr.’s states that “in laboratory-based studies, women have been found to exhibit greater pain sensitivity, enhanced pain facilitation, and reduced pain inhibition compared with men.” This, added to the fact that women often receive worse treatment, emphasizes the negative impacts of gender bias in medicine and how it affects the treatment of patients. So you might be wondering, if we know that women present symptoms variantly than men, then why don’t we give women different treatment than men? The problem is that gender bias in medicine is not simply caused by physicians thinking one gender is weak and another is strong. Gender bias in medicine is a much more rooted problem. It all really stems from the fact that “in the history of research into health outcomes in medicine, men’s biology was the default mode.” This is where the real root of the problem with gender bias in medicine begins: the fact that throughout the history of medicine, male bodies have been studied more than female bodies. Because of that it has been assumed for a long time that females were the same as males, but more and more, this assumption has been proved false.
Why Does Gender Bias Exist in Medicine?
By now, we can all agree that gender bias does exist in medicine and that it does affect how patients are treated, especially when it comes to women. When one thinks about why gender bias even exists in medicine, it can be easy to point fingers at physicians. But as discussed earlier, gender bias in medicine is a more deeply rooted issue and, for the most part, it is not the physician’s fault. Few medical professionals believe that that there is intentional discrimination of genders occuring. As Janine Clayton discusses, “much of medical science is based on the belief that male and female physiology differ only in terms of sex and reproductive organs.” It is because of this, a lot of research is based off of male animals and cells. Clayton is saying that the main cause of gender bias within medicine is male-centric research. The data that has been and continues to be collected during research is skewed to the male gender but is presented as a one-size-fits-all solution for both males and females. This generalization has been taught to medical professionals. When female patients enter a hospital to seek help, they are assumed to present like a male because according to Paulsen, “we have studied women less, we know less about them. The result is that women may not have always received the most optimal care.” Because of all this skewed research, there is a large lack of medical knowledge about females, which is one reason gender bias exists in medicine.
Another reason that gender bias exists in medicine is because men are the “standard,” nearly everywhere around the world but also when pertaining to the typical patient. A lot of medical students and doctors in residency “have medical training that is based on the average patient being a male, 75-kilogram white patient.” Females end up having poorer outcomes compared to males because males are the standard.
A lot of different procedures and instruments are conducted and developed using the male standard. One out of many examples of this is hip replacements. This just goes to show how much of a role the male standard plays in medicine, and it also helps us understand why, when treated for the same issue, females have a poorer outcome than males. This is due to the fact that most procedures or instruments are tailored towards males. This also helps us understand how physicians aren’t intentionally causing gender bias in the healthcare field. They are forced to work with tools made for men’s hands and forced to treat patients with materials made for the standard male patient.
What Can Be Done?
It has been established that, for the most part, physicians are not at fault for gender discrimination in medicine. This is mainly because medical research was historically done in a way to believe that the only difference between the male and female bodies is reproductive organs, but we now know this isn’t true. Physicians are not at fault for the existence of gender bias in medicine—rather, it is the product of a broken system. It has also been established that gender bias in medicine is not beneficial for anyone involved in healthcare, but especially not for women.
A number of things can be done to lessen the existence of gender bias in medicine, starting with increasing the medical knowledge base of females. In other words, we must study more women. A major reason bias exists in the medical field is because males are the standard. So, studying women more can help medical professionals understand the vast differences between female and male patients and start making procedures and instruments better fitted to females as well as males. Other actions that can be taken are diversifying health care teams, asking more open ended questions, using substitution, data collection and analysis, improving checklists and guidelines and having more training opportunities. All of these methods can improve the current situation of gender bias in medicine. Diversifying health care teams can be used to encourage discussion of gender bias and any other issues when working with those teams, and it can help medical personnel feel more comfortable speaking up about any concerns. Open-ended questions when talking to a patient can optimize patient care. Substitution, internally asking oneself whether one would diagnose a patient differently if they were a different gender, would prevent gender bias in the first place. Data collection and analysis to identify where physicians are unintentionally using gender bias can also inform what areas to improve. Last but not least, having more training opportunities for medical professionals in the area of gender bias can promote awareness of the issue and also help lessen or eliminate it altogether.