A study has established that it is difficult for female patients to convince health professionals to take their symptoms seriously. When Kathy tried to seek medical attention for abnormally heavy periods that were leaving her feeling so faint that she was unable to stand, four different medical professionals said it was all in her head. They concluded she was simply struggling with anxiety and perhaps even had a serious mental health disorder. She says her primary care doctor repeatedly told her, All your symptoms are your imagination.
It took nine months for Kathy to be diagnosed with potentially life-threatening uterine fibroids that required surgical intervention. And that was only after she took it upon herself to demand an ultrasound. She was suffering from anemia, not anxiety. I was left to my own ability to recognize what was happening and defend myself, Kathy, who didnt want to print her last name along with details about her sensitive medical information, told ThinkProgress. I was being treated as a mental incompetent and as a mentally ill hypochondriac. She added that she doesnt believe she would have received the same type of treatment if she were a man.
Kathys experience isnt unique. It can be difficult for female patients to convince health professionals to take their symptoms seriously which, in turn, makes some women hesitant to speak up about their medical concerns in the first place, for fear of being told theyre overreacting. Ultimately, this complicated interplay between gender roles and the health care system could be putting lives at stake.
Other women have also recounted visiting dozens of doctors for help with painful periods, only to be offered anti-anxiety medication and sent home. In March, the New York Times reported that this is one major reason why the symptoms of endometriosis go ignored in young girls. I knew something was wrong when I was 15, but no one listened to me, one woman told the Times.
The issue extends beyond the female reproductive system. Theres a particularly well-documented gender gap in the treatment of pain. Even though women are more likely to suffer from chronic pain fibromyalgia, for instance, almost exclusively affects women theyre less likely than their male counterparts to receive appropriate treatment for it. Multiple studies have found that medical interventions to manage pain, ranging from knee surgeries to opioid prescriptions, are less likely to be recommended for female patients. The widely-cited study The Girl Who Cried Pain found that medical professionals are more likely to tell women that their symptoms are psychosomatic, a term defined as a physical disorder that is caused by or notably influenced by emotional factors.
This means that, just as Kathy experienced, many female patients are told that its just in their head. According to a National Pain Report survey conducted last year, a staggering 90 percent of women with chronic pain feel that the health care system discriminates against them. There seems to be an Oh shes so neurotic attitude towards female chronic pain patients, one survey respondent said.
This approach toward female patients fits into a long history of attributing womens behavior to mental health disorders. In fact, the modern-day stereotype that women are dramatic, irrational, and crazy has its roots in a gendered approach to health.
Stretching back to at least as early as 1900 B.C., when ancient Egyptians attributed hysterics to the misplacement of the womb, womens reproductive systems have been linked with irrational emotions. (The term hysteria comes from the Greek hystera, which literally means uterus.) Since then, the notion of female hysteria has persisted, often as a method of deploying health professionals to keep women in line. During the 1800s, for example, the women who attempted to rebel against the Victorian-era domestic expectations for their gender were labeled hysterical and placed in mental asylums and, in some extreme cases, were forced to have hysterectomies.
Hysteria was officially removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, and psychiatrists now consider it to be a pejorative term. However, in this context, its not hard to see how gendered stereotypes about womens emotions may continue to color their experiences as they try to explain how theyre feeling. In fact, some doctors believe that psychosomatic symptoms has become the modern-day equivalent of hysteria a catch-all term for physical symptoms that cant be explained, and are therefore written off as neurological.
In the 1970s, feminist critiques of the health care system started to connect the dots and expose the role that sexism can play in the doctors office. I think its the same deeply rooted sexism that we see in other realms, like when it comes to not believing rape survivors. We dont trust women to be the experts on their own bodies, or to be reliable narrators of their own lives, Maya Dusenbery, the editorial executive director at Feministing and the author of a recent piece about gender bias in health care, told ThinkProgress. But when that comes into the medical system, its really dangerous.
Not every woman is as persistent as Kathy, whose symptoms were finally diagnosed after she kept following up with emergency room, urgent care, and primary care doctors. Particularly since women have been socialized to be passive and deferential to authority, theyre less likely to push back on a doctor whos telling them that their symptoms are all in their head and more likely to internalize the message that their issues must be imaginary. In fact, one recent study found that young women sometimes delay potentially life-saving treatment for heart attacks because theyre worried about being told theyre overreacting.
So, just as Sheryl Sandberg of Lean In fame has encouraged women to speak up at work, some medical experts want to empower women to find their voice at their doctors appointments. This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if theyre afraid theres something wrong, Dr. Jennifer Tremmel, a cardiologist at Stanford University, told NPR after the results from that heart attack study were published.
Dusenbery isnt convinced thats the solution. She recounted accompanying a close friend to a series of doctors appointments before she finally got to the bottom of her mysterious health symptoms. For six months, specialist after specialist told her friend it was probably just anxiety a process that Dusenbery said left her feeling enraged. Both of them, she noted, are already pretty empowered feminists.
Its not a problem we can solve on our own, she said. There really are these two levels of gender bias happening. Theres the level of actual interactions with doctors and providers, where theres this unconscious bias that makes them quicker to dismiss problems as psychological in women. But more broadly, theres the bias in the medical and clinical research that means womens health is underresearched.
In a recent piece published at Pacific Standard, Dusenbery argues that these issues need to be addressed at a much deeper level than womens individual behavior. In fact, one of the big reasons that womens symptoms baffle doctors is because the research in the medical field hasnt taken their bodies into account. Clinical trials have overwhelmingly been comprised of men, which means that our current medical research is skewed against the information that may be more accurate for women.
Theres an emerging body of research in cardiology, for instance, confirming that heart attack symptoms present very differently in women than they do in men. Medical professionals simply havent been adequately trained in those differences so women suffering from heart attacks are being sent home from the hospital because their doctors dont recognize whats happening to them.
Doctors are trying to do the right thing. Its not that theyre trying to be mean or dismissive, Dr. Janice Werbinski, the executive director of the Sex and Gender Womens Health Collaborative (SGWHC), told ThinkProgress. Gender differences just are not in the training, which is what our organization is trying to work on. SGWHC advocates for bringing a sex and gender perspective to clinical practice. While the research into gender-specific health issues has recently been progressing, that information can be slow to make it into medical schools curricula, so it doesnt always trickle down to doctors in the field. Werbrinski and her colleagues believe more work needs to be done to integrate this knowledge into medical education.
According to Werbinski, that could even include information explaining to doctors why its not helpful to tell female patients their health problems are in their head and pointing out that, in fact, women may be presenting symptoms that arent yet well-recognized by the medical establishment. It needs to be in the curriculum of caregivers so that we dont jump to the conclusion that its psychosomatic, and at least validate her symptoms and tell her that we just dont know whats wrong, she said.
Dusenbery said that, as a young woman, shes never been more aware of patriarchal authority than when shes trying to interact with the health care sector. Shes surprised this aspect of gender relations isnt discussed more broadly, especially since many of her female friends have similar stories about struggling to diagnose their symptoms. It feels like one of those things where once you start talking about it, everyone has their story and that really opens the floodgates, she said. We need women to document their experiences and share them so society becomes aware, Kathy agreed. This has been going on for centuries . conversion, hysteria, the name changes but its the same and its still happening today. No woman should have this experience in todays day and age.