Sunday, April 24, 2016

Undiagnosed and under-treated: how medical professionals misunderstand women's pain

We’ve got a Janus-​faced relationship to female pain. We’re attracted to it and revolted by it; proud and ashamed of it. So we’ve developed a post-​wounded voice, a stance of numbness or crutch of sarcasm that implies pain without claiming it, that seems to stave off certain accusations it can see on the horizon—melodrama, triviality, wallowing—​and an ethical and aesthetic commandment: Don’t valorize suffering women. Leslie Jamison.
I have recently fallen into a stress-induced, Netflix-encouraged, Nurse Jackie-shaped hole. The show is enjoyable for a number of reasons beyond its distracting qualities, but my favorite parts of the show are the numerous, dynamic and multi-faceted female characters. The show more-than passes the Bechdel test and tackles complicated issues from addiction, to mental health, to sexism. A recent episode made me think critically about how women are frequently misdiagnosed and mistreated by their medical professionals.

In the episode, a woman comes into the emergency room after an argument with her girlfriend. The woman states that she thinks she has a stress-induced stomachache. When Jackie asks where the pain is, the woman points to her solar plexus. Jackie then calmly explains that the woman most likely suffered a heart attack. The patient and her girlfriend were shocked by this news. Later in the episode, a doctor confirms the diagnosis and tells Jackie, “good catch.” I couldn’t help but think that diagnosing a woman’s heart attack shouldn’t be a good catch it should be routine medical treatment. Unfortunately, it isn’t.

According to an Atlantic article titled Why Doctors Still Misunderstand Heart Disease in Women, every year thousands of women in the United States are misdiagnosed, often with fatal consequences. This statistic is especially alarming given that heart disease is the number-one cause of women’s death in the U.S.

There are several reasons for these misdiagnoses – historically heart disease was considered a men’s disease and women were omitted from textbooks and curriculum. Two of the major ground-breaking studies about heart disease involved tens of thousands of male participants and no women. Moreover, heart disease symptoms can vary by gender. When Evan Woods lost his grandmother to heart disease after her heart attack went undetected, he was told that her symptoms were unusual. His response, “how can they be unusual, when it is more than half the population?”

Woods’s question gets to the heart of the matter – why is women’s healthcare considered a niche issue when women are more than half the population?

When Joe Fassler’s wife rushed to the ER with an ovarian torsion (a literal twisted ovary), she had to wait between 90 minutes and two hours to be admitted. When a doctor finally saw her after several hours, it was too late to surgically fix the torsion and her ovary had to be removed. Fassler’s article, How Doctors Take Women’s Pain Less Seriously, chronicles his wife’s experience and how “female pain might be perceived as constructed or exaggerated.” While men and women report different levels of pain, they are also treated disparately in the pain management they receive.

Diane Hoffmann, Associate Dean and Professor at the University of Maryland School of Law, and Anita K. Tarzian, researched bias against women in the treatment of pain in their article The Girl Who Cried Pain. The authors found that “women are more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients.’”

The authors also found that there are gender-based biases regarding how women experience pain.
Women’s pain tends to be viewed as more emotionally based and thus less credible — or, likewise, less credible if indeed it is emotionally based. Men’s pain is more likely to be acknowledged strictly as a physical symptom, thus reinforcing the societal expectation that men suppress their emotions, even if it impedes their pain treatment and recovery.
Biases in how women experience pain are not surprising in a society where women, in general, are perceived as the “weaker” sex.

Yet bias is not only shown in how pain is perceived, but also in the medical necessity of treatment at all. Even with strictly female medical procedures, like abortion, our society tends to flaunt it as a political battle rather than a necessary women’s medical service, as demonstrated by current SCOTUS discussions.

Healthcare bias against women in all medical services needs to be addressed, so that women are receiving adequate healthcare and pain management. Women need to be able to express pain and not be shamed for it; we need to know that we are heard and that our wounds will be treated as valid and just as serious as those of a man.


India Powell said...

I have personally been struggling with this bias for over a year now. What began as an undiagnosed stomach ulcer has transformed into a constant battle with my doctors over what is real and what's not. I can often tell from their tone of voice, whether male or female, that my symptoms are either benign or unconvincing. My mother experienced a slew of the same rhetoric when she was experiencing a number of physical manifestations related to mental illness. The bottom line is that doctors are so hesitant to trust female patients. It's disheartening and, unfortunately, very dangerous.

Meredith Hankins said...

This is so frustratingly true. I go through this problem frequently when trying to explain my migraines to people. I had a (male) boss once imply that I must be hungover when I called in sick to work one morning. No, I explained to him, my brain is swelling up and pinching nerves in my head sufficiently to cause temporary blindness, numbness throughout my body, and nausea. Does that sound like a hangover to you? Migraines are so often dismissed as "just a headache" because they are viewed as primarily a women's problem - it annoys me to no end.