Unfortunately, gender bias in medicine is a real thing and can impact your health. As much as we’d like to believe otherwise, men and women are not treated equally. Did you know that women are more likely to be misdiagnosed? Or that women may not receive the most effective treatment?
Importantly, almost all of us has some form of gender bias, whether or not we realize it. The term bias refers to a preference for, or aversion to, a person or group of people. When people recognize their own feelings of bias, it is considered explicit bias.
On the other hand, when people are unaware of their biased opinions, it is considered implicit bias. Implicit gender bias comes from the messages we unknowingly absorb about gender throughout our lives.
Importantly, both explicit and implicit biases influence behavior, which leads to discrimination and reinforces inequity.
What is gender bias in medicine?
In healthcare, gender bias primarily relates to doctors (and other healthcare professionals) providing a lower level of quality care to women, as compared to men with similar health problems. Therefore, women can be assessed, diagnosed, referred, and treated differently.
In several key areas, including cardiac care and pain management, doctors may recommend different treatments for women, leading to more complications, poorer outcomes, and higher death rates.
Additionally, medical research has historically focused on men, which has lead to insufficient knowledge regarding the disease process and treatment recommendations for women.
Gender bias in medical research.
It can be difficult for doctors to appropriately treat female patients if they don’t have access to scientific data regarding how disease manifests itself in women and how women will respond to treatments.
Why? Because historically, women were excluded from medical research. In part, researchers excluded women, especially those in child-bearing years, to protect them and their fetuses from potential adverse effects. Additionally, researchers felt they could not adequately control for women’s variable hormonal status.
Alarmingly, experts believe women may not always receive the most optimal care due to the lack of women in clinical trials.
Although women are not “little men”, for decades, health research focused on men – doctors assumed the results applied to women as well. But, leaving women out of clinical trials limited the understanding of how particular illnesses, and potential treatments, impact women.
Importantly, women are unique on a cellular level, and therefore can have different symptoms and manifestations of illnesses and can react differently to drugs and other treatments.
Fortunately, progress has been made. In fact, women now make up about 50% of participants in NIH-supported clinical research, which has increased the knowledge base about sex and gender differences.
But there is still room for improvement.
For instance, although a bit more than 50% of HIV patients worldwide are women, women are underrepresented in HIV trials. In 2016, women only represented 19% of participants on antiretroviral (ARV) studies, 38% in HIV vaccine studies and 11% in HIV cure studies. This has led to significant gaps in knowledge related to the efficacy, safety, and tolerability of HIV treatment in women.
Why do some doctors treat women differently?
I think it’s safe to say that very few, if any, doctors intend to provide less than optimal care to their female patients. However, several issues can influence a doctor’s gender bias.
Firstly, as mentioned above, there is a lack of scientific data relating to women’s health and treatment responses.
Secondly, some doctors assume men and women are physiologically similar or “equal”, but men and women differ in many significant ways. On the other hand, gender bias can also rise from doctors assuming there are differences when there are not. These misconceptions can lead to stereotypical views about men and women that can influence how doctors approach patient care.
As you might expect, some doctors acknowledge gender bias as an issue, and others dispute its existence.
Female patients can contribute to biased treatment.
Unfortunately, women can unknowingly contribute to gender bias as well. Two examples:
- Generally, women describe their symptoms and experience in a more personal, narrative way. In comparison, men tend to describe symptoms in a more straightforward, factual manner. In a study on chest pain, researchers found that women’s narrative approach reportedly contributed to an increase in diagnostic errors.
- Women often think of stroke and heart disease as “men’s diseases” and therefore assume they likely don’t have either of these conditions.
Gender bias in medicine impacts the care of female patients.
Gender bias can lead doctors to:
- Underestimate or misunderstand a woman’s risk for health problems or complications.
- Not understand that women may experience symptoms differently than men.
- Be less willing to engage female patients in shared decision making.
- Stereotype female patients with unconscious prejudices.
- Take women’s symptoms less seriously and/or believe women’s symptoms have emotional, not physical, causes.
Importantly, gender bias can lead to:
- Skipped diagnostic procedures.
- Delays in diagnosis.
- Medications not prescribed.
- Excluding lifesaving and/or life-extending procedures and surgeries.
- Not making referrals to specialists.
- Ignoring pain and suffering.
Additionally, when women have negative experiences in healthcare, they may lose their trust of the profession and avoid getting necessary care.
Gender bias can lead to delays in diagnosis.
In 2019, a study in Copenhagen found significant delays in diagnosis in women, as compared to men. For 770 types of diseases, women were diagnosed an average of 4 years later than men. For cancer, women were diagnosed on average 2.5 years later than men.
And for diabetes and other metabolic disorders, women were diagnosed an average of 4.5 years later than men.
Gender bias can lead to lower quality care.
Unfortunately, gender bias often leads to lower quality care. Consider these findings:
Studies in Europe and North America found gender differences for the management of stroke. Data suggests women who have strokes are less likely than men to get appropriate diagnostic imaging and subsequent treatments.
A similar study in Scotland found that the use of anticoagulants was comparable for men and women. But upon discharge, women were significantly less likely to receive prescriptions for medications that reduce the risk of future strokes.
Furthermore, researchers found that compared to men, women with stroke wait longer in the ER – 11% longer to see a doctor and 15% longer to receive a diagnostic image test.
Although these differences seem small, they are very important because effective treatment for stroke is extremely time sensitive, so even brief delays can mean patients miss their opportunity for the best treatment possible. Lastly, women receive less aggressive treatment than men once they admitted to the hospital.
There is some good news here – a recent study in Canada found no significant differences in the treatment of men and women with strokes.
Heart disease and heart attacks.
Importantly, some studies conclude the female anatomy and physiology increase the risk of heart disease and heart-related deaths. Nonetheless, studies show heart disease in women is underdiagnosed and undertreated.
What’s the research show?
These studies show gender bias in the treatment of heart conditions and heart attacks:
- Research found women who have acute myocardial infarction (heart attack) have a significantly worse prognosis than men, including a higher rate of additional heart attacks and heart failure.
- One study found women are more likely to die after a heart attack, while in the hospital or after discharge. Despite these differences, researchers found that after heart attacks, women are less likely to have surgery and/or receive medications to restore blood flow.
- Another study found women are nearly twice as likely as men to die within a year after a heart attack, partly because “cardiovascular care has been slow to acknowledge the gender differences in heart disease”.
- One study of women (30-55 years old) hospitalized for heart attacks found the healthcare system was not consistently responsive to women, resulting in delays in workup and diagnosis.
- Results from the traditional treadmill tests to detect heart problems are more likely to be inaccurate for women because the scoring system is based on results from middle-aged men.
- One study found that compared to men, women (18-55 years of age) in the ER with chest pain were less likely to be triaged as an emergency case, undergo electrocardiography, or be admitted to the hospital or observation units, although the ordering of tests for cardio biomarkers was similar.
- One investigation found that after a diagnosis of heart attack, women were 46% less likely to undergo investigative coronary testing.
- Women with peripheral artery disease were less likely to receive the recommended medications. Additionally, research shows doctors offer a surgical option less frequently to women of all ages.
Things are worse for women with diabetes, as compared to men:
- Women with diabetes have significantly poorer outcomes than men.
- Diabetic women are more prone to heart disease and more likely to suffer a fatal heart attack, but research shows they often receive less aggressive treatment for cardiovascular risk factors.
Doctors often overlook or minimize women’s pain. Women are more likely to suffer from pain than men; and both male and female doctors are more likely to dismiss women’s pain.
For instance, one survey found that 83% of women with chronic pain feel the healthcare system discriminates against female patients. Women report pain that is more frequent, more severe and longer lasting than men.
But research shows doctors less aggressively treat women for pain as compared to men. One emergency room study found that women waited 16 minutes longer than men to receive pain medication, and were less likely to receive opioids.
For patients with knee osteoarthritis, research found that doctors are more likely to recommend a total knee replacement for male patients than for female patients.
What do people think about gender bias in medicine?
In 2022, KFF (Kaiser Family Foundation) conducted a survey to learn about women’s experiences with the healthcare system. The responses from over 5,100 self-identified women, aged 18-64, are as follows:
- Among those who saw a healthcare provider in the past two years:
- 19% reported their doctor had dismissed their concerns
- 15% reported a provider did not believe they were telling the truth
- 19% said their doctor assumed something about them without asking
- 13% said a provider suggested they were personally to blame for a health problem.
- 38% reported having had at least one negative experiences with a healthcare provider.
- 9% said they experienced discrimination because of their age, gender, race, sexual orientation, religion, or some other personal characteristic during a healthcare visit.
- Although communication is a key to receiving quality healthcare, 21% of insured women, and 38% of uninsured women, reported it was hard to find a doctor who explains things in a way that is easy to understand.
- 35% of women ages 40-64 stated their health care provider had ever talked to them about what to expect in menopause.
Another survey shows experiences with discrimination vary by gender.
In April 2019, NBC’s TODAY in conjunction with Survey Monkey, asked US adults to discover if people experienced discrimination in a doctor’s office. The results from the 3,891 respondents indicate a widespread problem. Here are the questions and associated answers:
What percent of people think discrimination towards patients a serious issue?
- Women – 52%
- Men – 36%
How many felt their provider treated them differently because of their gender?
- Women – 17%
- Men – 6%
Among those who self-reported chronic health conditions and/or pain, the percent who felt they needed to “prove” their symptoms to a healthcare provider:
- Women – 31%
- Men – 19%
And, after reporting those symptoms, the percent who felt their doctor ignored or dismissed their symptoms:
- Women – 26%
- Men – 18%
What can you do about gender bias in medicine?
Fortunately, women can take steps to reduce the impact of gender bias in medicine. Of course, choosing a doctor who understands the medical differences of women and treats women with respect is essential. And speaking up if something doesn’t seem right is critical.
For more information on getting the best care possible, including reducing the risk of gender bias, read my blog posts:
- 10 Steps to Reduce Your Risk of Diagnostic Error.
- Should you Speak Up if You Think Your Doctor is Wrong? YES!
- Personal Stories of Diagnostic Errors.
- 10 Tips to Communicate Better with Doctors.
- When Is It Time To Change Doctors?
- How Can You Get the Best Healthcare? Actively Participate!
- Understanding Medical Information Is Harder Than Most Realize.
NOTE: I updated this post on 2-28-23.
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