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Is There Gender Bias in Medicine?

image of symbols for male and femaleAs much as we’d like to believe otherwise, men and women are not treated equally.  According to the ACLU, “ongoing struggles include ensuring equal economic opportunities, educational equity, and an end to gender-based violence.” But did you know that women are more likely to be misdiagnosed? Or that women may not receive the most effective treatment? Unfortunately, gender bias in medicine is a real thing and it might impact your health.

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.

Additionally, some medical research only studies men, which can lead to insufficient knowledge regarding the disease process and treatment recommendations for women.

Gender bias in the care of female patients.

Why do some doctors approach female patients with gender bias?

photo doctor talking to patientI 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. First of all, 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 differences that don’t exist! Either way, these misconceptions can lead to stereotypical views about men and women that can influence how doctors approach patient care.

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.
  • Discriminate based on gender. For instance, some doctors take women’s symptoms less seriously and/or believe women’s symptoms have emotional not physical causes.

Do female patients themselves 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.

What do doctors think about this issue?

As you might expect, some doctors acknowledge gender bias as an issue, and others dispute its existence.

What’s the impact of gender bias in healthcare?

Care inequality can lead to worse outcomes for women, as compared to men, including women experiencing higher complication rates, worse health, and higher death rates.

What kinds of discrepancies?

Gender bias can lead to:

  • Diagnostic procedures not performed
  • Delays in diagnosis
  • Medications not prescribed
  • Lifesaving and/or life-extending procedures and surgeries not performed
  • Referrals to specialists not made
  • Pain and suffering ignored

What are some examples?

image of month symbolsIn 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.

Additionally, a 2012 review of studies on gender bias identified many ways in which women receive lower quality care, including these examples:

Peripheral Arterial Disease

Women were less likely to receive the medications recommended by the American College of Cardiology/American Heart Association. Additionally, research shows doctors offer a surgical option less frequently to women of all ages.

Stroke

photo woman in wheelchair being pushed by manStudies 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.

Osteoarthritis

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.

Acute Myocardial Infarction

photo woman with chest painResearch shows that women who have acute myocardial infarction (heart attack in layman’s terms) have a significantly worse prognosis than men, including a higher rate of additional heart attacks and a higher rate of heart failure. Furthermore, 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. Although one investigation found that after a diagnosis of heart attack there was no evidence of gender bias in medication-based treatments or surgery, women were 46% less likely to undergo investigative coronary testing. Additional studies show gender bias in the treatment of heart conditions and heart attacks.

It’s worth noting that some studies conclude that the female anatomy and physiology increase the risk of heart disease and heart-related deaths.

What do American patients think about gender bias?

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 they were treated 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%

Gender bias in medical research.

photo vials of blood in a labUnfortunately, there are not enough women included in medical research which can limit the understanding of how particular illnesses, and potential treatments, impact women. Although women are not “little men”, for decades, health research focused on men; doctors assumed the results applied to women as well. But women are unique on a cellular level, and therefore can react differently to drugs and other treatments. Fortunately, progress has been made, but there is still significant room for improvement. For instance, although a bit more than 50% of HIV patients worldwide are women, and HIV is the leading cause of death worldwide among women of reproductive age, clinical trials rely heavily on gay men. But women and men respond differently to HIV infection, so the lack of women in these trials can significantly impact the health of female HIV patients.

What can you do?

Fortunately, women can take steps to reduce the impact of gender bias on their own healthcare. 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:

 

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