Gender Bias and Misdiagnosis of Symptoms

• "All your symptoms are your imagination"
• "More than 40 percent of women eventually diagnosed with a serious autoimmune disease have basically been told by a doctor that they're just too concerned with their health or they're a hypochondriac."

Polycystic Ovary Syndrome

• you go to a clinic for excessive bleeding and painful cramping during menstruation
• ...are told that that is normal
• ...are prescribed anti-anxiety medication
• weeks later you are admitted into the ER and are diagnosed with uterine fibroids

Women are nearly 2x likely as men to die in the year following a heart attack, partly because "cardiovascular care has been slow to acknowledge the gender differences in heart disease," says Noel Bairey Merz, M.D., director of the Barbra Streisand Women's Heart Center at Cedars-Sinai Heart Institute in Los Angeles.

Stress test scoring guidelines - devloped based on experiments done on a study of "only middle-aged men"

- Leslie Cho, M.D., director of the Women's Cardiovascular Center at the Cleveland Clinic

"If a doctor or other health care provider has ever misdiagnosed your ailment, did you feel like your gender contributed to the misdiagnosis?"

Response categories were:

(1) "I have not had a misdiagnosis."

(2) "No, I don't think my gender played a role."

(3) "My gender might have played a role, but only a small one."

(4) "I felt like my gender may have played a fairly important role."

(5) "I definitely felt like my gender played a role."

• 163 Baylor Students
• 31% reported having a misdiagnosis
• roughly 20% attributed the misdiagnosis to their gender
• this 20% were all women

Gender Bias in Medicine

Psychiatry

"His"tory

"Female Hysteria"

"Medical Gaze"

Male model

• Women 72% more likely than men to be labeled as depressed
• Women have a higher clinical prevalence
• Female patients with depressive symptoms are more likely than males to be diagnosed as depressed
• Physicians didn't allow marital status to affect diagnosis in men
• Women diagnosed with anxiety are 22% more likely to be diagnosed later on with other anxiety disorders

Was not until 1990's that female figures were widely used

PCOS:

ECG

120

Michel Foucault

bpm

"medical gaze"

• term coined by Foucault
• during its origin at the beginning of the 19th century, physicians based their medicine on "empiricism"
• observation of the human body to gain a better understanding

Hypothesis:

Patients are treated differently as a result of their gender and that of their physician.

Among 2,231 patients in a postinfarction intervention trial, men were twice as likely to undergo an invasive cardiac procedure as women, despite stronger cardiac disability in these female patients.

Survey results:

• French Enlightenment
• Medical gaze
• “Doctors treat bodies, not souls”

Works Cited

• CULP-RESSLER, TARA. “When Gender Stereotypes Become A Serious Hazard To Women's Health.” ThinkProgress.
• Łyszczarz, Błażej. “Gender Bias and Sex-Based Differences in Health Care Efficiency in Polish Regions.” International Journal for Equity in Health 16 (2017): 8. PMC. Web. 8 Oct. 2018.
• Sagon, Candy. “Women's Health Issues And Medical Gender Bias.” AARP, Feb. 2017.
• Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med.
• Zoldan, Rachel Jacoby. “The Real Story of Why Doctors Used to Diagnose Women With Hysteria.” Glamour, Glamour Magazine, 26 May 2017.

Discussion Questions:

1. In what ways can gender bias be mitigated in the healthcare field?

2. Should sex/gender studies be incorporated into medical school curriculum?

Conclusions?

• There is a longstanding stigma surrounding female health
• Men and women have different physiological symptoms for many diseases
• More work needs to be done studying these distinctions

It works in reverse too...

"Men suffer one-third of all hip fractures, but because osteoporosis is considered a "woman's disease," insufficient research has been conducted on men, and guidelines regarding bone mineral density testing of older men remain vague."

- Marcia Stefanick, codirector of the Stanford Center for Health Research on Women and Sex Differences in Medicine

Misdiagnosis in Action...

How often are women misdiagnosed?