Do medical professionals treat women differently when it comes to painful ailments?
Some people sure think so.
Others aren’t convinced.
Although there is evidence to support an unconscious gender bias against women — especially in emergency room or pain management settings — there are also many people who say that such a bias doesn’t exist.
An October 2015 article in The Atlantic gained a lot of traction in the discussion surrounding gender bias in healthcare.
It was titled “How Doctors Take Women’s Pain Less Seriously.” The article provided a first-person account from a husband who observed the way his wife was being treated in a hospital setting.
The op-ed essay stated, “Women are likely to be treated less aggressively until they prove that they are as sick as male patients.”
Another article titled The Gender Gap in Pain was also widely circulated.
It was originally published in 2013 in the New York Times, and concluded that “pain conditions are a particularly good example of the interplay between sex (our biological and chromosomal differences) and gender (the cultural roles and expectations attributed to a person).”
Sexism in medicine?
Beyond individual stories, there are also studies that conclude the possibility that this gender bias does exist.
In the early 2000s, a study by the University of Maryland Francis King Carey School of Law was published in SSRN. The study, called “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” attempted to identify why it was that women seemed to “report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively.”
The study stated, “… not only that men and women communicate differently to healthcare providers about their pain, but that healthcare providers may respond differently to them.”
This study found that female patients more likely to have their pain described as emotional or psychogenic.
The bias — although it may be an implicit or unintentional one — seems to be particularly pronounced in emergency settings.
Heart disease is the number one killer of women in the United States. In addition, experts say that many times women experience different symptoms of a heart attack than men.
In general, the consensus among documented patient experiences and the studies presented, is that often women, while more likely to report symptoms to a doctor, are often viewed as more emotional than men.
Avoiding the pain
This isn’t to diminish men’s experience with pain.
One rheumatologist, who didn’t want his name used, told Healthline that most doctors don’t like treating people with chronic pain at all, regardless of sex.
Pain is complex, hard to treat, and there aren’t a lot of good answers on how to best manage pain in people with chronic pain.
Still, taking the general stigma against people with chronic pain out of consideration, women seem to face more skepticism or indifference when it comes to their symptoms than men do given the same circumstances.
Women report doctors being condescending or not taking symptoms seriously. Sometimes women say they are told their symptoms are all in their heads — a refrain that doesn’t seem to always translate to men’s healthcare experiences.
A 2011 Institute of Medicine report on the public health impact of chronic pain found that not only did women seem to suffer more often from pain, but they also had a higher pain tolerance. Nonetheless, the study concluded that women’s reports of pain were more likely to be dismissed.
This can be problematic, since pain is self-reported and is relatively subjective. To properly treat and control pain, doctors have to trust that the person is describing pain accurately and in a trustworthy manner.
Gender bias against women is not solely an American phenomenon nor is it only “sexist” male doctors. This is bias that may potentially exist on a global scale, coming from both male and female healthcare providers. It can play a role in many situations from emergency care to childbirth and OB-GYN care to chronic pain management.
Simply put, according to Dr. Mary O’Connor of the Mayo Clinic in a 2015 blog post, “Women do not always receive the same medical care as men.”
This “built-in bias” can create more serious problems in an emergency room.
What do patients think?
A survey of 2,400 women conducted by the National Pain Report concluded that 90 percent of women with chronic pain feel the healthcare system discriminates against women.
About 65 percent of respondents felt that doctors of either gender took their pain less seriously simply because they were women.
Amiee Lesko of Pennsylvania, told Healthline, “My PCP is a woman, been seeing her for 10ish years. She's younger and the absolute best. She takes time to listen and never discounts any of my thoughts, feelings, or complaints. I totally trust her opinion. When I had a health scare in 2015, I had seen a handful of physicians, all male. They all brushed my complaints off as ‘mental’ since they couldn't see anything. I basically felt like brushed off as a ‘silly girl.’ Now when I'm looking for a specialist, I always try to find a female provider first.”
Lauren Karcher, another Pennsylvania resident, had similar experiences but noted not all doctors treat young women this way.
“It depends on the doctor I think ... but I have been treated by specific ones in a manner that they felt I had no idea what I was talking about and refused to listen to me,” she told Healthline. “My mom went with me to an appointment and even said to the doctor, ‘I don't feel like you are taking her very seriously.’ He said, ‘Look at her, she is smiling and bubbly, how could she be in so much pain?’… I am always smiling and bubbly, even when I'm pain, that’s just me.”
Tami H., who lives with rheumatoid arthritis, told Healthline, “I'm not able to speak for others. However, I have felt and seen the discrimination in doctors’ offices and the work force. My personal experiences have made me leery of new doctors and nurses … and God forbid I have to go to the ER! That’s more frustrating than just putting up with whatever is wrong with me.”
These women aren’t alone.
Alice Sparks of Florida is living with psoriatic arthritis. She told Healthline, “There is absolutely a gender bias. The typical stereotype is that women overreact to pain and symptoms while men do not seek medical care until it is absolutely the final measure. I can look back, prior to my diagnosis, when I presented with classic symptoms and was told that it was ‘stress’ or ‘depression.’”
Lucy Bowen of Texas said that in her situations, going with a female doctor helped.
“I purposely chose a female rheumatologist to treat my pain to bypass this issue,” Bowen told Healthline. “It has made a world of difference. I used to feel like I had to justify what I was feeling but now there is so much less pressure.”
This feeling of being judged or talked down to can leave some women feeling mistrustful of, or intimidated, by their doctors.
Some male patients say they have noticed a bias against women.
“I can't tell you that I know this to be true. However, I have listened to many ladies talk about how their doctor doesn't seem to believe the intensity of their pain,” Jose Velarde, an advocate living with rheumatoid arthritis, told Healthline. “I have seen three rheumatologists, a pain specialist, and my GP. Not once has anyone suggested I wasn't in the pain I say I'm in. Not once have they questioned my need for the pain meds.”
But some people say they don’t see any discrimination or differences in treatment or care.
Tavie George, who has juvenile rheumatoid arthritis, told Healthline, “This question of gender bias against women kind of made me laugh because I always think female doctors are way more rude than male doctors … I think being young has been more of a discrimination against me than being a female. I also have received discrimination over having Medicare and Medicaid at such a young age.”
“I do think,” she added, “women in general have an emotional habit of getting their feelings hurt in unneeded situations when they are in pain, emotional or physical.”
Lindsay Paige Tonner, who has rheumatoid arthritis, told Healthline, “Bias hasn't been the case for me. I've been treated with care and respect throughout from both male and female doctors. Having said that I have been told that if I say I'm in a lot of pain then I really must be as I have had a baby so know what I'm talking about.”
What do professionals think?
“Women are seen as less pain tolerant, but actually I see the opposite in prehospital medicine. Men always ask for pain meds while women seem to wait to ask. Maybe women have the general thought process that we will think they are whiners or med seekers and abusers,” DeNell S., a healthcare worker, told Healthline.
Brenda Unhajer, a nurse from Pennsylvania, told Healthline, “From the other side of the bed, I can tell you there is a gender bias in healthcare. In an acute versus chronic situation, many women having acute chest pain are often overlooked and given anti-anxiety medications before receiving treatment, or in addition to, being worked up for a cardiac problem.”
She continued, “One of the biggest frustrations I face as a provider [non-physician] is the ‘golden standard.’ While we promote individualized care, it's far from that. Evidence-based practice has changed a lot of things for the good, but treatment-wise, I think it's hindered a lot from the physicians' standpoint.”
Carrie Wood of Pennsylvania disagreed.
“I’ve worked in the ER for six years and I can say I never treated or saw a patient treated differently for their gender,” she told Healthline. “We treated based on facts, tests, and symptoms, and there were at least 10 different providers. Nor have I ever been treated differently in my healthcare field because I am a woman.”
But she added that this may vary from person to person or institution to institution.
As cultural norms shift and gender identities and values are challenged, this may continue to be a topic of conversation.
Medical schools are beginning to address the nuances of gender in healthcare and also teach med students about implicit bias, whether against women, people of color, or the LGBTQ community.