Quick Hit: Is medicine’s gender bias killing young women?

A recent qualitative study out of the Yale School of Public Health suggests that younger women who have heart attacks may hesitate to seek care for fear of being considered hypochondriacs, contributing to the mortality gap between men and women who have heart attacks that Chloe has written about previously here at Feministing. 

At a piece over at Pacific Standard today, I argue that the larger problem is how justified that fear is. The research on women and heart attacks is just a particularly stark illustration of the gender bias that’s pervasive throughout the medical system — in which women are under-studied within clinical research, while their health concerns are psychologized and dismissed by health care providers.

Feminist critiques of modern medicine have long noted that, particularly when the cause of an ailment is unknown, doctors default to a psychological explanation in women more than in men. There are certainly some factors that may heighten this tendency when it comes to heart attacks. After all, only 20 percent of people who come to the ER with chest pain are actually having a heart attack. There is also clear symptom overlap between a heart attack and an anxiety attack, and younger women are at relatively lower risk for the former and higher risk for the latter. This reality, the Yale researchers suggest, might contribute to “initial triage strategies to attribute symptoms to non-cardiac conditions” in young women. One cardiologist put it more bluntly: “In training, we were taught to be on the lookout for hysterical females who come to the emergency room.”

But to a large degree, that sentiment reflects the kind of treatment many women receive from the health care system as a whole. The fact that psychological problems, like anxiety disorders and depression, can have a wide range of “non-specific” symptoms means they can serve as remarkably plastic diagnoses. To take just a few examples from the experiences of young women I know: For a month, multiple health care providers insisted that a friend’s stabbing chest pain was likely just anxiety before they realized it was pericarditis, an inflammation of the lining around the heart that causes symptoms similar to a heart attack. Dizziness, wooziness, ringing in your ears, and floaters in your eyes? An infectious disease specialist suggested that another friend see a therapist for depression, when she was actually suffering from West Nile virus. Others have encountered physicians eager to play armchair psychologists and explain away the fatigue and widespread pain of fibromyalgia, and the abdominal pain and incontinence of a ureaplasma infection.

This pervasive bias may simply be easier to see in the especially high-stakes context of a heart attack, in which the true cause usually becomes crystal clear—too often tragically—in a matter of hours or days. When it comes to less acute problems, the effect of such medical gaslighting is harder to quantify, as many women either accept misdiagnoses or persist until they find a health care provider who believes their symptoms aren’t just in their head. But it can be observed indirectly: In the ever-increasing numbers of women prescribed anti-anxiety meds and anti-depressants. In the fact that women make up the majority of the 100 million Americans suffering from (often under-treated) chronic pain. In the fact that it takes nearly five years and five doctors, on average, for patients with autoimmune diseases, more than 75 percent of whom are women, to receive a proper diagnosis, and that half report being labeled “chronic complainers” in the early stages of their illness. Then there are the diseases, like chronic fatigue syndrome and fibromyalgia, that exist so squarely at the overlap of the Venn diagrams of “affects mostly women” and “unknown etiology” that they’ve only recently begun to be recognized as “real” diseases at all.

You can read the rest here. And feel free to share your own experiences with medical sexism in the comments.