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The Past and Present Mistreatment of Women by Medical Professionals: Are Doctors Really Capable of ‘Doing No Harm?’

Photo by Brittany England (Fisher)

Overview

     Women’s health is a topic that has been finally getting attention after centuries of disregard. On a personal level, women generally face more challenges when trying to get medical care because doctors are “more likely to assert that there is a psychosomatic component in women’s complaints” (Ruiz). This has been a common theme, with the now outdated term ‘hysteria.’ In the early 1900s, doctors would forgo medical testing and diagnose their patients with hysteria, though hysteria’s broad scope of symptoms included shortness of breath, anxiety, muscular spasms, and fainting (Wellcome). In the late 1950s, a British psychiatrist found that over 60% of women previously diagnosed with hysteria had physical problems (Dusenbery).

     While there have been improvements in medical care, women still face many obstacles when trying to get a proper diagnosis. At the government level, women are frequently excluded from drug trials and clinical studies. When researchers are determining the safety of a drug, the test results from male patients are, in many cases, “just extrapolated to, or assumed to be, identical in females” (Examining). That assumption causes more women to die than men when faced with the same health issue (Examining).

     For women to have equal access to healthcare, unbiased treatment, and a better understanding of their own anatomy, individuals and organizations must work to eliminate gender-based prejudice.

Personal Interest

     My interest in this topic started one day in eighth grade when I was browsing a women’s health forum. Initially, I was curious to read any tips related to general health, but then I noticed a worrying theme. Too many women talked about having chronic pain that was ignored by their doctor. Plenty of people responded with their own stories with a similar plot. The woman feels something physically wrong, like increased fatigue or abdominal pain. She is dismissed by the first doctor she sees and is given a prescription for an anti-anxiety medicine or is told to get more sleep. Months, sometimes even years later, the woman sees another doctor because nothing has improved. The new doctor runs tests and finds a physical problem. Though I was surprised to see so many people with the same experience, I thought to myself, “this is just an echo chamber of people with similar stories. These women are in this forum only because they have a physical problem.” In ninth grade, I revisited the theme of women spending a lot of time getting healthcare for the I-Search project. I did not choose that as a topic, though, because I realized that there was a bigger problem in women’s health. The first doctor’s assumption that the woman has a mental health problem, not a physical problem, is not just a one-time mistake: that way of thinking stems from centuries of women not being listened to.

History of the Problem

     To understand the present problem of women being mistreated by their doctors, one must look at the history of abuse against women without power. Between 1845 and 1849, enslaved women were experimented on so that a leading gynecologist, Dr. J.Marion Sims, could develop a solution to a common problem that women faced. The women that survived the experiments were often left permanently hurt and otherwise violated (Ojanuga). As women gained more freedom and bodily autonomy in the 20th century, the mistreatment of women became less flagrant and more nuanced. Terms like ‘hysteria’ and ‘anxiety’ were used by doctors to explain an unreasonably large range of problems. The majority of people diagnosed were women, and most did not receive further treatment (Wellcome). After the same psychiatrist mentioned earlier revisited past hysteria patients, he found that the bulk of patients had an underlying cause for their problems that wasn’t a mental health issue (Dusenbery). Some of the problems included epilepsy or brain tumors. 14 percent of the original patients had died. Shouldn’t those women have been tested for physical causes? Would those women have had a better quality of life if they had been correctly diagnosed earlier? Those are questions that people have been working to solve for decades. While much has improved, there is still a long way to go. 

 

What You Need to Know: The Present Day Version of this Problem

      While people have been fighting systematic gender biases in healthcare for decades, significant inequities stemming from years of sexism and prejudice still afflict our society. 

      In a study of patients who presented to emergency rooms for heart attacks, between 1991 to 2010, involving almost 582,000 people, it is estimated that 3.5 times more women died from the same issue as men when treated by a male doctor than when treated by a female doctor (“Examining”). Because heart disease is the most common cause of death for both men and women in America (Heart Disease Facts), fractions of percentages represent thousands of lives. 

      There are two main takeaways from that study, the first being that women are more likely to die from the same health event than their male counterpart. While it is true that illnesses can affect women in different ways than men, which could plausibly result in a higher mortality rate, the issue lies in the neglect of women’s health. Studies and drug trials often discount reactions that women have as trivial or inexplicable, leaving women vulnerable to harm when they experience reactions that were previously minimized (“Examining”). 

      Sadly, if women’s experiences in healthcare are not categorized as an abnormal reaction, women are often excluded entirely from research. On the Heart Foundation’s online page relating to symptoms of heart attacks in women, the writer states, “most of what we know about diagnosis and treatment of heart disease comes from research done on middle-aged men” (Erlinger). Data concerning an illness that does not reflect the population that is susceptible to that studied illness “is simply inadequate and cannot be generalized to the whole (diverse) population without any confidence” (Dodds). In order for people to accurately understand women’s health, studies must not treat women’s reactions as abnormal or completely exclude women from the treatment development process. 

      The second takeaway speaks to the issues women face in healthcare: not being taken seriously. With a difference of 0.5% more women dying when treated by male doctors than female doctors, it is evident it is harder for women to receive treatment when treated by male doctors. Maya Dusenbery, a woman who shared her experience in getting diagnosed with an autoimmune disease, is very outspoken about fighting gender-based discrimination. All things considered, she considers herself lucky to be accurately diagnosed in a relatively short time. She says that when women present a problem to their doctor, “their symptoms [are] not taken seriously or they [are] dismissed as stress or just otherwise sort of minimized” (Gross). 

 

Activism in the Present Day

 

      Thankfully, there are many organizations as well as individuals that are working towards gender equality in healthcare. Maya Dusenbery wrote Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, which raises awareness about the difficulties women face when trying to get treatment. 

      In 2019, speakers Laura Huang, PhD, and Dr. David C. Page spoke at a conference dealing with gender-based discrimination in medical research. They concluded that medical professionals would need to “go back to the beginning of the enterprise and essentially rebuild it,” referring to the historical and present exclusion of women in clinical testing (Examining). Though doctors are expected to remain impartial when treating their patients, failures in care often happen to women who are frequently dismissed. 

      The NIH (National Institutes of Health) announced a policy in 2001 requiring that “all NIH-funded clinical research will be carried out in a manner sufficient to elicit information about individuals of both sexes/genders… to examine differential effects on such groups” (“NIH Policy”) which aimed to help promote gender equality in drug testing. With more studies being conducted to fight problems like dismissiveness and misinformation about women’s health, gender equality in medical treatment is becoming an attainable goal for the future. 

 

“Percentage of Women in CVD Clinical Trials vs. Deaths”
(“Designing Health & Biomedical Research.”)

     In a study conducted on Cardiovascular Disease Patients of both sexes, you can see that the ratio between men to women is not 1:1. More men are included in CVD studies than women, even though more women die overall from general CVD events. 

     Try this: how many symptoms of a heart attack can you name?

     Did you mention chest pain or shortness of breath? These are the most common symptoms of a heart attack in men. Women often report similar symptoms, but also nausea, dizziness, neck, jaw, or stomach pain (Erlinger). Unfortunately, women often “chalk up the symptoms to less life-threatening conditions like acid reflux, the flu or normal aging” (Heart Attack Symptoms in Women), as the symptoms of a heart attack in women are not widely known.

     Do you think that fewer women would die if there was more information on female heart attack symptoms?

For Now: Personal Level Solutions

  1. Get a Second Opinion: As an individual, it is difficult to know if your doctor is taking your case seriously. If you think that your symptoms do not match the illness that your doctor says you have, you should get another doctor’s opinion on the matter. Your health should always come first, so it is important that doctors do not overlook certain aspects of your health because they are slightly biased against your case. 
  2. Patient Advocacy: A patient advocate helps somebody with health issues navigate their doctor’s appointment, treatment, and other aspects of the medical world. Since this is a relatively new type of healthcare, you can help people in a variety of ways: you can help people that need assistance, whether that be helping someone choose the right doctor for them or caring for someone in their home. If you are interested in doing this kind of work, you should check out local advocacy programs. Similarly, if you would like somebody to help you deal with the medical world, you can ask your healthcare provider if there are advocates that would help you. Often, patient advocates help with tricky subjects like insurance, payment plans, and other services relating to the medical world. 
  3. Raise Awareness: Raising awareness is the key to change. Inequalities based on gender are often subtle and personal matters, so others may not realize that their doctors are not giving them the best care possible. With research proving that women face more difficulties getting diagnosed, hopefully more women will realize that their health conditions should not be dismissed or ignored. As heart disease is the leading cause of death among Americans, it is critical that studies and treatments are made available to men and women that account for gender-based differences. 

 

(Parker-Pope)

Macro Solutions

  1. Equalized Standards in the Government: The recent NIH announcement that made gender-based differences was a step in the right direction. Similarly, a 1994 study showed that only around half of all insurance companies covered various types of birth control, but 97% of those insurance plans “have traditionally covered ‘male drugs,’ such as those prescribed for prostate and urological issues” (Chen). To counteract this, the Affordable Care Act under President Obama included most forms of birth control. In this example, the insurance laws changed because the government became involved. In order to correct the current issues, the government needs to involve itself in the laws regarding medical studies and medical practice. 
  2. Medical Education: For doctors to understand and accurately treat health issues in women, medical schools across the country need to teach the students how to care for patients with both male and female models. While all (good) doctors know the symptoms of a heart attack in men as well as women, the differences in care between men and women should be equally studied. Furthermore, all medical schools should be required to show how female birth control works, as that is another gender-specific subject often neglected in education.

As social change takes decades, the issue of gender-based discrimination will not be resolved overnight. While change is usually enacted on the federal scale, it takes the efforts of individuals like you and me to improve our society. Hopefully, through these suggestions to become involved, meaningful contributions to change can be made.

 

Are there other problems to consider? Do you have any solutions or advice?

If you are interested in discussion, please leave a comment! I would love any feedback, questions, and more. 

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COMMENTS: 4
  1. April 24, 2020 by Elizabeth

    This is really interesting! I didn’t know about a lot of the current manifestations of the problem, especially regarding clinical trials!

    • April 24, 2020 by Sandhya

      Thank you!

  2. April 24, 2020 by Nisha

    This is really amazing! I had known a little bit about the prevalence of this issue in the past, but I’m so glad that you brought light to the current manifestations of this issue. I especially liked your infographic on trials vs. deaths. I thought it was so interesting and informative. Awesome job!

    • April 24, 2020 by Sandhya

      Thank you!

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