When Doctors Downplay Women’s Health Concerns
By Camille Noe Pagán
- May 3, 2018
“Well, you look like you’re doing great,” my primary care physician cheerfully informed me.
I stared at her from the examination table in disbelief. I had just told her that I wasn’t enjoying being with my children and was having trouble doing what needed to be done at work and at home. As a health journalist, I had interviewed dozens of physicians and psychologists. I knew that being unable to live one’s life was the big red flag signaling it was time to get help.
I was asking for help.
But my doctor was under the impression I didn’t need it. “I don’t think you’re at the point where medication is an option, and anyway, it can be addictive. Keep exercising and doing yoga, and maybe consider meditating,” she said with a tight smile. “Try to get some more sleep.”
I had just told her these very steps weren’t helping. And anxiety was keeping me from falling asleep and getting restful sleep. “But …” I began.
She quickly interjected. “If you’re still having trouble a few months from now, come back and see me again. O.K.?”
I nodded numbly. My physician was just like me: A relatively young, educated mother of small children with plenty on her plate. And she had an M.D. after her name. Wouldn’t she know if I were truly in need of treatment?
It took several months for me to summon the courage to see another health professional — this time, a cognitive behavioral therapist who was horrified by my experience with my doctor (who, for the record, is no longer my doctor) and told me there was a lot we could try to help me start feeling better.
Therapy worked. My anxiety decreased immensely in just a few months, freeing up mental space for bigger questions. And I began to wonder just how common it was for women to have their health concerns downplayed or dismissed by a physician.
As it turns out, very. “It’s a huge issue in medicine,” says Dr. Tia Powell, a bioethicist and a professor of clinical epidemiology and population health at Albert Einstein College of Medicine in New York. Health care providers may have implicit biases that affect the way women are heard, understood and treated, she said. “Medical schools and professional guidelines are starting to address this problem, but there’s still much to be done.”
Dr. Powell, who is also the director of the Montefiore Einstein Center for Bioethics, speaks from experience: “A while back, I lost 10 pounds over a couple months, so I went to my doctor and told him I thought it was a sign I was having a recurrence of an old illness. He gave me a few reasons he disagreed and added, “Plus you’ve been on a diet.” That struck her as odd — she had never said this, and doubted her doctor would have made the same assumption about a male patient. A set of tests with a new physician confirmed that Dr. Powell was correct about the recurrence of a previous illness, for which she was immediately treated.
But research on disparities between how women and men are treated in medical settings is growing — and it is concerning for any woman seeking care. Research shows that both doctors and nurses prescribe less pain medication to women than men after surgery, even though women report more frequent and severe pain levels. And a University of Pennsylvania study found that women waited 16 minutes longer than men to receive pain medication when they visited an emergency room. Women are also more likely to be told their pain is “psychosomatic,” or influenced by emotional distress. And in a survey of more than 2,400 women with chronic pain, 83 percent said they felt they had experienced gender discrimination from their health care providers.
And then there are the stories that physicians themselves share about their patients. “I can’t tell you how many women I’ve seen who have gone to see numerous doctors, only to be told their issues were stress-related or all in their heads,” says Dr. Fiona Gupta, a neurologist and director of wellness and health in the department of neurosurgery at the Icahn School of Medicine at Mount Sinai in New York City. “Many of these patients were later diagnosed with serious neurological problems, like multiple sclerosis and Parkinson’s disease. They knew something was wrong, but had been discounted and instructed not to trust their own intuition.”
“It can be hard to speak up if you feel you’re not being treated fairly,” Dr. Powell said. “I’m a professor at a medical school and I struggled with it.”
Here are three steps to help ensure your health concerns are taken seriously.
Ask about guidelines
If your doctor recommends something you suspect isn’t right (including “watch and wait”), Dr. Powell advises asking: “What’s the basis for your recommendation? Are there guidelines for this, and what do they say?” “Guidelines tend to be fairly objective and data-driven, so women do better when their doctors follow them,” she notes.
If you still feel like you’re being dismissed, say, “I’m concerned, and I feel that maybe you aren’t hearing me. Help me understand why you don’t see this as a problem.” “A good physician can have biases,” says Dr. Powell. “But a good physician should also be able to take a step back and say, ‘I hear you. Let’s talk this through.’”
Check your own bias
“As women, we’ve been taught from an early age to rationalize warning signs of physical or mental health problems,” says Dr. Gupta. (To wit: a Yale cardiology study found that many women hesitated to seek help for a heart attack because they worried about being thought of as hypochondriacs.) Recognize that expressing concern over symptoms doesn’t mean you’re overreacting, self-diagnosing, or trying to do your health care provider’s job for them. Says Dr. Gupta: “If you feel like something isn’t right with your health, honor that — even if a doctor is disagreeing with you. It’s better to find out you’re wrong than to wait too long.”
There’s little evidence to show that female providers offer women more equal care than male providers do. The best doctor, says Dr. Powell, is the one who listens to you and views health care as a conversation — not a set of orders.