Gender bias in healthcare: what it is & why it matters

How gender bias in healthcare affects women

Overall, women–and especially women of color–are more likely to have legitimate health concerns dismissed by healthcare providers than men. They are also less likely to receive evidence-based care than male counterparts who present with comparable symptoms or conditions. For example, a woman brought to the hospital for a heart attack is more likely to die from it than a man brought to the hospital under identical circumstances.²

The trust gap

Women are perceived in a different emotional light than men, and that can cause major problems when it comes to getting an accurate medical diagnosis.³ Their symptoms are often minimized, dismissed, or outright disbelieved by healthcare providers–instead, women are made to believe they’re overreacting, over-embellishing for attention, or having some kind of a mental health crisis.

Back in the day–think 19th, 20th century–a woman using honest, descriptive language to communicate pain was referred to as “hysterical”. Today, the terms have changed, but the sentiment hasn’t–women are still inherently expected to be more anxious and emotional than men. A complaint they bring to a doctor, legitimate though it may be, is sometimes brushed off as moodiness or excessive worry.

This long-ingrained systemic bias is, of course, objectively annoying, but it’s also dangerous. Women are getting diagnosed with painful and life-threatening conditions like lupus, cancer, and diabetes literally years later than men are.

Examples of gender disparities in healthcare

1. Heart attacks. Women are less likely to be accurately diagnosed with heart attacks than men and more likely to die from them.⁴ This is partially due to a design flaw in medical training protocol around heart attacks, which teaches doctors to recognize a certain set of symptoms in an average-sized male patient. The problem is, heart attack symptoms don’t always translate across sexes. Women experience wider ranges of symptoms and often don’t have the crushing chest pain men often do. Female gender--alongside family history, body weight, diet, and stress, the female gender--is its own independent risk factor for heart attack mortality.
2. Clinical trials. Women tend to be underrepresented in clinical studies because their hormones fluctuate, and because they can get pregnant. (In medical research, flux is not a variable that can be controlled for, and uncontrolled variables are not ideal for producing statistically reliable outcomes.) Even until as recently as 1990, women were effectively excluded from participating in drug trials. The risk of fetal exposure during pregnancy has also deterred researchers from making pregnant women part of their studies. Unfortunately, the practice of excluding women from clinical studies has had a cascading detrimental effect on female health. Women have been studied less, so doctors know less about them. Because less is known about them, they don’t always get the same quality of care as men.
3. Autoimmune disorders. Here’s a mind-blowing statistic for you: 50 million people in the United States have autoimmune disorders, and 75% of them are women. Seventy-five percent. So why isn’t more known about autoimmune disorders? Why aren’t physicians coordinating care with previous providers better, and communicating outcomes and results along each step of the diagnostic path? Because they’re dismissive. Apparently, something like two thirds of people with diagnosed autoimmune disorders have been labeled by their healthcare providers as “chronic complainers” and are considered to be unreasonably concerned with their health.⁵
4. Mental health. It is widely known and accepted in the medical community that women are about twice as likely to be diagnosed with mental health disorders as men. But even when clinical studies adjust their models for this fact, it is clear that women are disproportionately diagnosed with and medicated for mental health disorders, while men are chronically under-diagnosed.⁶ In some instances, women are getting treated for mental illness when their symptoms are actually being caused by a medical condition, and men are getting treated for medical conditions when their symptoms are actually being caused by mental illness.

What's the solution?

It is possible for doctors and the wider medical community to make meaningful strides toward gender equity in the healthcare space.

Changing teaching and training protocols to reflect patients of all genders, weights, races, ages, and sexual orientations would create a more level medical playing field. That foundation would be strengthened by diversifying healthcare teams to make them look more like the patients they treat, asking patients more open-ended questions, offering training on systemic gender bias, and making a more concerted effort to include women in clinical trials.

Resources:

1. physicians.dukehealth.org: Recognizing, Addressing Unintended Gender Bias in Patient Care | Duke Health Referring Physicians

2. cedars-sinai.edu: Examining Gender Bias in Medical Care | Cedars-Sinai

3. greatergood.berkeley.edu: How to Address Gender Inequality in Health Care

4. escardio.org: Heart attack diagnosis missed in women more often than in men

5. medicalnewstoday.com: Gender bias in medical diagnosis: Facts, causes, and impact

6. journals.sagepub.com: Gender inequalities in depression/anxiety and the consumption of psychotropic drugs: Are we medicalising women's mental health? - Amaia Bacigalupe, Unai Martín, 2021