Patient Bias in the Medical Field

Women in the medical field are getting glossed over because of centuries of preconceived notions, leading to them being glossed over in many important areas.

“We can’t really do much for women compared to men,” were the words that Whitney Aquino, a Paly Wellness Outreach Worker, heard as she sat in a room at Kaiser Permanente looking for assistance for what could potentially be a medical emergency. She had returned in a rush from a overnight vacation with her husband upon discovering that she was unable to properly go to the bathroom, and was diagnosed with acute urinary retention.

To alleviate her symptoms, the doctor promised that they would send someone in shortly with a catheter and an ultrasound to check Aquino’s urinary tract. After almost an hour, a nurse came in and helped her with the catheter.

“I started crying because it was really painful, and she [the nurse] said ‘welcome to womanhood,’” recalls Aquino.

Aquino’s condition is not uncommon. Among men, that is. Research has shown that men are up to ten times as likely to get this condition than women as they age, which is why acute urinary retention research for men has gone much more in-depth than for women.

This is alarming for multiple reasons. Typical causes of urinary retention that are specific to women can include a mass or cancer in the uterus, either the bladder or rectum sagging out to push into the vagina, or infections in the vagina or bladder.

None of this was told to Aquino, who was let out of the hospital with instructions to “wait and see if it goes away.”

“I was like, ‘That’s really all you have for me?’” she says, “it was really just sh-tty because I didn’t know and they didn’t have an answer for how long it was going to last.”

Aquino was fortunate in that her condition receded after two weeks of waiting and frustration. However, at no point during that period or after did her doctors ever find a cause or even address the issue more thoroughly, leaving her in a state of uncertainty about the entire ordeal.

It is difficult to say whether or not it was a case of active gender bias for Aquino, only that she had experienced suffering because of the effects of gender bias in medicine. But experiences like hers, where women are dismissed during a time of extreme vulnerability, are not uncommon and have been present for thousands of years.

Women And Hysteria In The History Of Mental Health, a scientific article published in 2012 in the journal Clinical Practice and Epidemiology in Mental Health, cites the earliest known case of gender-biased diagnosis as far back as 4,000 years ago in Ancient Egypt when women were disproportionately diagnosed with hysteria. This term was used as a medical umbrella for anything that doctors could not explain about a woman’s condition, covering anything from sexual desire to insomnia.

Thousands of years of social and technological progress still have not changed how gender bias influences the medical field today. A 2019 survey by TODAY, a news outlet under NBC, found that one in five women walk into a medical office looking for answers, yet feel ignored or dismissed by their health care providers.  

Further studies done by TODAY show that even after getting diagnosed 31% of women with a chronic condition or pain report feeling like they need to prove their symptoms to their doctor compared to 19% of men. For women in general however, 17% of female patients feel that they have not been given the same evidence-based treatment that should be standard for every patient because of their sex.

“One in five women walk into a medical office looking for answers yet feel ignored or dismissed by their health care providers.”

A study done in 2015 by a multi-university team of scientists that published their work on PLOS ONE, a scientific journal and website, covered the interval between going to the doctor and getting diagnosed for 15 different types of cancer. Their research showed that women experienced a longer wait for diagnosis in 7 out of the 15 cancers, including lung, gastric, and lymphoma cancer, while the other 3 lags in diagnosis time varied in terms of age and National Institute for Health and Care Excellence (NICE) status.

In emergency rooms, women often suffer a difference in pain management and urgency, having their pain ignored or underestimated by the doctors on duty. A nationwide study by the Department of Emergency Medicine in the Hospital of the University of Pennsylvania showed that men in the ER waited an average of 49 minutes to receive pain relievers for acute abdominal pain in contrast to women with the same condition, who experienced an average wait of 65 minutes under the same circumstances.

Even with the numerous feminist movements in this period like the #MeToo movement, even with the people that are impacted every day as a result of conceptual biases, a notion as fluid and broad as gender bias is hard to truly pin down and address.

“He [the doctor] seemed so certain that it was a super easy thing to recover from,” says Sophie, a college student who had undergone several major abdominal surgeries, “I ended up going to Europe a week later and it was very difficult to move. And I was like. What was he talking about?”

She had undergone the procedure in the summer after senior year, right before she entered college. The transition between high school and college can be difficult for anyone, but Sophie found herself limited even further by her healing surgical wounds.

“My whole first introduction to college was me having to recover from this pretty big surgery,” says Sophie.

After the procedure, she was unable to pick up objects heavier than ten pounds or do any sort of physical activity until she recovered. To cope with this, Sophie had to take a lighter course load and rely on her parents for help with moving into her dorm.

In a male dominated field like medicine, women are unfortunately overshadowed. The lack of female representation and generations worth of outdated values and gender roles in a field as prevalent as medicine not only endangers the lives and health of female patients due to the lack of research and equal care, but also acts as a deterrent for any woman in the medical field, both acting and aspiring medical professionals.

“There is an inherent light bias, an inherent categorization of women,” says Dorothy Nguyen, a former general hematologist and medical oncologist at Kaiser Permanente. “Looking back, that was probably a factor that came into my decision not to go into certain types of fields.”

“There is an inherent light bias, an inherent categorization of women”

A study published by the National Academy of Sciences and researched by Brad N. Greenwood, Seth Carnahan, and Laura Huang covered 580,000 heart patients admitted to Florida hospitals over the last two decades, comparing them in terms of the gender of their primary doctor. They discovered that while mortality rates for men and women were about the same when treated by a female physician, women treated by male physicians had a higher mortality rate, which grew the less a physician was exposed to female patients and colleagues.

A 2016 Harvard study also discovered that female doctors have a 0.5 percent lower mortality rate than male doctors on average. That percentage, when applied to the entire Medicare population, translates into about 32,000 less deaths for patients seen by a women than men. Further research by the same organization into why this could be concluded that women listen to their patients more, spending an average of 2 minutes longer than male physicians for each one. While this may result in their being unable to see less patients at the end of the day, female physicians are shown to engage on a significantly higher emotional level. More positive talk, psychosocial discussion, and actively interactive behaviors can be seen in the way they approach the problem, and the difference can be seen even by their patients.

“I find that female doctors, unfortunately, are more empathetic and really give you the time and the attention and make you feel like you’re okay,” says Emily Wang, a Palo Alto resident who suffers from Hashimoto’s disease. “You’re doing the right thing by coming in.” 

Her condition had gone undiagnosed for several years until she revisited her rheumatologist with hives and serious fatigue. “When you’re having a symptom… having that connection almost makes you feel like you want to cry because somebody really understands.”

The ultimate issue with our medical system is not the gender of the doctor so much as how numerous patients every day are being put at serious risk because of how their symptoms are being brushed aside or rushed past because of issues like time constraints, ignorance, or even something as unchangeable as gender.

An internet controversy late last year highlights this issue. Twitter user and TikTok-er Danyelle Rose posted a TikTok last November of her dancing in scrubs and accusing patients of “faking”. The backlash from her video gave rise to the hashtag #PatientsAreNotFaking on twitter, with tens of thousands of people tweeting their stories of being ignored or mistreated by the doctors and nurses that were supposed to be taking care of them.

Their stories are sobering and more relevant than ever. A study done by the University of Maryland showed that while women experience chronic pain or diseases linked to chronic pain more often and are biologically more sensitive to pain than men, their reports are taken less seriously and they often receive less aggressive treatments. Their reports are also more likely to be labeled “emotional” or “psychogenic,” and dismissed or underestimated as false or overdramatic.

“When I lived in Chicago, I had a client who had fibromyalgia and she was constantly in pain… [she] felt like her pain wasn’t taken seriously by the government medical professionals” says Elizabeth Spector, a licensed Mental Health and Wellness Coordinator at Paly. “She felt like she was dismissed as just exaggerating and it was really debilitating.”

In a survey of over 2,400 women with chronic pain by the National Pain Report, 65% of women reported feeling that doctors took their pain less seriously because they were female, and over 90% felt that the healthcare system discriminates against female patients.

This is not only a medical issue but an ethical issue. Patients, no matter their condition or symptoms, should be taken seriously and treated on an equal but effective basis. To neglect such a large amount of the population on something as unchangeable but impactful as sex violates the original doctors code to do no harm.

The official Declaration of Geneva as currently published by the World Medical Association states the following:

AS A MEMBER OF THE MEDICAL PROFESSION:

  • THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
  • I WILL RESPECT the autonomy and dignity of my patient;
  • I WILL NOT PERMIT considerations of age, disease or disability, ethnic origin, gender, or any other factor to intervene between my duty and my patient;
  • I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

While this list does not include all the points in the official Declaration, the principle is the same. All Doctors are supposed to respect life regardless of sex, race, or age. But with the thousands of medical surveys, trending hashtags like #PatientsAreNotFaking, widespread gender bias among professionals and patients, and numerous articles and stories about neglect and discrimination, the question arises.

Do they really?