Bias in Medicine: Are Female Patients Treated Differently from Male Patients?
Gender bias has been so pervasive in our society that it does not come as a surprise that it is ingrained in medical practice, from treating females differently to affecting drug trials and research. With the advent of AI, there is a real danger of these biases being built into algorithms that may affect resource allocation in future, and it is time to speak up. Talk to your medical malpractice attorney at Cochran, Kroll & Associates, P.C., if you feel you were treated differently and experienced an adverse outcome.
Should males and females be treated differently?
It is rather obvious that males and females are different anatomically; they have different biological processes, levels of hormones, respond differently to stress and live different lives. One would therefore expect their medical care to be patient-centric, i.e. to focus on their unique differences, and in many cases, it does.
The problem of gender bias arises because most research focuses on males, large numbers of drugs are tested on male laboratory animals for fear that female hormone levels would obscure the results, and medical training traditionally focused on male responses to treatments, often in an implicit way, but it is ingrained non-the-less.
Doctors, in general, care deeply about their patients and their health and will do anything to ensure they give them the best care possible – often being completely unaware of how their own biases influence their caregiving nor the effect it has on their female patients.
However, gender bias in medicine can affect men and women in some form or the other, but the overriding result of the gender bias affects women more.
What is bias?
Everybody is biased in some way or the other, no matter how much we deny this. It is more often than not unconscious but can be innate or learned.
It may be for or against an idea, a belief, an individual or a group and is generally used in a way that is unfair. It is a prejudice, unfair weighting or distortion, and it implies unfairness and partiality or favoritism.
It is a seriously threatening phenomenon in all of society – in research or engineering, it is considered a systematic error.
In medicine, it refers to unintentional systematic neglect of either gender. It amounts to stereotyping and applying preconceptions about behavior, needs, health or beliefs.
It is important to take gender bias into consideration not only in clinical practice but also in education and medical research.
Is there a difference between sex and gender in medicine?
We may think that ‘gender’ is the politically more correct term for ‘sex’ and that they are interchangeable, and in most cases, they are, but in medical research, there is an important distinction between the two.
Sex signifies the biological characteristics such as reproduction, hormones or chromosomes. Gender describes the differences that can be attributed to societal and cultural influences.
Gender influences our perceptions of what is considered masculine or feminine and is based on sociocultural norms and power. What is referred to as the ‘gender order’ in society generally assumes that a ‘normal’ human being is a man – how often do you write “he (or she)”? It is well known that there is an unequal distribution of political power, education and wealth between genders. We are not going to debate the reasons but how this affects medical treatment.
As everything is connected – your physical health, mental state, economic situation, emotional and social activity or spirituality – in not only how you behave, make decisions or live your life, and regulate your social interactions, this applies to the doctor-patient relationship too.
No matter how individualistic we regard ourselves to be, in some way or the other, we all conform to socially acceptable presentations in our interactions with others. And this is where the differences between sex and gender can influence medical practice decisions, as doctors not only have to try and find causes of symptoms presented to them but also have to interpret the patient’s story.
Fausto-Stirling explains the difference clearly in the bone-building process: The bones of a male, in general, is much heavier than that of a female, but girls who exercise will end up with bones much heavier than those of boys that are not. Thus, doctors have to consider both gender and sex when treating patients.
Gender bias in medicine making headlines
Cultural practices such as foot-binding, genital mutilation and neck stretching have been headline material for decades, but not much attention is paid to gender biases in clinical practices.
In 2014 the NIH urged researchers to start including at least 50% of female lab animals in studies, to represent the population, as they were concerned with the effects of certain drugs on female patients, and finding them to have been tested mostly on male laboratory animals. It is believed that female laboratory animals were avoided due to fear that their hormones and reproductive cycles would skew the results. Francis Collings, the NIH Director recently issued a full, formal apology to women and women scientists for their failure to step up sooner.
The FDA has warned against minimally invasive surgeries that are practiced on women that have not been approved for use in the USA, such as morcellation, and thousands have had weak pelvic floors fixed with mesh surgeries that have caused problems. Breast implants have been in the news, and it is believed that women are not given enough information to make informed decisions.
Sometimes the best intentions can backfire, as is the case with warning pregnant mothers not to drink and implementing punitive policies for those who do, which simply result in them avoiding prenatal care. Affirmative policies allow them priority access to substance abuse programs, and punitive policies define alcohol use as neglect. This has been shown to have a negative effect, and pregnancy should not be made a special case, but all substance abuse treated with the same standards.
A female neurologist, Dr Laura Boylan suffered from movement disorder symptoms and claimed that doctors treated her as if she was ‘hysterical’, and repeatedly diagnosed her symptoms as psychological, whereas in a male patient they would have tested for Parkinson’s. She eventually had a cyst in her brain removed, and her symptoms improved. What was originally referred to as hysterical movement disorder, then hysteria, later psychogenic is now called ‘functional disorder’ and has similar symptoms to Parkinson’s, and up to 80% of those diagnosed are women.
The climbing maternal mortality rate in the USA is of great concern, and it is estimated that hundreds of thousands of women undergo surgeries that are not medically necessary or undergo chemotherapy at much higher rates than necessary.
A young mother described how she took her newborn baby to the emergency room 16 times, suspecting heart failure, and was turned away and sent home, and often told to relax. Eventually, her husband accompanied her, and the child was diagnosed with heart failure and admitted for treatment.
Time’s Up Health was launched to address gender bias issues in medicine for patients and providers. They claim female patients are often not taken seriously, and that even female doctors think that female patients exaggerate their pain. The example provided was endometriosis, which is a condition that takes on average, 9 years to diagnose.
On the plus side, California took early steps to address gender bias issues in medical treatment by enforcing the application of best practice protocols for all patients and following up on its implementation, and they have seen very encouraging results in all areas, especially reducing serious complications and death in female patients by more than fifty percent.
Are there research studies that show gender bias in medicine?
Evidence shows that female patients are not offered the same level of diagnostics and treatment as men. Some examples of published studies include:
- Using only male patients in research has been criticised since the ‘70s. It was postulated that apart from reproduction, male and female subjects are the same.
- Initially, estrogen and androgen were labelled as sex hormones, and now they are labelled as growth hormones.
- Research biases led to the NIH issuing several instructions for the inclusion of both sexes in research studies in 1990 and directing the inclusion of sex-based analyses in all NIH funded studies in 1994. Yet many studies are mostly male-based, and no sex-differential offered in the analysis.
- Many original studies on depression focused mostly on women and excluded patients with substance abuse (higher prevalence of men) thus reinforcing depression as a female disorder.
- In general, females are less likely to be offered advanced diagnostic and treatment options.
- This extends to several studies done for specific conditions, which include
- Coronary Artery Disease
- Knee Joint Arthrosis
- IBS (Irritable bowel syndrome)
- Neck pain
- Intensive care disparities
In particular women over the age of 50 were less likely to be admitted or to be provided with life-saving treatment.
- Migraine diagnosis – more than 80% of patients with a migraine diagnosis is female; thus, it is underdiagnosed in men. The pharmaceutical industry targets females in advertisements for drugs, reinforcing the belief that it is a female disorder.
- Depression – although depressive symptoms present very differently in men than in women, it is often misdiagnosed in men as it is seen as a female disorder (due to the prevalence being twice as high in women as compared to men), and many men that could have been treated are not. High scores on depression scales are interpreted differently, with more females being diagnosed based on the same scores. This seems to correspond with a stigma attached to depression being diagnosed and unconscious bias towards sparing males the ignominy of a depression diagnosis.
- Psychoactive drugs – prescribed more often to females. While treating depression is higher in females, it is often used as a ‘catchall’ diagnosis for a wide range of symptoms, and not investigated appropriately, with diagnoses being missed due to the assumption that it is depression or ‘the blues’ which is seen as a typically female condition.
- Hypothyroidism – much more common in female patients, but often misdiagnosed as depression or needing some exercise and a better diet, and often diagnosed late when symptoms have become severe. But because it is seen as a female condition, male patients are neglected and misdiagnosed.
- Heart attacks (myocardial infarction) – presents very differently in men and women, whom often have MI’s without plaque, and many women are turned away from emergency rooms and sent home as they are not displaying the ‘typical symptoms’ of a heart attack.
- Psoriasis – female patients were given ointments, male patients clinic-based treatments.
- Non-specific diagnosis – more prevalent for females.
- Interpretation of symptoms – female as psychosocial but the same symptoms in men interpreted as organic.
One may think that symptoms do vary between male and female patients, and that may be the leading cause for the treatment differences. It may also be related to innate gender bias in the physician, training in relation to gender bias (i.e. women may be more likely to complain, men are more stoic, certain religions display more hysterical symptoms, etc.), or communication problems between the physician and the patient.
Gender bias research has shown medical professionals interpreting the exact same story and symptoms differently based on their preconceived ideas about gender and medicine.
Physicians claim that men are straightforward in describing symptoms, women are vague and are less likely to agree to intensive procedures, but research using video patients (thus eliminating patient interactions) still showed bias in treatment.
It is only recently that the dummies used to practice CPR are modelled on female anatomy; for many years, you could only practice on a male dummy.
How does this translate to Medical Malpractice?
Gender bias may influence many decisions made in your clinical care – from being misdiagnosed, under-diagnosed to being sent home without any investigation or treatment when you are, in fact suffering a serious illness. It may translate to receiving sub-standard care in relation to diagnostic interventions or treatments. You may suffer serious side-effects from medication only tested on male subjects.
Today more than half the medical school students enrolled in the USA are female, and the hope is that they will speak up for gender bias in medicine, for both female and male patients, as well as race bias. Awareness of the potential problems is a huge step in the right direction that will bring laws and regulations that will enforce the use of clinical protocols, unbiased research and medical education, to minimize the effect of this androcentric bias in medicine and ensure equitable care.
Eileen Kroll, a registered nurse and personal injury trial attorney, at Cochran, Kroll & Associates, P.C. is ready to fight for your rights! Eileen or another member of our legal team can be contacted at 1-866-MICH-LAW (1-866-642-4529) to provide a no obligation evaluation on whether gender bias played a role in the mismanagement of your medical care. Our law firm never charges a fee unless we win your case.