Medical Misogyny: the history
Note: This article uses the term “women” throughout, but the issues of distrust discussed affect anyone who is perceived to be and treated as a woman in medical settings, regardless of sex or gender identity. This article focuses on the sociomedical perception of the category “women.”
Women are less likely than men to be taken at their word in medical settings. Some people call this the “trust gap.” Some call it “medical gaslighting” or “medical sexism.” No matter what terminology you use, the point is that medical professionals are less likely to believe that women, as compared to men, accurately and reliably report their own symptoms. Clinicians are more likely to underestimate and undertreat women’s pain, especially if the patient is a woman of color. Women are more likely to be misdiagnosed and more likely to be told that their symptoms are psychological in origin, particularly racial minority and low-income women. Women experience longer delays in testing, less intense screening and treatment, longer delays in treatment, and higher mortality rates for various kinds of diseases, including cancers, heart disease, COPD, and autoimmune disorders.
Unsurprisingly, a quick Google search will turn up thousands of stories of women’s unfortunate encounters with healthcare professionals: decade-long searches for an accurate diagnosis, being brushed aside or belittled, and being told their symptoms are “all in your head.” Even less surprising: Women don’t trust doctors who don’t believe them. Women who have had these kinds of negative experiences are less likely to trust doctors as a whole, which makes efficient and accurate testing and diagnosis more difficult.
How did we get here? Discounting and disbelieving women, specifically in the medical setting, is a firmly established norm. In the fifth century, the word “hysteria” was used to refer to illnesses caused by the womb (basically, any illness contracted by a woman). In the eighteenth century, “hysteria” became more commonly associated with illnesses believed to be psychological in origin. The idea that symptoms unconnected to the reproductive system must be psychological was still going strong in the twentieth century (thanks, Freud), and it continues to plague the medical profession today. For instance, emergency room physicians are still trained to “be on the look-out for hysterical females.” The only difference is that, instead of “hysteria,” we now call it “somatoform disorder,” “conversion disorder,” “psychogenic illness,” or “medically unexplained symptoms.”
The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes these kinds of illnesses as being more common among women than men. There is no objective test for these diagnoses, and they are based on speculation about cause rather than on symptoms themselves. A patient with one of these diagnoses who continues to seek help for physical symptoms is more likely to be labeled by subsequent medical professionals as a chronic complainer. For these patients, getting an accurate diagnosis, not to mention appropriate treatment, is an uphill battle.
And what happens outside the doctor’s office? If an illness leads to disability, patients without an accurate diagnosis may not be able to access legal protections under the Americans with Disabilities Act and Social Security Disability Insurance, which affects their ability to work and their financial stability. If a patient feels their doctor did not give them the appropriate standard of care, they may be able to sue for medical malpractice, but only if they can afford such a lawsuit or convince an attorney that their case has sufficient economic value, which is particularly problematic for older women. If a patient manages to sue, there are plenty of reasons they may not win their case. After all, women who were misdiagnosed with conversion disorder after multiple strokes, who died because their severe pain was underestimated, or who were told to “stop worrying and go home and relax” instead of being diagnosed with breast cancer have failed to win their cases. Patients might have better luck on appeal, but that takes time, resources, and a willingness to slog through years of legal process that most people don’t have. Even when female patients do win their cases, they are awarded less money on average than their male counterparts for the same severity of injury, especially if they are over the age of sixty.
The upshot is that too many women are having too difficult a time getting effective medical treatment, and this has been the case for far too long. So, why should we care? Aside from basic empathy, there are plenty of good reasons to be concerned.
There is an economic cost to all of us when women are systematically misdiagnosed. Leaving conditions undiagnosed and untreated can cause permanent physical damage, lead to long-term disability, and impact the cost of a patient’s treatment if and when they are finally diagnosed. The financial costs to the patient and their family can be disastrous. Moreover, rising rates of chronic illness put additional strain on an already overburdened healthcare system, which drives up costs for all of us. Chronic disability also diminishes the productivity of the workforce.
Distrusting women also seriously hindered our ability to fight a pandemic. At the height of the COVID-19 pandemic, women were refused tests, told they were not “sick enough” to be tested, and dismissed as being simply anxious. Women who contracted COVID-19 were often misdiagnosed, refused hospital admission, and refused specialist referrals. Women who developed long-term symptoms were similarly refused treatment and dismissed as being anxious or neurotic. An inability to prevent the spread of and treat infectious disease puts all of us at risk. Ultimately, distrusting women is dangerous and expensive for everyone.
What can we do? If you don’t trust your doctor, and your insurance or financial status allows you to do so, find another doctor. Your care won’t be productive if you don’t trust your doctor enough to follow their advice. You can use social media groups, online directories and reviews, and your own social network to find a doctor that is a good fit for you. What that means: Ask your friends and family if they have a doctor they like and feel comfortable with. Use your insurer’s website or public review websites like Zocdoc to see how other patients feel about doctors in your area. Use services like iCareBetter to find vetted specialists, if necessary. If you have been diagnosed with or strongly suspect you have a particular illness, you can use social media groups to find support or recommendations for specialists in your area. You can also search for additional information from reputable sources, such as peer-reviewed medical journals or trusted organizations like the International Society for the Study of Women’s Sexual Health. Don’t surf Google and WebMD at midnight until you’re thoroughly panicked, and don’t take substantive medical advice from social media. Using resources should help connect you to a professional that is right for you, not replace a professional altogether—and beware of incomplete information or information from disreputable sources.
But we shouldn’t stop there. We can do better than taking steps to protect our health as individuals. We can strive to change the cultural narrative. We can collectively decide that women’s pain is not “normal.” Too many women fail to seek or delay seeking medical attention when their bodies give them a warning sign because they believe their pain is normal. They fear being branded as complainers or hypochondriacs or being told they are high-maintenance or have a low pain tolerance. If you are concerned, or if your physical symptoms are impacting your quality of life, it is appropriate to seek medical treatment. We should stop thinking of seeking medical help, particularly for pain, as “complaining” or “exaggerating.” We can stop telling women—our friends, coworkers, classmates, relatives—that their pain is not serious, that “it’s just bad cramps,” or that “it’s probably nothing.” Above all, we can encourage each other to trust ourselves.
Sources: (All sources not hyperlinked in the article are included in alphabetical order below).
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Markus Bönte et al., Women and Men with Coronary Heart Disease in Three Countries: Are They Treated Differently?, 18 Women’s Health Issues 191, 195 (2008).
Brain Tumor Charity, Finding Myself in Your Hands: The Reality of Brain Tumor Treatment and Care 6 (2016).
Kenneth R. Chapman, Donald P. Tashkin, & David J. Pye, Gender Bias in the Diagnosis of COPD, 119 Chest J. 1691 (2001).
Ester H. Chen et al., Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain, 15 Academic Emergency Med. 414, 414, 416 (2008).
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Statutes & Cases
- 42 U.S.C. § 12111 (2018)
- 42 U.S.C. § 423 (2018)
- Pleasants v. Alliance Corp., 209 W.Va. 39, 41, 47-48 (2000)
- Wilburn v. Cleveland Psychiatric Institute, 743 N.E.2d 515-16, 519 (Ohio Ct. App. 2000)
- Evers v. Dollinger, 95 N.J. 399, 402 (1984)