For some of us, going to the doctor with a pain problem is, itself, at least a level 5 pain. Why do doctors dismiss the reality of women’s pain? Don’t medical school teach new doctors that being female and reporting severe pain doesn’t automatically mean the patient is emotionally overwrought and should be disbelieved? The problem of doctors dismissing women’s pain doesn’t rest on an inadequate scale of pain reporting, the frailty of women, or, conversely, the ability of women to tolerate pain because we’re biologically built for childbirth. It’s a problem arising from research inadequacies and patriarchal assumptions.
Every woman knows that the world is constructed to suit men. The Guardian published an eye-opening article about all the items and situations that use adult males as the basis for suitable design, including our health: The deadly truth about a world built for men – from stab vests to car crashes. (My emphasis added.)
...we continue to rely on data from studies done on men as if they apply to women. Specifically, Caucasian men aged 25 to 30, who weigh 70kg. This is “Reference Man” and his superpower is being able to represent humanity as a whole. Of course, he does not.
Men and women have different immune systems and hormones, which can play a role in how chemicals are absorbed. Women tend to be smaller than men and have thinner skin, both of which can lower the level of toxins they can be safely exposed to. This lower tolerance threshold is compounded by women’s higher percentage of body fat, in which some chemicals can accumulate. Chemicals are still usually tested in isolation, and on the basis of a single exposure. But this is not how women tend to encounter them.
While it’s inconvenient not to have tools fit our hands or be able to buy hip waders that fit our feet, this doesn’t kill us. The dismissal and belittling of our medical concerns by doctors, however, can result in prolonged suffering and kill us. Women are treated differently by doctors. Actually, this altered treatment includes anyone not Reference Man (thus LGBTQ, POC, etc) but for ease of writing today, I’m using the term “women” and focusing only on pain.
It isn’t just male doctors dismissing the severity of a woman’s pain. My worst experience of having pain and symptoms viewed as frivolous was by a female doctor. My best situation when pains were taken seriously was by a male doctor. He routinely considered my pain scale levels as one or two higher than I claimed because he had observed that I under-reported my pain. I’d been seeing this doctor monthly over a 10 year period for Lyme and other tick-borne diseases, thus he had a frame of reference for understanding me.
But what happens when we see a new doctor, or go to the ER? The first article linked here relates a story from a man who took his wife Rachel to the ER because she had crippling acute pain.
Women are “more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients,’” the study concludes—a phenomenon referred to in the medical community as “Yentl Syndrome.” [...]
Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing.
One morning Rachel “doubled over, hugging herself in pain.” Her husband was worried because he knew his wife wasn’t an alarmist, so he called an ambulance. At the ER, Rachel’s obvious pain wasn’t taken seriously and when she finally received treatment hours later, it was without any medical examination to determine cause. The doctor assumed it was kidney stones, a condition known to be painful, and that Rachel was being melodramatic. The doc ordered an opioid IV and a CT scan but never looked at the scan results. He didn’t even physically exam Rachel.
The diagnosis of kidney stones—repeated by the nurses and confirmed by the attending physician’s prescribed course of treatment—was a denial of the specifically female nature of Rachel’s pain. A more careful examiner would have seen the need for gynecological evaluation; later, doctors told us that Rachel’s swollen ovary was likely palpable through the surface of her skin. But this particular ER, like many in the United States, had no attending OB-GYN. And every nurse’s shrug seemed to say, “Women cry—what can you do?”
After the doctor left the hospital at end of shift, a younger, woman doctor took his place. The husband begged her to look at Rachel’s CT scan results. That likely saved Rachel’s life.
Rachel had an ovarian cyst, a fairly common thing. But it had grown, undetected, until it was so large that it finally weighed her ovary down, twisting the fallopian tube like you’d wring out a sponge. This is called ovarian torsion, and it creates the kind of organ-failure pain few people experience and live to tell about.
“Ovarian torsion represents a true surgical emergency,” says an article in the medical journal Case Reports in Emergency Medicine. “High clinical suspicion is important. … Ramifications include ovarian loss, intra-abdominal infection, sepsis, and even death.” The best chance of salvaging a torsed ovary is surgery within eight hours of when the pain starts.
It took 14 hours for Rachel’s pain to be taken seriously enough to treat the cause.
According to a 2015 study, women waited longer than men to be diagnosed with several different types of cancers. It's not because the women delayed going to the doctor once they noticed symptoms. The delays in diagnosis occurred after a woman's initial visit to a primary care physician. [...]
In a 2008 study of nearly 1,000 people who visited an emergency room, men and women reported similar pain scores, yet women were 13 to 25 percent less likely than men to receive opioid pain medicine. In addition, women waited longer to receive their pain medication — 65 minutes versus 49 minutes on average for men. The study was published in the journal Academic Emergency Medicine.
Another study from 1990, published in the journal Sex Role, looked at the medication records of 30 male and 30 female patients who had recently undergone coronary artery bypass graft surgery. The results showed that the male patients were given pain medication more frequently than the female patients, while the women were more likely to be given sedatives, rather than actual pain medicine, for their pain.
The authors wrote that, "the hypotheses in the study were based on a review of the literature indicating that health care professionals hold stereotypic views of women as emotionally labile and more apt to exaggerate complaints of pain than men."
A 2001 study called “The Girl Who Cried Pain” tries to make sense of the fact that men are more likely than women to be given medication when they report pain to their doctors. Women are more likely to be given sedatives. The study makes visible a disturbing set of assumptions: It’s not just that women are prone to hurting—a pain that never goes away—but also that they’re prone to making it up. The report finds that despite evidence that “women are biologically more sensitive to pain than men … [their] pain reports are taken less seriously.” Less seriously meaning, more specifically, “they are more likely to have their pain reports discounted as ‘emotional’ or ‘psychogenic’ and, therefore, ‘not real.’ ”
Despite higher incidence of pain reports, and their increased susceptibility to pain, women are systematically treated less aggressively than men for their pain. Women's pain complaints are often written off as emotional responses, which explains the finding that women are prescribed psychotropics more often in pain treatment whereas men are given analgesics.
The undertreatment of pain in women may also be due to the widely held but false notion that women have higher pain tolerance than men. The fact that women do undergo normal biological processes that are painful may have given rise to this generalization. Studies have also found that women have more pain coping mechanisms, such as seeking social support, relaxation, or distraction whereas men more often deny they are in pain or deal with pain through tension reducing behaviors such as consuming alcohol. But women's ability to deal with pain better should not be translated into the idea that they experience less pain when many studies point to the opposite conclusion.
One main problem I found is that when we most need to be assertive and demand appropriate medical attention, we are in pain and thus more likely to be viewed as emotional, overly dramatic. We might actually be more emotional than usual because pain hurts and we are frightened. But this doesn’t mean what we tell the doctor is wrong.
My worst situation of dismissal was when I saw a doctor (female) for the first time after being infected with Lyme, although I didn’t know I was infected. For 8 months I had viewed my disease symptoms as situational — I needed more sleep or spent too much time at the computer, driving, hiking uneven surfaces while staring at the ground. After several months, the constant increases in pain and extensions of what hurt were unmistakably not right. And insidiously, as my cognition was sliding away I was less able to see my cognition disappear and I felt more and more emotionally distraught.
So when the new-to-me female doctor suggested that all my problems would be fixed by injecting the sciatic nerve with a shot of Botox and everything else was an excuse used by weak people to get out of doing anything, my response was to burst into tears. Luckily, I knew I’d been bit by a tick before the symptoms began and found enough presence of mind to tell the doctor she didn’t meet my standards for medical care. But I ran out of her office crying and sat in my car for an hour shaking with distress before I could drive away. I had to begin all over again and find another new-to-me doctor because I’d not been sick in so long I had no regular doctor.
My story isn’t usual nor is it the worst. Neither is Rachel’s. Some people die when doctors dismiss their pains and self-reported medical concerns. Even when we are articulate, assertive, intelligent women, doctors will demean what we tell them and write dismissive notes in our medical charts. If we don’t take the sedatives or anti-depressants they prescribe instead of considering we have an actual physical medical problem, we are labelled non-compliant patients and other doctors won’t take us as patients. Too often, by the time women’s pains are validated, their medical status has worsened so much that treatment needs have increased. Or we’ve passed the point where treatment is possible. I know women who died because doctors didn’t believe them.
How can we circumvent this biased treatment? It’s not possible for every woman to have a Caucasian man aged 25 to 30 who weighs 70kg go to the doctor’s visit with them to be authoritative and validate the urgency. And a male advocate isn’t a guarantee of better attention, as we see in Rachel’s situation.
Have you personally experienced a doctor dismissing your pain (whether you are a woman or not)?
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