The Pain Isn't In Your Head. And Other Truths Of The Female Experience

Gender bias in medicine is well-known and deeply ingrained: a disproportionate number of women experience pain conditions, their symptoms are more likely than men’s to be considered psychogenic and treated with antidepressants rather than pain medicine, and when women do receive appropriate treatment for symptoms, they wait longer to receive it.

We can now add a potential new angle to the gender bias conversation. According to a new report by the International Consortium of Investigative Journalism, when it comes to medical device and implant failures, women face disproportionate harm.

There are two key scenarios outlined in the ICIJ report — complications and failures in devices and implants designed for conditions that primarily affect women, including bladder prolapse or breast cancer, and higher complications and failure rates compared to men with devices like heart pumps or artificial hips. But perhaps the most compelling takeaway from the year-long investigation and interviews with patients is that when women reported symptoms and illnesses they suspected were related to their implants, their complaints were dismissed.

Unfortunately, that dismissal sounds all too familiar.

I recently had to make an unexpected visit to the hospital. As I was waiting to sign my discharge papers, the emergency room physician asked me, “Have you had a colonoscopy?” (It was the first time I’d seen him all evening.)

Confused, I told him about the invasive diagnostic test I’d just had, the results it showed and the distinctly gynecologic diagnosis I’d received on the basis of those results. Undeterred, he queried me further about gastrointestinal symptoms I didn’t have and hadn’t reported at any point. After exchanging puzzled glances with each other, my husband and I asked if perhaps he had the wrong patient.

“When you’ve been at this as long as I have, you know that sometimes symptoms that seem like they are from one area really aren’t,” he said.

On its own, his statement has some truth, of course. In this particular context, though, it was wildly dismissive of my story, my symptoms and the test results that illustrated exactly where my symptoms were coming from. And it was very much in line with research on gender bias in the emergency room and in the greater medical establishment.

“Did that really just happen?” I asked my husband. Was I really here again?

It wasn’t the first time my symptoms had been dismissed by a doctor. For years, my symptoms of airway constriction, thick secretions and respiratory distress were attributed to stress or not properly taking my medication. Eventually, after multiple lung biopsies, I was diagnosed with primary ciliary dyskinesia, a rare genetic respiratory condition.

... it was also easier for physicians to cast my very real physical symptoms as emotional, than to admit they didn’t know what was wrong or how to help me.

Part of my diagnostic delay was because rare diseases are poorly understood and difficult to spot. But it was also easier for physicians to cast my very real physical symptoms as emotional, than to admit they didn’t know what was wrong or how to help me.

Yet despite this diagnostic experience, and despite having written about the gender gap in pain extensively, I was still stunned during my recent ER experience by how automatic it was to be told that what I knew was happening inside my body wasn’t what was really happening.

One of the biggest obstacles women in pain face is that pain is subjective and self-reported.

Many times, more nebulous conditions like fibromyalgia and chronic fatigue syndrome — conditions that affect women in higher numbers than men — lack concrete, standard diagnostic tests, which further strains the credibility gap. In my recent ER experience, I had the benefit of corroborative and unambiguous test results; but it still didn’t matter.

I had the benefit of corroborative and unambiguous test results; but it still didn’t matter.

Gender bias in medicine has received much more scrutiny in 2018, especially with the publication of three different and necessary books on gender and the medical establishment. Yet true progress is mixed at best — actionable change lags behind conversations. For example, while more attention is being paid to the well-known gender bias in heart disease and heart attacks, new research in Women’s Health Issues looked at the treatment of cardiac patients outside the hospital and emergency room. The journal found that emergency responders were less likely to use recommended, evidence-based treatments — such as aspirin for women with chest pain and cardiac arrest (than they were for men), and were also less likely to use lights and sirens when transporting women with chest pain to the hospital.

Conversations about how women’s experiences are heard and responded to beyond the medical establishment are just as important. After all, 2018 was the year the #MeToo movement stretched beyond Hollywood into other fields, like science and academia and politics. Who could forget Christine Blasey Ford’s testimony?

There is a clear connection between gender bias in medicine to something even more pervasive and fundamental in our society: the ability of women to be seen as reliable narrators of their own experiences, medical or otherwise.