Bias in Pain

Most people don’t like to go to the doctor. And for good reason--no one likes to be poked, prodded and pestered about their day-to-day lives, not to mention having to pay the exorbitant medical fees distinctive to our country. For example, in the instance of pregnancy, a typical childbirth in the US costs about $10,808, while the cost in Canada is about $3,195. However, financial burden is not the only problem some patients face. For women, going to the doctor is not simply an inconvenience or financial cost; it can be a reminder that what they feel is not valid.

There is a clear and inherent gender bias in medicine and medical treatment which stems from long-standing, socially-ingrained ideas that women are more emotional or are unable to handle pain as well as men. Furthermore, intersectional identities, like race and sexual orientation, often result in medical practitioners minimizing the experiences of their patients, whether that means not taking women’s medical concerns seriously or prescribing non-white patients less pain medication than white patients. This kind of behavior transcends even class status and wealth, as seen in the case of Olympic tennis player Serena Williams, who experienced post-pregnancy complications as a result of her history of pulmonary embolisms. Despite Williams’ medical history, her doctors failed to conduct a CT scan and administer a heparin drip, resulting in the formation of blood clots in her lungs. Williams’ experience is just one example of many inequities that black women in America face in regards to medical care--they are three to four times more likely than white women to die from pregnancy-related complications, such as hypertension and anemia. Not only does a systematic bias in medicine lead to inadequate diagnoses, but dismissing women’s medical concerns results in measurable, long-term negative effects.

In order to understand the effects of gender bias in medicine,  we can first look to the general sentiment surrounding women’s opinions and personal feelings in Western society. Historically, there have been two sides to how women’s feelings are seen and interpreted by society. On one hand, women are traditionally seen as more emotional and sensitive than their male counterparts. This kind of generalization has led to societal norms such as women having a dominant role in the home, with “women tending to do more housework than their male partners, irrespective of their age, income, or own workloads,” as well the expectation that the ultimate purpose of existence for women is to give birth and raise a family. Effects of these beliefs  can be seen in outdated arguments concerning a woman’s role in the workplace and a woman’s right to vote. More recently, the general sentiment surrounding women’s sports, and how they are viewed as somehow less legitimate than men’s sports, contribute to the idea that nontraditional female roles are not taken seriously. On the other hand, women who do not adhere to traditional gender norms are seen as being different from “real” women and disconnected from society. The societal association of emotion and sensitivity with women’s identities contributes to a narrow perception of what it means to be a woman. Moreover, women find themselves having to sacrifice any kind of femininity they possess in order to act beyond the stereotypes associated with being a woman.

As a result of societal expectations surrounding women’s emotions, women face the problem of having to live up to a certain image, particularly when it comes to receiving medical treatment. From the moment a woman walks into a doctor’s office to the moment they leave, they are more susceptible to biases from medical professionals. For example, a report published by the Women’s Health Research Institute at Northwestern University found that “women wait 3 minutes longer to receive an initial EKG than men,” and “women wait 7 minutes longer than men for a heart attack treatment protocol to be activated,” displaying a clear disparity between men and women when it comes to the treatment of heart attacks. In addition to having wait longer for treatment, women frequently face disparity when explaining their symptoms. Studies have found that doctors often write off women’s pain as psychological pain or dismiss various pains as gynaecological problems rather than performing a more thorough examination.  After experiencing longer wait-times and being told that their symptoms are not real or only in their head, women are also more likely to receive incorrect or inadequate treatment. This kind of undertreatment and misdiagnosis of women is known in the medical community as “Yentl Syndrome,” a term used to describe how “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.’” Undertreatment most commonly manifests in the form of insufficient pain medication. For example, a National Institute of Health study found that “women are 13 to 25 percent less likely to receive opioids when they are dealing with pain.” In examining the experiences of women through the healthcare system, it is clearly evident that bias and subsequent discrimination occurs in diagnosis, evaluation, and treatment.

This disparity in health care, however, is not specific to just women. As with most issues, inequality is amplified when factors such as economic status, race, sexual orientation, and gender identity are taken in to consideration. One of the most glaring instances of bias in medicine was shown in a 2016 UVA study conducted by Kelly Hoffman, a doctoral-candidate in psychology. The study surveyed white medical students and residents on various incorrect differences between white and black patients. In conducting the survey, it was found that “fully half thought at least one of the false statements presented was possible, probably, or definitely true.” Additionally, black patient’s pain was perceived as lower than white patient’s pain and subsequent treatment corresponded to the inaccurate assessments. Not only did this study further highlight the type of bias and preconceived notions that seem absurd, but it shed light on a less evident consequence of discrimination in medicine. The study found that “only half of residents knew that whites are less susceptible to heart disease than blacks.” In treating patients under false notions of difference, doctors often overlook well-researched, biological differences that require specialized treatment. In addition to race corresponding to different risks of heart disease, researchers have found that estrogen affects an individual’s perception of pain and response to painkillers. Not only are these differences essential to recognize key differences in symptoms and signs, but it is crucial that doctors consider differences when prescribing treatment programs.

Before officially practicing medicine, medical professionals take the Hippocratic Oath, swearing to uphold ethical standards,  including to “do no harm.” However, the countless experiences of women, as well as other individuals who are not straight, white, heterosexual men, have shown that bias finds a way to influence every process of healthcare, whether it is the wait time in a doctor’s office, receiving a diagnosis, or going through treatment. While bias and discriminatory sentiments can not be removed overnight, it is imperative that medical professionals are not only aware of the biases that they may have, but make decisions that truly have their patient’s well-being in mind, whether that means taking concerns more seriously or considering patients’ backgrounds when providing treatment. While doctor’s appointments can never quite be enjoyable, an individual should not have to doubt their own feelings or expect doubt from healthcare providers when seeking medical consultation and treatment.