What is a time of joy for many women was my darkest hour.
Sexism, as I'm fond of saying, is everywhere. That includes in the practice of medicine, where women, particularly women of color, have short shrift compared to men. Medical research and studies as well as clinical training were historically based on a male “standard patient,” focusing medical practice on specifically how to treat men, who experience different illnesses and symptoms than women.
While there have been some big changes in medical policy in recent years, including shifts like requirements for more women in medical research studies, the fact is that medicine is still very hung up on that male standard patient. Which means that women miss out big time. They are, for example, more likely to experience chronic pain conditions, yet less likely to receive adequate pain management. Complaints of pain among women are often dismissed by care providers.
Women are also more likely to have conditions like fibromyalgia and chronic fatigue syndrome, both of which are often dismissed and mocked in the vernacular. The fact that these diagnoses are still widely regarded as nebulous at best and most likely spurious is telling: these are conditions that affect women, and it is not a coincidence that people dismiss them.
Even breast cancer, the disease that sometimes seems to dominate medical research, has some serious inequalities going on. Women of color tend to be diagnosed later than their white counterparts, and they also receive treatment and interventions at a much later date. Despite knowing that this is an issue thanks to numerous studies highlighting it, providers still aren't taking steps to solve the problem.
Heart disease in women, which happens to be the number one killer of women despite breast cancer's fame, is a particularly fraught issue. Many women are not aware of their risk of heart disease and myocardial infarction, because these are popularly represented as male problems; it's old men you hear about having heart attacks, not women of any age (and certainly not young women). And many doctors don't evaluate their female patients very well for heart disease, even when those patients are reporting clear symptoms.
Consequently, as Laura Beck just pointed out at Jezebel, women are dying because doctors are assessing them and claiming they're fine, sending them out of the office without any treatment, advice for followups, or additional directives. This is not a new issue; multiple studies have illustrated that women with heart disease are underdiagnosed and undertreated, and that they tend to have more acute heart problems when they do finally get the treatment they need, because they've been ignored for so long.
One physician, Doctor Melissa Walton-Shirley, puts it bluntly: “Some would suggest that about the only place in the medical arena where women are fairly represented or studied is on the gynecology exam table.”
Like men, women can experience a sense of tightness, squeezing, or agonizing pain in the chest if they're having heart problems, along with tingling along their arms, shortness of breath, cold sweat, and nausea. If you have cardiopulmonary problems (hi!) you can experience wheezing and difficulty completing even basic tasks without feeling like your chest is going to explode.
Here's where things get tricky, though. Women are more likely to experience jaw pain, nausea, and shortness of breath along with their heart problems. Some women write these symptoms off to other things (heartburn, say), and those who don't get the brushoff when they go to a doctor because their symptoms don't match what a heart attack is “supposed” to look like in our good old standard patient. Consequently, women experiencing episodes of acute angina get sent home with no further evaluation or treatment.
And they keep experiencing them. And that keeps happening, damaging more and more of the heart, until they have a major myocardial infarction. Which either kills them or necessitates costly treatment and months of recovery, all of which could have been avoided by an early medical intervention to get them evaluated and treated. A similar pattern can be seen with atrial fibrillation, a condition that can lead to stroke.
Two recent studies, in Paris and across the Channel in England, showed clear rates of underdiagnosis among women. The Parisian study was particularly interesting, and troubling, because the researchers found that doctors tended not to take patient complaints seriously, or evaluate them as closely, because they “looked healthy.”
This is a curious statement indeed. Health is a complex issue, and it's actually not something that can be determined by a casual glance. Someone who “looks healthy” (which, by general social standards, means has a small to medium build, doesn't use an assistive device to get around, seems to move freely and comfortably, breathes easily) could in fact be quite ill with an acute or chronic disease, could be having mental health problems, or could experience a disability. By contrast, someone who looks “unhealthy” (by which people usually mean “fat”) could be perfectly well, with all medical indicators (blood pressure, heart rate, bloodwork) testifying to the patient's state of wellbeing.
Doctors of all people should know better than to make surface judgments about patients because they should be aware of how disease hides below the surface and creeps, waiting, eager to take the lives of unwary people. But they succumb to the same social attitudes many people do, assuming it's possible to determine how healthy someone is at a glance, and that belief is proving fatal for patients who rely on their providers to be there for them.
Women are dying of strokes, myocardial infarction, and other serious medical conditions all because they show up to the doctor's “looking healthy” and wearing nice clothes.