Nicki James was 19 when she began suffering from exhaustion so severe she could barely function. She went up four dress sizes, her hair grew brittle and her eyebrows fell out. For two years, she made trip after trip to her GP, who insisted that her problems were mental and prescribed antidepressants.
‘I knew I wasn’t depressed,’ says Nicki. ‘I was ill, but I wasn’t being listened to.’ After two years, in despair, she saw another doctor who ordered tests that revealed she was suffering from an underactive thyroid. ‘It took a long time to stabilise my condition because it had been left to run for so long, while I was gaslighted into thinking it was all in my head.
Nicki, now 29 and a brand and business coach, believes she was a victim of the gender health gap, in which women’s ailments are routinely dismissed or diminished by the medical establishment. As a growing body of research shows, this discrimination is causing years of delays in accessing treatment, needless pain and suffering and even preventable deaths.
Earlier this month, a study funded by the British Heart Foundation revealed that women who suffer heart attacks are half as likely as men to receive the recommended medical treatment – for instance, only 15% of female patients were fitted with a stent compared to 34% of men. It follows other recent research by the BHF, which found a ‘heart attack gender gap’ caused more than 8,200 women in England and Wales to die needlessly over a 10-year period.
Now it appears this inequality is even built into the widely used GP app Babylon, which uses an algorithm to identify health issues. Shockingly, earlier this month it was found that while a 60-year-old male smoker reporting sudden chest pain and nausea is advised to go to A&E as he may be suffering a heart attack, a woman with the same profile and symptoms is told she is likely having a panic attack. (Babylon says its chatbot is not a diagnostic tool and provides answers on ‘the basis of probability’. It said women’s risk of coronary heart disease ‘is well known to be different from men’ and ‘studies show women are almost twice as likely as men to suffer from anxiety disorders’. It said the chatbot had been used 1.5m times ‘with no reports of a serious problem’ raised by a patient.
It’s not only in heart disease – which kills twice as many women as breast cancer, and more women than men – that our care falls short. In fields as diverse as brain cancer, chronic pain, endometriosis and dementia, women are o en misdiagnosed and under- treated. In Britain today, 55% of registered medical practitioners are male, as are 66% of specialists. Although there’s no suggestion that doctors of either gender deliberately minimise female patients’ concerns, there appears to be ingrained unconscious bias at play.
‘The health gender gap is fed by perceptions of women as being over- emotional and exaggerating the extent of their pain and suffering,’ says women’s health specialist Dr Larisa Corda. ‘In reality, many women under-report symptoms, because they’re busy and they don’t want to make a fuss. If they’re not taken seriously when they do see a doctor, it propagates the notion that whatever they’re going through isn’t serious, which can have massive implications.
Women’s stoicism when experiencing pain is a scientifically proven fact, and unsurprising considering our bodies are built to withstand childbirth. Yet study after study has shown that female pain is given less credence than male pain. When men and women have the same symptoms, women are more likely to be told their pain is psychosomatic – patronisingly dismissed as ‘anxious’ rather than unwell – and prescribed sedatives instead of painkillers.
In A&E, when men and women present with abdominal pain of the same severity, men wait an average of 49 minutes before being treated, while the average wait for women is 65 minutes. Doctors and nurses also prescribe less pain medication to women than men post-surgery.
‘It’s a hangover from the Victorian era, when women’s illnesses were said to be the result of “hysteria” and women were institutionalised rather than treated,’ says Monica Karpinski, founder of women’s health platform The Femedic. ‘Women are being told their very real symptoms are all in their head, which is incredibly damaging.’
Journalist and author Julia Buckley can attest to this. Her chronic pain first started during primary school, but was frequently dismissed by doctors. At 30, when the pain in her legs became too much to cope with, one medic told her it was simply ‘part of the ageing process’. Eventually, she was diagnosed with Ehlers-Danlos Syndrome, an inherited condition that affects connective tissue, but her battle to be taken seriously continued. ‘I had an accident at work that crushed a nerve in my neck, but I was told by so many doctors that it wasn’t an injury, just part of my EDS,’ she says. ‘I was told I’d be in pain for the rest of my life, that I’d never work again, and essentially patted on the head and sent home.
On one occasion, when Julia asked for physiotherapy on her arm, she was told to wait a year, because she had already had physiotherapy on her lower back. ‘I don’t think that if I’d been a man saying I needed to get back to work, my issues would have been swept under the carpet in the same way,’ says Julia, whose book about her experiences, Heal Me: In Search Of A Cure, was published last year.
‘So often, I felt patronised and belittled by the doctors I saw. I even started dropping scientific terms into our conversations to try to get them to listen to me. Sometimes, I’d be so frustrated I’d cry, which meant I was dismissed even more quickly. Spending years being told I was wrong about everything was so undermining – it really affected my confidence and trust in myself. Women are spending their lives in pain and not being given the chance to get better, which makes me really angry.’
Lack of accurate diagnosis is particularly common when it comes to gynaecological issues such as endometriosis, an often highly debilitating condition that affects one in 10 women but takes an average of seven to 10 years to be diagnosed.‘Too often, symptoms are dismissed as ordinary period pain and not investigated, and the mental health implications of that can be horrific,’ says Dr Corda. ‘Last year, over 100 women took their own lives because of endometriosis.
For black, Asian and minority ethnic women the picture is even bleaker. A 2010 study by the National Perinatal Epidemiology Unit reviewing the experiences of over 24,000 women receiving maternity care in Britain found that black African women were least likely to receive pain relief in labour. They are also more than four times more likely to die during or soon after pregnancy than Caucasian women.
The sense that the traditional medical establishment is not listening to women may be contributing to the boom in alternative and complementary therapies, which women are more likely to seek than men. Nutritionist Sana Khan says she often sees women who are desperate for help. ‘I have to write to doctors requesting that they test my female clients’ thyroid function, because they haven’t investigated their symptoms, or clients have been told they have IBS when it’s actually a parasitic infection,’ she says.
‘I understand the NHS is under a great deal of pressure and funding is an issue, but often my clients feel their voices haven’t been heard at all, so they end up spending a fortune trying to get answers elsewhere.’
As feminist campaigner Caroline Criado Perez points out in her book, Invisible Women, compounding the unconscious sexism feeding the gender health gap is the fact the medical community knows far less about the female body than the male. Until recently, female humans, animals and cells were largely excluded from clinical research, with males taken to represent humanity as a whole. She describes this approach as ‘treating women’s bodies as strange, unknowable deviations from a male norm’
The perception is that women exaggerate the extent of their pain. In reality, many under-report symptom
Women’s hormonal fluctuations, which can disrupt test results, are often cited as the reason for our exclusion. In the real world, however, women are being given these drugs – and the impact of these fluctuations on their efficacy and safety aren’t known until then. Likewise, little research has been done into the impact of women’s menstrual cycles on their susceptibility to pain, and whether different medications would work better for female bodies.
Women’s symptoms often differ from men’s, even for the same conditions, as in the case of heart disease. While both suffer chest pain, women are also likely to have ‘silent’ symptoms, such as a shortness of breath, fatigue, nausea, dizziness or pain in unlikely places, such as the jaw.
Dr Sanne Peters, a research fellow in epidemiology at Oxford University’s George Institute, is currently researching inconsistencies between male and female access to treatment for heart conditions. ‘We’ve only really started to look at these gender differences over the past decade,’ she says. ‘So there’s a problem in terms of awareness that they’re an issue, and also in terms of our knowledge of what’s causing them – whether they’re down to biological factors that put women at a higher risk, or gaps in treatment caused by bias.’
In other words, we’re only at the start of the process of gathering the data needed for the situation to change on a systemic level. Femtech, a fast-growing sector including period tracker apps, is playing a part in collecting female-centric data, which is beginning to increase the healthcare industry’s understanding of women’s illnesses.
To change the unconscious biases often at work when we visit our GP or walk into an appointment with a specialist, more effort and awareness is needed at training level. ‘Medical misogyny is more widely known about than ever before, but tackling it needs to be a priority from the start of doctors’ careers,’ says Julia. ‘It starts with listening to women, not assuming they’re hysterical.’
Dr Corda agrees. ‘Quite simply, women deserve to be taken seriously from the beginning,’ she says.
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