33 The Unspoken Gender Bias in the Medical Industry

Keywords: gender, bias, healthcare, inequality

Although men and women have similar anatomy and often experience many of the same health conditions and illnesses, women are often overlooked and frequently treated differently in regard to involvement and care in the medical community. In a world where gender equality is a driving force, it can come as a shock to discover that there are countless women who are still disadvantaged due to their biological sex. The medical industry provides almost all of us with the care necessary to achieve and maintain a physically healthy body that is free from pain, illness and ailments. Diagnosis is a powerful tool that creates space for illnesses to be properly treated, and can help predict the outcome of the patient; therefore, an unarguably needed resource for all. Although readily available for the most recognized and commonly represented members of the population– namely heterosexual caucasian men– there are some distinct few who receive a lesser quality of care than the aforementioned, among them women. Women everywhere are made to jump through hoops imposed by a patriarchal medical system in order to attain the most basic of medical care – incorrect diagnoses, poor treatment, and a lack of autonomy over their own health and bodies to name a few. All these experiences shed light on the gender bias in the medical field and allow insight for everyone to experience such inequalities on a first hand basis.

The history of medical practices and views towards women are important to consider when approaching the topic of a gendered medical bias. Even in recent Western history; some instances dating to less than a century ago, many women suffering from what are now common illnesses were dismissed, and were instead diagnosed with what doctors called hysteria. Hysteria, derived from the Greek word for uterus, was a common diagnosis for a variety of ailments proposedly caused by “an unfulfilled, unemployed uterus moving out of place, [and] wreaking havoc on the organs it reached”(Cleghorn 2021:abstract). Instead of taking the conditions of women and looking at them with a sense of validity, the doctors of the time, all of them men, regarded the women as inherently deficient. Although hysteria is no longer a valid medical diagnosis, there are still assumptions placed upon women that stem from these sexist roots.

Women, not unlike many groups, suffer at the hand of assumptions and stereotypes every day, and the medical field is just the same. The female body is assumed to be different from the male body, and although there is some validity to such a belief, the differences are often vastly exaggerated. These perceived assumptions create the opportunity for biases to blossom. When an alpha bias, the exaggeration in the differences between male and female bodies, becomes present, both sexes are at risk of being treated differently. Although there are biological differences between men and women, the exaggeration between the two sexes often ends with one of them being excluded. For example, heart attacks occur more frequently in men forty five years and older, and women are not usually affected until they are at least fifty five years, but there are internal changes and genetic precursors that can lessen the disparities between the two; just as a man could have a heart attack at forty years old, so could a woman. However, although in some cases the odds of having a heart attack are even between men and women, due to the alpha bias, there is a difference in diagnosis between the sexes that becomes present. If a man and a woman are both in the hospital experiencing the symptoms of a heart attack, the man is more likely to get an accurate diagnosis due to the alpha bias and the assumptions that accompany it. As well as the fact that although women are less at risk until they reach an older age, once they reach that age their risk of a heart attack surpasses that of men. Yet they are still overlooked in favour of their male counterparts in medical settings due to the alpha bias.

Furthermore, there is also the problematic beta bias. The beta bias is the opposite of the alpha bias. Where the alpha bias augmented the biological differences between men and women, the beta bias minimizes them, often to the point where they become non-existent. The beta bias becomes problematic when men and women are treated as if there are no differences in their biological needs. For example, there are illnesses that solely affect biological women, like uterine cancer, PCOS, ovarian cancer, and pregnancy. The beta bias would cause women to not receive the diagnosis for their illness or ailment due to the fact that they would be treated the same as a biological man; men are never tested for uterine cancer or PCOS, so women would not be either. These biases are often described in relation to healthcare as “Type A: exaggeration or construction of difference between female and male bodies in ways that compromise health and/or cause inequity in care; and Type B: the absence of difference between female and male bodies while making one sex (typically male) the standard for both” (Thompson and Blake 2020:23). Being conscious of these biases is crucial in the development of the medical industry as they bring further awareness to the possibility of other gendered prejudices blooming.

It is essential to recognize that the gender bias in the medical field does not only apply to diagnosis. There are many forms of gender bias present in regards to the treatment women receive as well. The medical industry is a male-oriented field, and women often suffer the consequences of the expectations and beliefs that stem from such patriarchal systems. For instance, it is said that “some women are unable to cope effectively with their illness when they do not have an adequate explanation for their physical symptoms” (Levin et al., 2003; Waldron et al., 2012 as cited in Thompson and Blake 2020:22). The term ‘medical gaslighting’, where legitimate claims of pain or unwellness are dismissed as something more minor or deliberately overlooked, is becoming a very common experience for women attempting to seek medical advice. Whether it is “an autoimmune disorder attributed to depression, or ovarian cysts chalked up to ‘normal period pain’” (Northwell Health 2022), medical issues in women are constantly being dismissed. Moreover, it has been demonstrated that women typically receive less medication for their ailments than men. In a study focused on the treatment rates for nonpregnancy-related abdominal pain, it was demonstrated that even though both the men and women presented the same pain levels, the women were treated with pain medication at a lesser rate. The study demonstrated that, “after controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia” (Chen, Schofer et al. 2008:416), wherein opioid analgesia was the chosen pain medication in the study. A discrepancy of such a high degree is a clear demonstration of the gender bias at work. Although often done with intention, it is important to acknowledge that much of the poorer treatment given towards women can be done on a subconscious level. To exemplify the concept, nurses see, treat, and admit dozens of patients on any given day. If a woman goes to the emergency room or a walk-in clinic complaining of chest pains, but is also presenting with signs of extreme anxiety, the nurse may make the subconscious assumption that their health issues are of a mental nature rather than physical. It is the fact that gender biases are so ingrained into the medical industry as a whole that renders it such a difficult topic to identify and an even harder one to address.

Another concern that is both ingrained in the industry and difficult to address is the blatant control the medical field has over people, especially women. Depending on where someone lives, there are instances where they may only have access to a single medical establishment for care; or in some cases, no access to medical care at all. If there are situations that make them feel ignored or if they have their ailments dismissed, there are often no other places for them to seek out proper treatment. Thus, if a woman goes to see a doctor with concerns regarding her health and gets dismissed, as has been shown to be a common issue, there may be no other options for her to access the support she needs. Another major factor in regards to the control women are subjected to in terms of medical care is the focus on who holds the control. In terms of where medications and treatments come from, it is the politicians, courts and health insurance companies that really regulate who can or, more importantly, who cannot access the services provided by the medical industry. Societal status has a huge influence over the access women have to medical care. There was a university study performed in the United States that looked into the access women had to birth control. It was noted in the study that “since doctors who serve communities insured by Medicaid are more likely to require exams for contraception prescriptions, we know that poorer patients face greater obstacles in gaining access to birth control than wealthier ones. Since poorer patients are also the least likely to be able to handle such obstacles, we can assume that at least some poor patients who want birth control and have access to doctors through insurance are not receiving it” (Delston 2017:705). This is devastating when you take into consideration that in America, 21.55% of women under the age of 24 are living below the poverty line; especially when contrasted against the percentage of men the same age living below the poverty line, which totals to only 16.49% (Statista Research Department 2022). Although Canadian statistics are lesser then the statistics of their American neighbours, the information still helps to provide a scope into the North American treatment of women. This enhances the struggle many women face when trying to attain access to even the most basic of medical care.

When exploring the topic of gender bias and lesser treatment of women in the medical industry, it is important to acknowledge the lack of autonomy women experience. As previously mentioned, women struggle to access even the most basic means of expressing medical autonomy, such as accessing contraceptives. This blatant lack of autonomy has been proven to be indirect causes of sickness, trauma, and even death in women. It is important to acknowledge the outside contributing factors to what encompasses a woman’s autonomy. There have been studies that show that it is not always the outside circumstances a women experiences that remove her autonomy; often times, the woman is supported in such decision making, it is simply the resources available to her or her own personal life situation that take away her autonomy. For example, it was found that “in addition to autonomy in decision-making power, attitude and experience of gender-based violence was used as an indicator of female autonomy” (Banda et al. 2015: 407). Although the gender bias is often the key feature leading to a lack of autonomy, and has been shown to carry a large influence over the issue, it is important to recognize that there are other factors at play that hold power over the access to medical care a woman can achieve. According to a report done by the United Nations Human Rights Commission, “maternal mortality and morbidity is a consequence of gender inequality, discrimination, health inequity and a failure to guarantee women’s human rights” (UNHRC 2011 as cited by Banda et al. 2015: 405). This statement shows that the flawed medical system is not only making the access to healthcare more difficult, but is actually leading to the death of women.

Much of the lack of autonomy women face is in regards to their own sexual and reproductive rights. The term ‘reproductive rights’ is used in regards to both men and women, however, is more widely associated with women as individuals. Women are quite often marginalized but none more so than indigenious women living in industrialized countries. For example, indigenious women are extremely underrepresented in data collection which creates a gap in statistical data leading to disparities between populations. This disparity prevents any possibility of any kind of effective action being taken to offer more care to such women. Of the 90 national and sub-national surveys conducted under the last two rounds of the Multiple Indicator Cluster Surveys (MICS) and Demographic Health Surveys (DHS), only 43 included a question on ethnicity and only 27 of the published reports included an analysis based on ethnicity (United Nations 2018). This aids to demonstrate how that although the statistics are representing troubling information, there is always the consideration for those who are not aswell represented. Ethnicity happens to be an impactful factor to the quality and care of the medical services thet are offered.

In conclusion, women across the globe are subjected to poorer medical care simply due to their gender.. Whether done intentionally or not, due to the medical industry’s historically sexist roots, modern day women are still held to a standard that bears detriment on the quality of care they receive. Although we as a society are becoming more consciously aware of the gender bias in the medical industry, there has not yet been a great deal of progress made to eliminate this inequality. Fortunately, as more women enter the medical field themselves, the discrepancies within the industry should ideally begin to diminish as the next generation of doctors view patients with a greater sense of empathy, responsibility, and knowledge of the inherent gender bias.

References:

Chen, Esther H. et al. 2008. “Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain.” Academic Emergency Medicine 15(5):414–18.

Delston, J. B. 2017. “When Doctors Deny Drugs: Sexism and Contraception Access in the Medical Field.” Bioethics 31(9):703–10.

Health, Northwell. 2022. “Gaslighting in Women’s Health: No It’s Not Just in Your Head.” Katz Institute for Women’s Health. Retrieved November 30, 2022

(https://www.northwell.edu/katz-institute-for-womens-health/articles/gaslighting-in-womens-healt h).

Hoda, Raza S. and Syed A. Hoda. 2021. “Unwell Women: Misdiagnosis and Myth in a Man-Made World.” American Journal of Clinical Pathology 157(5):799–99.

Nations, United, 2018. “United Nations for Indigenous Peoples | Indigenous Peoples.” United Nations,https://www.un.org/development/desa/indigenouspeoples/.

Princewill, Chitu Womehoma, Ayodele Samuel Jegede, Tenzin Wangmo, Anita Riecher-Rössler, and Bernice Simone Elger. 2017. “Autonomy and Reproductive Rights of Married Ikwerre Women in Rivers State, Nigeria.” Journal of Bioethical Inquiry 14(2):205–15.

Published by Statista Research Department and Oct 11. 2022. “Poverty Rate by Age and Gender U.S. 2021.” Statista. Retrieved November 30, 2022 (https://www.statista.com/statistics/233154/us-poverty-rate-by-gender/).

Thompson, Jessica and Denise Blake. 2020. “Women’s Experiences of Medical Miss-Diagnosis: How Does Gender Matter in Healthcare Settings?” Women’s Studies Journal 34(1/2):22–36.