Benevolent Sexism: When Cherishing Women Leads to Their Death

While there is plenty of data showing that women aren't treated as well by doctors (they get less pain medication, doctors take more time before they treat them in emergency situations, they are less likely to be put on transplant lists, etc.), current studies do not tell us why this happens.

Is it, as some have suggested, because doctors value women's lives less? This is possible since many people assume men are the breadwinners, and therefore their health is more important to the family. Is it because doctors think women are more likely to be crazy* and are therefore making up their symptoms? That's certainly a factor too, but there is another possible cause that might not immediately come to mind:  benevolent sexism. 

First, what is benevolent sexism? defines it as: "a chivalrous attitude toward women that feels favorable but is actually sexist because it casts women as weak creatures in need of men's protection." What's so wrong with this, you ask. That's the sort of "sexism" that leads to men paying for dinner and opening car doors. All good things, right? 

Well, while I like having my chair pulled out for me as much as the next woman (actually more as I've gotten into debates with feminist friends about how they think my principles should not allow me to enjoy this--and yet I still do!), benevolent sexism can actually lead to women's deaths, so I might have to rethink my devotion to "quaint old-fashioned traditions."

How is it possible that chivalry is killing women? If women are seen as weak, doctors may not want to put them through medically beneficial, although painful, medical procedures. For instance, they might not recommend a woman go through chemotherapy thinking she can't handle the discomfort, while offering that treatment to a similarly situated man. And this theory seems to be born out by the data. 

In a fascinating study performed in Canada, Cory Borkhoff looked at the effect of gender on physician recommendations for knee-replacement surgery. Dr. Borkhoff and colleagues paired one man and one woman with severe knee arthritis and one man and one woman with moderate knee arthritis. These fake patients were trained to present to doctors with the same level of pain, physical limitations, and X-rays.

This is where things get interesting. For the fake patients with severe arthritis, doctors recommended knee-replacement surgery to both the male and female patient equally. Thus, when knee replacement surgery was the only feasible option, doctors recommended it for patients regardless of gender. However, when the fake patients had moderate arthritis, orthopedic surgeons were 22 times more likely to recommend surgery to the man than to the woman.

What does this tell us? Well, it could tell us that doctors think men need the use of their knees more than women do. (Which is just blatantly sexist.) It could also mean, however, that doctors steeped in benevolent sexism do not want to put women through a painful surgery unless it is absolutely necessary, and so in the face of ambiguous data, they will only prescribe surgery for men. In fact, this seems more likely because if doctors just didn't care about women's knees at all (and why shouldn't they? they're the ones who get paid for doing the surgery), you'd expect to see a difference for both high and moderate arthritis patients.

In Health Care Disparities: The Impact of Benevolent Sexism, the author notes that "women are less likely to undergo more invasive, yet life altering or saving, medical procedures. For example, practice patterns suggesting the involvement of benevolent sexism in medical treatment may be found with regard to hip and knee arthroplasty (Hawker, et al., 2000), treatment for various types of cancer (Donovan & Syngal, 1998; Maloney, et al., 2006; 23 McMahon, et al., 1999; Rosen & Schneider, 2004), among older women (Canetto, 2001; Gessert, Haller, Kane, & Degenholtz, 2006; Howerton & Travis, 2010), and in heart procedures (Anand, et al., 2005; Bertoni, et al., 2004; Kozak, DeFrances, Hall, & National Center for Health Statistics, 2006)." Thus, benevolent sexism isn't just preventing women from getting knee replacement surgery; it's preventing them from getting life saving therapies. Surely, then, benevolent sexism is leading to women's deaths.

The author of that study then tests her hypothesis directly by giving physicians a benevolent sexism inventory and asking them to provide a treatment recommendation for patients with varying symptoms. She did not find a main effect for benevolent sexism and treatment decisions, but she did find a number of interactions. Moreover, she notes that her study was limited because participating doctors may have been able to surmise what the study was about and therefore modify their treatment decisions so as not to appear sexist.

In any event, it is clear that something is going on that's causing all this disparate treatment. More studies need to be done to tease apart whether the causal factor is benevolent sexism, valuing men's lives more than women's, unconscious factors, or some combination thereof. Regardless, I'm going to think a little bit harder the next time my husband pulls out my chair for me. That same sort of impulse coming from a doctor could one day lead to my death.


*Note: I intend to write a full blog post about this in the future, but I want to make it clear here. Mental health conditions are real and should be taken seriously by doctors and society. They should not be stigmatized or seen as a good reason to give patients subpar medical treatment. So then why would I use the term "crazy"? It is because many doctors see their patients this way. They often write-off women as "crazy"or "hysterical" and then think that means they need to do no further investigation into potential organic causes of their illnesses. However, because many doctors have such a flippant attitude toward mental health, please don't believe that I subscribe to that way of thinking. I'm merely writing about it from the perspective of many in the medical community.