Stress: Indication Men are Dying, Women are Lying (or Overreacting)

Any woman with a chronic health condition has experienced a condescending doctor telling her she's malingering or overreacting. Or, well, 90% of us have.* After you've seen a good number of doctors you get the sense that they think women:

(1) just love going to the doctor. What a fun time! And look at all the attention we get! Isn't it great? Doctors definitely shouldn't take our complaints seriously because we obviously go to them for their sunny disposition when they tell us (or heavily imply) that we're crazy.

(2) can't tell the difference between depression and fatigue. Can't get out of bed because of your lupus flare up? NOPE. You don't *want* to get out of bed. Because of your depression. That has no other symptoms. And even though you've actually been diagnosed with lupus whereas no psychologist has ever diagnosed you with depression.

and most importantly (3) are hysterical creatures whose stress can cause any manner of symptoms. I listened to a recent episode of the podcast Reply All (I'm a huge Gimlet Media fan, but that is irrelevant to this post). The woman in this episode, referred to as only "Hope" saw eight doctors. The tagline for the show reads "none of whom could diagnose her." But that isn't exactly true. They all diagnosed her: with anxiety leading to somatoform disorder. That is, they diagnosed her as so crazy/depressed/stressed out that her body was producing the following symptoms with absolutely no physical cause: hand twitching, facial numbness, dizziness, the worst headaches of her life, and a "zigzag freaky thing" in only one quarter of her field of vision. Now, that all sounds neurological to me, but doctors didn't even want to give her an MRI to rule out a brain tumor. Her husband had died three years earlier and once they heard that, they immediately diagnosed her with stress or depression with no further investigation necessary. If a woman has any stressor, it must be causing her symptoms, right?   

That's what doctors seem to think, and now there are studies showing why. When a man presents with troubling symptoms and his doctor asks what's going on in his life, if the man is going through a stressful time, the doctor is *more* likely to believe he is truly sick (and that the stress is exacerbating his illness). Whereas if a doctor learns that a woman is going through a stressful time (or even went through one three years ago, as in Hope's case), that makes the doctor convinced there's no physiological problem and the woman is just stressed out.

In a series of studies by Gabrielle Chiaramonte, doctors were asked to evaluate two hypothetical patients: a man and woman who presented with identical "textbook" symptoms of heart attack and risk factors for heart disease. Half of the vignettes included a note that the patient had recently been through a stressful life event and half of them didn't. In the patients without the note about stress, doctors were equally good at diagnosing both the man and woman as having a heart attack. (Showing that if you tell them a person has chest pain, shortness of breath, irregular heart rhythm and a high risk for a heart disease, most doctors are capable of labeling a person as having a heart attack.)

But this is where things get interesting. Once stress was added as a factor, an enormous gender gap appeared. Now only 15% of doctors diagnosed the women as having heart disease compared to 56% for the men. Why did this happen? For men, doctors saw the addition of stress as a confirmatory piece of evidence of their initial suspicion of heart attack. Stress can bring on heart attacks, so if the man is stressed out, then that's further evidence that he's having one. However, for female patients, the addition of stress as a factor caused a "shift of meaning" in the doctor's mind, as the researchers put it. That is, once a doctor sees that a woman is stressed, he or she immediately thinks, "oh, the patient must be having a panic attack" and no longer attributes her obvious symptoms of heart attack to organic causes. 

This wouldn't be a big deal if doctors would do tests to confirm or disconfirm their suspicions, but unfortunately they don't. This study also asked doctors what course of action they would take with their hypothetical patients. In the presence of stress, only 30 percent of women would be referred to a cardiologist compared to 62 percent of men. Also, only 13 percent of doctors suggested cardiac medication for women compared to 47 for men. [I have to acknowledge the elephant in the room that 40% of doctors wouldn't even send the men to a cardiologist with these textbook symptoms of cardiac distress, but that's a point for another blog.]

The take-home from this study is clear: doctors love to dismiss women's health complaints as psychogenic if given even half the chance. What does that mean for you when you go to the doctor? DO NOT discuss your life stresses. There are other studies that show women are more likely to discuss their stress unprovoked in a clinical setting. Just don't. It'll make the doctor far less likely to take you seriously. Also, I and many friends have found that is helpful to bring a man with you to your doctors' appointments. If you have a man in the room (your husband, your father, whomever) to confirm that you're actually not crazy and that they believe you're having a real medical event, the doctor is far more likely to take you seriously. This is true whether your doctor is a man or a woman. This should *ABSOLUTELY NOT* be something a woman needs to do to get competent medical care, but when it comes to your health, you have to do whatever works to get the treatment you need.

Also, it's generally best to describe your symptoms in as unemotional a manner as possible. This is difficult, I know. When you've been in excruciating pain for months or you've been so fatigued you haven't gotten out of the house for a week, it is, in fact, the appropriate emotional response to be distressed. However, the second a doctor sees you cry, he or she will immediately discount your symptoms.

I hate writing this because it's really doctors who need to change. Doctors who need more education. So the final thing you can do is to keep up the good fight putting pressure on the AMA and other medical organizations to stop this sort of gender discrimination because it is not consequence-free. Thousands of women die every year because of doctors discounting their real and serious physical symptoms. Lives that would never be lost if doctors saw that women can have very real medical conditions, even if they are stressed out.


*The statistic is actually that 90% of women with chronic pain conditions feel that the healthcare system discriminates against them. I would assume that this would be the same among women with any chronic health condition, but I've never seen a statistic on that.