Annotated Suggested Reading

*Note* The following is a list of articles on the topic of discrimination against women by the medical profession. I will be updating this page as my research progresses. If you have found additional articles on this topic, please email me at misstreatedblog@gmail.com.

  • News Articles Regarding Medicine's Gender Bias

    • Sex Bias in Surgical Research Physician's Weekly, June 2017.

      • Highlights:

        • In the past, there has been criticism surrounding the inclusion of both sexes and considering sex differences in clinical research. “We recommend that there be an FDA mandate requiring that drugs, devices, and new therapies be tested equally in men and women in clinical trials before they reach market approval,” says Dr. Kibbe. The study suggests that medications which have been recalled due to adverse effects in one sex should be tested independently in both sexes. It is possible that these drugs may be considered for rerelease with different dosing parameters for each sex.

    • Why Is New Technology Primarily Designed for Men? World Economic Forumn, March 2016. 

      • Highlights:

        • "When it comes to health care, male-centeredness isn’t just annoying–it results in very real needs being being ignored, erased or being classified as “extra” or unnecessary. To give another, more tangible example, one advanced artificial heart was designed to fit 86% of men’s chest cavities, but only 20% of women’s. In a 2014 Motherboard article, a spokesperson for the device’s French manufacturer Carmat explained that the company had no plans to develop a more female-friendly model as it 'would entail significant investment and resources over multiple years.'"

        • “Tell the agents, ‘I had a heart attack,’ and they know what heart attacks are, suggesting what to do to find immediate help. Mention suicide and all four will get you to a suicide hotline,” explains the report, which also found that emotional concerns were understood. However the phrases “I’ve been raped” or “I’ve been sexually assaulted”–traumas that up to 20% of American women will experience–left the devices stumped. Siri, Google Now, and S Voice responded with: “I don’t know what that is.” The problem was the same when researchers tested for physical abuse. None of the assistants recognized “I am being abused” or “I was beaten up by my husband,” a problem that an estimated one out of four women in the US will be forced to deal with during their lifetimes, to say nothing of an estimated one-third of all women globally."

    • Do Doctors Take Women’s Pain Less Seriously Than Men’s? Here & Now, NPR, November 2015.

    • The Healthy Woman: A Complete Guide for All Ages Pain. Womenshealth.gov, retrieved November 2015.

      • Highlights:

        • "Are you in a lot of pain every day? Have you had doctors tell you that “it’s all in your head” or “it’s just nerves”? If so, you’re not alone. Pain is often undertreated in women."

        • "Still, it can be hard for a woman to get help for her pain. Some doctors are less likely to give women painkillers because they think that women overstate the amount of pain they feel." 

        • "No matter why women have more painful disorders than men, the fact is that they do. If you’re in pain and you’re not getting the help you need from your doctor, feel free to switch doctors. If your health plan doesn’t allow you to switch doctors or you live in an area where there aren’t any other doctors, then you need to speak up for yourself to get the treat- ment you need.No woman should be told that her pain isn’t real or not severe enough for treat- ment. You deserve to live your life as pain-free as possible." 

    • Doctors Blamed Her Pain on Her Weight. Turns Out She Had Cancer. Huffington Post, October 2015. 

      • Highlights:

        • "For Mayday, not being taken seriously was nearly a matter of life and death. 'How dare you think that I'm not aware of my body enough to tell you that there's something wrong?' she asked.

          'I find it funny, people are like, "Oh, well thank God they caught it," They didn't catch it at all,' Mayday said. 'I did. If I would have listened to them, I'd be dead.'"

    • How Doctors Take Women's Pain Less SeriouslyThe Atlantic, October 2015.

      • Highlights:

        • "Women are  “more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients,’” the study concludes—a phenomenon referred to in the medical community as 'Yentl Syndrome.'"

        • "Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing."

    • 'It's Just Lady Pains': Are Doctors Not Taking Women's Agony Seriously Enough? The Telegraph, October 2015.

      • Highlights:

        • "In 1997, a woman went to the NHS because she was experiencing “severe and unrelenting” facial pain. For the next 15 years, she was repeatedly refused an MRI scan.

          It was only in 2012 that she was finally given a scan. It showed she needed surgery, and soon after the operation, her pain disappeared."

        • "Take the tragic case of 21-year-old Kirstie Wilson. She died last month after being diagnosed with cervical cancer three years ago. At the age of 17 she started having painful stomach cramps. She immediately went to her doctor but was told they were ‘growing pains or thrush’.

          Her GP dismissed her three times. But Kirstie begged to be referred to a specialist. It was only then that a smear test revealed she had cervical cancer."

        • "It’s hard to know to what extent these individual failings are tied up in sexist assumptions, or whether they’re just inevitable errors."

        • "The problem isn’t physical as much as societal. In the past, women who complained of pain were seen as ‘hysterical’ and actually diagnosed with ‘hysteria’ by Victorian physicians. In literature of that age – and even more recently – women are depicted as dainty flowers fainting over the slightest setback. All of this contributes to an environment where some male doctors may find themselves dismissing women’s pain as ‘an over-exaggeration’ or ‘sheer dramatics’."

        • "There will always be hypochondriacs but if a woman hasn’t seen her GP for years, and then comes in one day complaining of excruciating pains, it’s unlikely she’s ‘making it up’. For a doctor to not take her seriously could, in the best case scenario, leave that patient feeling like her voice isn’t being heard. But in a worst case situation, that patient could go on to suffer serious problems or tragically end up losing her life."

    • Why Do Doctors Take Women's Pain Less Seriously? Mother Nature Network October 2015. 

      • Highlights:

        • "At only 25, Ally Niemiec of Atlanta has been diagnosed with two kidney diseases and endometriosis. She has had a remarkable 28 surgeries in the last five years and deals with chronic pain that leaves her unable to work, drive and keep many relationships.

          Despite her rock-solid diagnoses and obvious distress, she has been ignored in emergency rooms and refused pain medication when she was in agony. Niemiec said she has often been made to feel as if she were a drug addict or that she was exaggerating her pain.

          Interestingly, she is in several support groups with men who have the exact same symptoms and have made similar trips to the ER — yet they are treated much differently. 'The men don't have any experiences like us women,' Niemiec says. 'We are sent home. The men in our support group are constantly in the hospital having their pain addressed.'"

    • Unconscious Bias: Why Women Don't Get the Same Care Men Do Heart Sisters, August 2015. 

      • Highlights:

        • "In a landmark study reported in the New England Journal of Medicine researchers found that women under the age of 55 who are experiencing a heart attack are seven times more likely to be misdiagnosed and sent home from the E.R. compared to their male counterparts presenting with identical symptoms.  The consequences of this are enormous: being sent away from the hospital doubles the chances of dying."

        • "Doctors may actually be reluctant to consider heart disease when a woman has cardiac symptoms, so instead will look for other causes. A 2005 American Heart Association study showed, in fact, that only 8% of family physicians and – even worse! – just 17% of cardiologists were aware that heart disease kills more women than men each year (a statistic that’s been true since 1984)."

    • How Sexism Affects Women’s Health Every DayRole Reboot by Soraya Chemaly, June 2015.

      • Highlights:

        • "[G]ender bias and stereotypes infuse the way doctors treat women’s pain. A 2014 survey of more than 2,000 women, conducted by the National Pain Report and For Grace, a non-profit devoted to finding solutions for women in pain, found that three quarters of the women surveyed were told at least once by a doctor that nothing could be done for them and that they would just have to live with chronic physical hurt. 57% report being told by a doctor, “I don’t know what’s wrong with you.” 51% report having doctor’s say, “You look good, so you must be feeling better.” 45% reported that they were told, “The pain is all in your head.” My personal favorites? “You are too pretty to have so many problems,” and “You can’t be too sick because you have makeup on and you are not in your sweatpants.”

        • "Sometimes, the effects of sexism and implicit gender bias are difficult to show. However, in the case of women’s health care, there’s very little ambiguity. Women should be aware of what these problems look like, so that they can identify doctors who similarly understand them and can fairly diagnose and treat them. Last year, I had occasion to visit my doctor, who prescribed some medicine. When I asked him if any of the clinical trials for the medicine had included women, he admitted that he didn’t know, but assured me that it was the best solution available. So I looked it up. The trials showed that the medication worked for men, but actually had several high risks and contraindications for women. So I found a new doctor, one who didn’t dismiss my concerns with a paternalistic and sexist arrogance."

    • When Gender Stereotypes Become A Serious Hazard To Women’s HealthThink Progress May 2015.

      • Highlights:

        • "When Kathy tried to seek medical attention for abnormally heavy periods that were leaving her feeling so faint that she was unable to stand, four different medical professionals said it was all in her head. They concluded she was simply struggling with anxiety and perhaps even had a serious mental health disorder. She says her primary care doctor repeatedly told her, 'All your symptoms are your imagination.' It took nine months for Kathy to be diagnosed with potentially life-threatening uterine fibroids that required surgical intervention. And that was only after she took it upon herself to demand an ultrasound. She was suffering from anemia, not anxiety."

        • "This means that, just as Kathy experienced, many female patients are told that it’s just in their head. According to a National Pain Report survey conducted last year, a staggering 90 percent of women with chronic pain feel that the health care system discriminates against them. “There seems to be an ‘Oh she’s so neurotic’ attitude towards female chronic pain patients,” one survey respondent said."

        • "“Hysteria” was officially removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, and psychiatrists now consider it to be a pejorative term. However, in this context, it’s not hard to see how gendered stereotypes about women’s emotions may continue to color their experiences as they try to explain how they’re feeling. In fact, some doctors believe that “psychosomatic symptoms” has become the modern-day equivalent of “hysteria” — a catch-all term for physical symptoms that can’t be explained, and are therefore written off as neurological."

        • “I think it’s the same deeply rooted sexism that we see in other realms, like when it comes to not believing rape survivors. We don’t trust women to be the experts on their own bodies, or to be reliable narrators of their own lives,” Maya Dusenbery, the editorial executive director atFeministing and the author of a recent piece about gender bias in health care, told ThinkProgress. “But when that comes into the medical system, it’s really dangerous.”

        • “Doctors are trying to do the right thing. It’s not that they’re trying to be mean or dismissive,” Dr. Janice Werbinski, the executive director of the Sex and Gender Women’s Health Collaborative(SGWHC), told ThinkProgress. “Gender differences just are not in the training, which is what our organization is trying to work on. SGWHC advocates for bringing a sex and gender perspective to clinical practice. While the researchinto gender-specific health issues has recently been progressing, that information can be slow to make it into medical schools’ curricula, so it doesn’t always trickle down to doctors in the field. Werbrinski and her colleagues believe more work needs to be done to integrate this knowledgeinto medical education.”

        • "According to Werbinski, that could even include information explaining to doctors why it’s not helpful to tell female patients their health problems are in their head — and pointing out that, in fact, women may be presenting symptoms that aren’t yet well-recognized by the medical establishment. “It needs to be in the curriculum of caregivers so that we don’t jump to the conclusion that it’s psychosomatic, and at least validate her symptoms and tell her that we just don’t know what’s wrong,” she said."

        • "Dusenbery said that, as a young woman, she’s “never been more aware of patriarchal authority” than when she’s trying to interact with the health care sector. She’s surprised this aspect of gender relations isn’t discussed more broadly, especially since many of her female friends have similar stories about struggling to diagnose their symptoms. “It feels like one of those things where once you start talking about it, everyone has their story and that really opens the floodgates,” she said.

          “We need women to document their experiences and share them so society becomes aware,” Kathy agreed. “This has been going on for centuries…. conversion, hysteria, the name changes but it’s the same and it’s still happening today. No woman should have this experience in today’s day and age.” Just what I'm doing!

    • Is Medicine's Gender Bias Killing Young Women? Pacific Standard, March 2015.

      • Highlights:

        •  "A recent study suggests younger women who have heart attacks may hesitate to get help because they're afraid of being labeled hypochondriacs. But the bigger problem is just how justified that fear really is." 

        • "When younger women do have heart attacks, though, studies have found that they are about twice as likely to die as their male counterparts--and more than 15,000 women under the age of 55 do every year." So that suggests that 7,500 young women die needlessly every year from heart attacks because of bias in the medical system. And that's just one disease in one age group.

        • "Although more women than men have died each year from cardiovascular-related causes since 1984, fewer than one in five doctors--primary care physicians, OB/GYNs, and even cardiologists--surveyed in a 2005 study knew that. And they tended to underestimate female patients' personal risk for the disease, recommending fewer preventative measures to them compared to men."

        • "Fixing these bigger problems—lack of access to preventive care, the gender bias in medical research and education, the psychologization of women’s ailments—is hard. It’s much easier to conclude that “we” just need to “empower” women to recognize their symptoms and seek help without fear of judgment. But that’s just a way of saying that individual women need to compensate for the health care system’s biases: that they should know their risk of heart disease better than their doctors do, should be able to identify the symptoms of a heart attack more readily than their doctors can, and should demand care—and be prepared to fight for it—in spite of their doctors’ tendency to dismiss them."

        • I could pretty much cut and paste this entire article. It's great. Read the whole thing!

    • Women Don’t Seek Help For Heart Attacks Because They Worry About Seeming Too EmotionalThink Progress February 2015.

    • Younger Women Hesitate To Say They're Having A Heart AttackNPR News, February 2015. 

      • Highlights:

        • "[E]ven when women suspected that they were having a heart attack, many said they were hesitant to bring it up because they didn't want to look like hypochondriacs.

          "We need to do a better job of empowering women to share their concerns and symptoms," Lichtman says.

          And medical professionals may need to do a better job of listening, she adds. Several women reported that their doctors initially misdiagnosed the pain, assuming that the women were suffering from acid reflux or gas."

        • "This study also highlights the importance of empowering women to speak up about their worries, says. Dr. Jennifer Tremmel, a cardiologist at Stanford University.

          "It's interesting because the whole idea of female hysteria dates back to ancient times," Tremmel says. "This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they're afraid there's something wrong." -But when they're still treated like hysterics by doctors, of course they're not "empowered". This isn't an issue of women not being assertive enough. This is an issue of doctors not listening!

    • Chronic Pain Is Overwhelmingly Experienced by Women—So Why Do They Have Trouble Getting Care for It? RH Reality Check, February 2015.

      • Highlights:

        • "Physicians frequently dismiss women who report chronic pain or write them off as experiencing emotional hysteria, unlike their male counterparts. In turn, public perceptions of these women reflect this this derision. Until the sexism inherent in the social and medical response to chronic pain is addressed, women won’t be able to access the treatments they need."

        • "Study after study has shown that doctors are more likely to request tests for men with chronic pain and treat their symptoms as a physical and neurological condition; physicians treat similar symptoms in women as a psychological or psychosocial issue, asking patients about factors like stress and their situations at home. Medical providers refer women to therapists rather than pain clinics, or tell them they’re exaggerating their experiences and refuse entirely to offer support and treatment."

        • "With that in mind, women’s medical advocates and rights groups need to start calling for an end to the very real pain women are experiencing across the nation. That should also include demands for better education for physicians about medical discrimination, unconscious bias, and the provision of complete care for women with chronic pain."

    • Is Thyroid Diagnosis and Treatment Sexist? About Health May 2014.

      • Highlights:

        • "After two decades as a thyroid patient advocate, it's become evident to me that sexism is unfortunately far too common in the thyroid world."

        • "Patients have shared stories about how their doctors routinely diagnosed "stress" or "depression" or "hormone issues" -- without running any blood tests, and despite clinical signs and symptoms of thyroid issues. Women patients are regularly describe being handed an antidepressant prescription long before their doctor decides to conduct a comprehensive thyroid panel, if ever. Women patients are told that being tired and depressed is normal, and to be expected, because after all, you're a 'wife' or 'mother.'"

        • "If we go to a doctor and complain in an emotional way about our symptoms, doctors may "hear" that we have an emotional problem, rather than a physical one. This is why I recommend that women patients quantify symptoms (I've gained x pounds a week, eating y calories per day) and discuss thyroid symptoms in a rational, clinical, and unemotional, way."

    • Younger Men Receive Faster Care for Heart Attacks, Angina Compared with Women of Same Age, Science Codex, March 2014.

      • Highlights:

        • "The researchers found, interestingly, that both men and women with feminine character traits were less likely to receive timely care than patients with masculine traits."

    • Doctors Shame Women More than Men About Their Bodies and BehaviorQuartz, January 2014. 

      • Highlights:

        • "In the first cohort, which was made up of university students, 26% of women reported being “shamed” by a physician, while only 15% of the men surveyed said the same. The most common topics of this shaming were sex, dental hygiene, and weight. The second study, which included a much broader age and demographic range, showed similar results: While only 38% of men reported feeling guilt or shame because of something their physician said, 53% of women could recall such behavior."

        • "Upon seeing that women reacted more negatively to these criticisms, the study authors thought they might be taking the incidents more personally. In fact, women were no more likely to focus on being “bad” (as opposed to having a bad habit) than men were." Maybe doctors are just meaner to women.

    • Why Millions of Women Are Living in the Discomfort ZoneWall Street Journal, January 2014.

      • Highlights:

        • "But many other studies point to undertreatment of women's chronic pain—a pattern that fits an overall picture of differential care for men and women. With heart attacks, for instance, a team of Canadian researchers reviewed the charts of 142 men and 81 women with comparable symptoms and reported in 2002 that men were more likely to be given lipid-lowering drugs, to get angiograms (to detect potentially clogged blood vessels) and to have coronary-artery bypass surgery."

        • "Other data suggest that women are also less likely than men to be admitted to intensive care units and to get certain procedures, such as being put on a respirator, once they arrive there; they are also more likely to die in the ICU, in the hospital or within a year of admission."

        • "The odds of a surgeon recommending knee replacement were 22 times higher for the male patient than the female, the Canadian team found."

        • "In Sweden, researchers used a modified version of a national exam for young doctors in which hypothetical patients with neck pain were described. Some of the hypothetical patients were male and some female; all were described as bus drivers who were living in tense family situations. The interns taking the exam were more likely to ask female patients psychosocial questions (implying a psychosomatic origin of the pain) and more likely to request lab tests in the males. Female interns were just as biased as males.

    • Is There Still Sexism in Medicine? KevinMD.com post by Suzanne Koven, MD, May 2013.

      • Highlights:

        • "There’s also still sexism against female patients. We may have moved beyond the days of the most egregious paternalism, but women are still more likely than men to have their symptoms attributed to psychological factors, and especially more likely to have symptoms of heart disease misdiagnosed as “stress.” Funding for research in women’s health still lags, and health care access, especially for poor women, remains suboptimal."

    • The Gender Gap in PainThe New York Times, March 2013.

      • Highlights:

        • "I am a sufferer of pain and chronic disease. Like many, I’ve had physical symptoms (in my case, respiratory problems and infections) explained away as emotional. My freshman year in college, I was in the emergency room, flanked by machines and struggling to breathe while doctors lobbed questions at me: Why wasn’t I responding to the medication the way they expected I would? Was I just too anxious? Could I not handle stress, and was that making me sick?

          I was 23 before I was given a correct diagnosis of a rare genetic lung disease called primary ciliary dyskinesia. I’d been sick since birth, but long diagnostic journeys are occupational hazards of living with conditions doctors don’t often see. Still, my journey was unnecessarily protracted by my doctors’ dismissal of my symptoms as those of a neurotic young woman."

        • "A report by the Campaign to End Chronic Pain in Women found that inadequate physician training in diagnosing and treating just six pain disorders that affect women either exclusively or predominantly, including fibromyalgia and chronic fatigue syndrome, added as much as $80 billion a year to America’s health care bills."

    • Medical Sexism and Fibromyalgia. Whole Health Chicago Blog post by Dr.David Edelberg, MD, December 2011.

      • Highlights:

        • "The total number of fibromyalgia patients worldwide is jaw-dropping and the situation is much worsened by the medical profession’s failure to adequately diagnose and sympathetically treat this virtual epidemic, displaying a medical sexism that’s hard to miss even if you’re not looking closely. The sexism I see is the result of a male-dominated healthcare system dealing with a condition that simply doesn’t follow the rules we learned in medical school. And because fibromyalgia doesn’t follow the rules, its victims–virtually all women–get second-rate treatment from physicians.

        • "The women who came to our clinic in the early days were seeking something other than what they’d been hearing from their own physicians. In fact, a steady stream of our patients came to us by way of Northwestern Memorial Hospital’s Rheumatology Department, which for years told women (and taught generations of mis-educated Chicago rheumatologists) that there was “no such thing as fibromyalgia” before referring them to psychiatrists."

        • "Seventeen years later, the situation has guardedly improved. Now we have three FDA-approved medications for fibromyalgia, documented effectiveness of alternative therapies (including supplements, herbs, chiropractic, and acupuncture), numerous articles in medical journals, fibro websites, and support groups. But still, after all these years, a majority of doctors (75%) feel uncomfortable making a diagnosis or initiating treatment."

        • "Here’s why: Typically, when you arrive in your doctor’s office with a symptom (headache, tummy ache, weight loss, anything) he or she is trained to look for disease as the basis for your symptom. To hunt for disease, tests are ordered (blood tests, x-rays, and so forth). If everything comes back negative, your doctor can say “everything’s fine, your tests are normal,” and by ruling out the possibility of a disease being present he earnestly feel he’s done a good job. The real flaw here is the doctor’s reluctance to make a firm commitment about your diagnosis without the confirmation of positive test results. Not feeling confident in making a diagnosis means he’s equally reluctant to initiate any effective treatment. With nothing “positive,” consciously or unconsciously doctors too often categorize the fibromyalgia patient as “another tired and complaining woman” and move on. Or the patient is sent to a psychiatrist or to a rheumatologist. Woe betide if you dare ask for a pain pill. In this case you’ll be categorized as “demonstrates drug-seeking behavior.”

        • "For the past two years I’ve been giving talks on fibromyalgia to medical groups and I’m not happy with what I’ve found. I still actually hear doctors say, “There’s no such thing as fibro” and “Fibromyalgia is a woman’s way of having her husband do the housework.” The pharmaceutical reps for the three FDA-approved fibro drugs have told me they were unprepared for the degree of physician resistance (from both male and female physicians) and occasional outright hostility to the diagnosis of fibromyalgia and its treatment."

    • 'Medical Sexism': Women's Heart Disease Symptoms Often DismissedABC Los Angeles, November 2011.

      • Highlights:

        • "[W]hen men have heart symptoms, 62 percent of doctors send them to a cardiologist for further testing, while less than half as many doctors refer female patients. Some call it "medical sexism" and want to know if women are being ignored by doctors.

        • "Cardiologist Dr. Adam Splaver says a symptom like shortness of breath is too often dismissed as anxiety among women. 

          "In training, we were taught to be on the lookout for hysterical females who come to the emergency room," said Splaver."

        • "Another disturbing statistic: While nearly 50 percent of doctors prescribed heart medication for men, only 13 percent prescribed it for women."

    • A Message to Women From a Man: You Are Not "Crazy." Huffington Post September 2011.

      • Highlights:

        • This article is about gaslighting women generally rather than specifically in the healthcare context, but I think it's points are particularly important for women who've been medically gaslighted.

        • "You're so sensitive. You're so emotional. You're defensive. You're overreacting. Calm down. Relax. Stop freaking out! You're crazy! I was just joking, don't you have a sense of humor? You're so dramatic. Just get over it already! Sound familiar? If you're a woman, it probably does."

        • "And this is the sort of emotional manipulation that feeds an epidemic in our country, an epidemic that defines women as crazy, irrational, overly sensitive, unhinged. This epidemic helps fuel the idea that women need only the slightest provocation to unleash their (crazy) emotions. It's patently false and unfair."

        • "Gaslighting is a term often used by mental health professionals (I am not one) to describe manipulative behavior used to confuse people into thinking their reactions are so far off base that they're crazy.

          The term comes from the 1944 MGM film, Gaslight, starring Ingrid Bergman. Bergman's husband in the film, played by Charles Boyer, wants to get his hands on her jewelry. He realizes he can accomplish this by having her certified as insane and hauled off to a mental institution. To pull of this task, he intentionally sets the gaslights in their home to flicker off and on, and every time Bergman's character reacts to it, he tells her she's just seeing things. In this setting, a gaslighter is someone who presents false information to alter the victim's perception of him or herself."

        • "The form of gaslighting I'm addressing is not always pre-mediated or intentional, which makes it worse, because it means all of us, especially women, have dealt with it at one time or another.Those who engage in gaslighting create a reaction -- whether it's anger, frustration, sadness -- in the person they are dealing with. Then, when that person reacts, the gaslighter makes them feel uncomfortable and insecure by behaving as if their feelings aren't rational or normal." Like when doctor after doctor belittles you and tells you your medical symptoms are all in your head. Which makes you so frustrated you start to cry which then only acts as confirmation that you're crazy. But wouldn't a sane person cry in the face of debilitating symptoms and doctor after doctor who all won't help?

    • Study Reveals that Signs of Heart Disease Are Attributed to Stress More Frequently in Women than MenEurekAlert! American Association for the Advancement of Science, October 2008. 

      • Highlights:

        • "Gender bias could explain delay in assessment of women with heart disease"

        • "Dr. Chiaramonte stated, 'For women, the presence of stress or anxiety drives the interpretation of accompanying symptoms so that symptoms such as chest pain or shortness of breath undergo a 'meaning shift' when presented in the context of stress or anxiety and they are perceived as a manifestation of the stress or anxiety and not as CHD symptoms. For men, cardiac symptoms drive the interpretation of accompanying symptoms so that anxiety or stress is perceived (rightly so) as a risk factor for CHD and may in fact augment the CHD assessment. The presence of anxiety or stress in men does not deter from the CHD assessment; for women, it appears to preclude a CHD assessment.'"

        • "Dr. Chiaramonte concluded, 'The consistent results observed with participants of varying clinical experience attest to the strength of the research and the pervasiveness of the effect. Our results suggest the need for the development of educational initiatives aimed at improving health care providers' understanding of gender differences in symptom presentation.'" Yes!

    • The Undertreatment of Women in PainThe Echenberg Institute for Pelvic and Sexual Pain, March 2003.

      • Highlights:

        • "Since women are two to three times more likely to suffer from migraines, and six times more likely to have fibromyalgia (a chronic illness that is marked by fatigue and generalized musculoskeletal pain and sensitivity), I spent lots of time talking to women in pain. A familiar pattern emerged — years of exasperation in the search for sympathetic, informed treatment."

        • "[One woman] had to break down in tears in his office in order to get some action. She was lucky — many doctors view tears as evidence of an “emotional issue”, rather than the by-product of living with daily, grinding pain."

        • "With women, we are too quick to assume that some level of unhappiness or frustration lurks behind a painful symptom. Sometimes it does, in fact. Pain always has a story to tell. But doctors often forget that depression and anger are often the product of chronic pain, not the precursors of it."

    • Do Doctors Treat Women Differently? Orlando Sentinel, August 1993. 

      • HIghlights:

        • "According to a survey released this summer by the Commonwealth Fund, a New York philanthropic institution that sponsors health and social policy research, women  report greater communication problems with their doctors than do men. Twenty-five percent of women, but only 12 percent of men, said their doctors talk down to them or treat them like a child."

        • "Women were twice as likely as men to be told that a medical condition  was all in their head. Two of five women changed physicians as a result of insensitive treatment."

        • "Studies show that most of us want as much information as possible from our health-care providers, but we're often too afraid to ask for it. 'Part of the reason is patient anxiety,' says M. Robin DiMatteo, professor of psychology at the University of California at Riverside. 'We're afraid we'll disturb the doctor or communicate a sense of distrust, so we keep quiet, and the physician is not forthcoming.'" This article engages in the usual victim blaming, saying that women are not being assertive enough with their doctors. If only women just needed so speak up and then doctors would listen. Maybe it's that when women have asked questions in the past, they've been rebuffed by doctors or the doctors have used their questions as further evidence that they're hypochondriacs and so it makes women afraid to speak up again in the future.

  • Research Regarding Medicine's Gender Bias

    • Sex-Related Differences in Access to Care Among Patients with Premature Acute Coronary Syndrome. Pelletier, R. et al. April 2015. 

      • Highlights:

        • "[A] 2014 study looking at over 1,000 patients, aged 18 to 55, who had heart attacks in Canada, the United States, and Switzerland suggests...that men received faster access to cardiac testing and care than women; the average time it took for men to get an electrocardiogram, for example, was 15 minutes, compared to 21 minutes for women. While some factors—including an absence of chest pain—seemed to cause delays in both genders, anxiety was associated with the failure to meet the 10-minute benchmark for ECG only in treating female patients. The researchers also gave the patients a personality test gauging how closely they adhered to traditional gender roles and found that both men and women with more stereotypically feminine traits faced more delays than patients with masculine traits." Description of these studies from Is Medicine's Gender Bias Killing Young Women? 

    • The Influence of Patient Sex, Provider Sex, and Sexist Attitudes on Pain Treatment Decisions. Hirsh, A. et al. May 2014. 

      • Abstract: "Research suggests that patient sex, provider sex, and providers' sexist attitudes interact to influence pain care; however, few empirical studies have examined these influences. We investigated sex (patient and provider) differences in pain treatment and the extent to which providers' sexist attitudes were associated with these differences. Ninety-eight health care providers (52% female) completed the Ambivalent Sexism Inventory and made treatment ratings for 16 computer-simulated patients with low back pain. Patient sex was balanced across vignettes. Results indicated that female patients received significantly higher antidepressant (F[1, 96] = 4.51, P < .05,  p= .05) and mental health referral (F[1, 96] = 3.89, P = .05,  p= .04) ratings than male patients, which is consistent with our hypotheses; however, these differences were significant only among female providers. Controlling for providers' sexism scores did not substantially alter these results, which is counter to our hypotheses. These results suggest that female providers are more likely to recommend psychosocial treatments for female than for male pain patients, and providers' sexist attitudes do not account for these differences. Research is needed to elucidate the contributors to sex/gender differences in treatment in order to reduce pain disparities."

    • The Impact of Patients' Gender, Race, and Age on Health Care Professionals' Pain Management Decisions: An Online Survey Using Virtual Human Technology. Wandner et al. September 2013.

      • Highlights:

        • "[C]onsistent with clinical research, but inconsistent with previous virtual human results, physicians and nurses rated male virtual humans’ pain higher and were willing to treat their pain more aggressively than female virtual humans."

    • The Woman Patient: Is Her Voice Heard? Mary O'Connor, M.D. Chair of the Mayo Clinic in Jacksonville Florida, August 2013. 

      • Highlights:

        • "Unconscious bias may be the reason women receive fewer kidney transplants and heart surgeries. It may be so powerful that it even influences the care provided to children. A 2011 study by Butani and Perez showed girls are 22 percent less likely to be placed on a kidney transplant list than boys. Because an earlier transplant equates to better health, this gender disparity likely impacts the long-term outcome of these young women."

        • "In a powerful study performed in Canada, where access to physicians was no barrier, my friend Cory Borkhoff, Ph.D., studied the effect of gender on physician recommendations for knee-replacement surgery. Dr. Borkhoff and colleagues selected four patients: pairing one man and one woman with severe knee arthritis, and pairing one woman and one man with moderate knee arthritis. These ‘paired fake patients were trained to present to doctors with the same levels of pain, physical limitations and X-ray findings. The results were very interesting. For the paired fake patients with severe arthritis, doctors consistently recommended knee-replacement surgery to both the man and woman. However, for the paired fake patients with moderate arthritis, in which the judgment of the doctor would influence the recommendation for surgery, the orthopedic surgeons were 22 times more likely to recommend knee-replacement to the man than to the woman."

        • "So should a woman have a female doctor? I don’t know, but I think that women need to make sure their doctor hears their voice. For those of us with husbands, it is easy to see how the differences in communication styles influence interpretations of conversations and subsequent actions. Make sure your doctor has a female ear."

    • Health Care Disparities: The Impact of Benevolent Sexism. Howerton, D.M. a dissertation 2012. 

      • Highlights:

        •  "Concannon studied a sample of 5,887 patients in Dallas, Texas. All patients had utilized emergency medical services in the past year, were picked up by one of 98 emergency medical 16 service depots, and had been admitted to one of 29 hospitals. In this sample, when compared to men, women were found to have 50% greater odds of being delayed by remaining in the care of emergency medical services for at least 15 minutes longer than the median patient. The results remained consistent when adjusting for other characteristics, including neighborhood socioeconomic status and distance to the nearest service depot and hospital."

        • "Research indicates those endorsing benevolent sexist values believe women to be pure, frail creatures who should be cherished and protected (Glick & Fiske, 1996, 2001). With this in mind, women may be at a disadvantage when receiving medical care from both female and male providers who hold beliefs consistent with benevolent sexism. Specifically, medical professionals holding these beliefs may consider women less able to physically tolerate the same proactive and more aggressive procedures offered to men. Research supports this possibility, because 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)."

        • "Additional support for the possible role of benevolent 24 sexism is found among women of obese and normal body mass indices by rates of screening for colorectal cancer. Women who are classified as “morbidly obese” are less likely than women with a “normal” body mass index to be screened for colorectal cancer (37.1% and 42.7%, respectively); these differences are not observed among men (Rosen & Schneider, 2004). These statistics support benevolent sexism, because there is a clear bias and stigmatization against obese individuals in Western societies, and particularly against obese women. This bias has been demonstrated in research suggesting anti-fat attitudes toward women are positively correlated with adversarial sexual beliefs and negatively correlated with gender-role egalitarianism (PerezLopez, Lewis, & Cash, 2001)." 

    • Gender Disparities in Health Care. Kent, J. et al. September 2012.

      • Abstract:

        • The existence of disparities in delivery of health care has been the subject of increased empirical study in recent years. Some studies have suggested that disparities between men and women exist in the diagnoses and treatment of health conditions, and as a result measures have been taken to identify these differences. This article uses several examples to illustrate health care gender bias in medicine. These examples include surgery, peripheral artery disease, cardiovascular disease, critical care, and cardiovascular risk factors. Additionally, we discuss reasons why these issues still occur, trends in health care that may address these issues, and the need for acknowledgement of the current system's inequities in order to provide unbiased care for women in the future. 

    • Women and Men with Coronary Heart Disease in Three Countries: Are They Treated Differently? Bonte, M. et al May 2008.

      • Highlights:

        • Conclusion: "Although patients with identical symptoms were presented, primary care doctors' behavior differed by patients' gender in all 3 countries under study. These gender differences suggest that women may be less likely to receive an accurate diagnosis and appropriate treatment than men."

    • Physicians' Gender Bias in the Diagnosis, Treatment, and Interpretation of Coronary Heart Symptoms. A Dissertation Presented by Gabrielle Rosina Chiaramonte. Stony Brook University. August 2007. 

      • Highlights:

        • "We propose that when presented with stress, women's – but not men's – cardiac symptoms undergo a "a shift in meaning" and are perceived to have a psychogenic and not an organic/cardiac etiology. For women, the presence of stress deters a CHD (Coronary Heart Disease) diagnosis while for men stress/anxiety may be viewed as a risk factor that augments a CHD diagnosis." 

        • "A series of studies led by psychologist Gabrielle R. Chiaramonte in 2008 provides some clues as to why that may be. In the first study, 230 family doctors and internists were asked to evaluate two hypothetical patients: a 47-year-old man and a 56-year-old woman with identical risk factors and the “textbook” symptoms—including chest pain, shortness of breath, and irregular heart beat—of a heart attack. Half of the vignettes included a note that the patient had recently experienced a stressful life event and appeared to be anxious. In the vignettes without that single line, there was no difference between the doctors’ recommendations to the woman and man. Despite the popular conception of the quintessential heart attack patient as male, they seemed perfectly capable of making the right call in the female patient too.

          But when stress was added as a symptom, an enormous gender gap suddenly appeared. Only 15 percent of the doctors diagnosed heart disease in the woman, compared to 56 percent for the man, and only 30 percent referred the woman to a cardiologist, compared to 62 percent for the man. Finally, only 13 percent suggested cardiac medication for the woman, compared to 47 percent for the man. The presence of stress, the researchers explained, sparked a “meaning shift” in which women’s physical symptoms were reinterpreted as psychological, while “men's symptoms were perceived as organic whether or not stressors were present.”

          That was when the patients did experience the “classic” heart attack symptoms. In the next twist on the study, the researchers asked 142 family physicians to assess a male and female patient presenting with atypical symptoms, including nausea and back pain. This muddied the picture further: The woman was slightly less likely than the man to receive a heart disease diagnosis, but neither was likely to get one at all. And when stress was added to the mix, both men and women became even more likely to be diagnosed with a gastrointestinal problem instead. Given that women more commonly have both atypical symptoms and signs of anxiety, the end result is, yet again, that women are left under-diagnosed." Description of these studies from Is Medicine's Gender Bias Killing Young Women?

        • These results weren't just found with physicians. They were found in both male and female 3rd and 4th year medical students as well as young residents. Thus, this is a bias that isn't going away any time soon. That also suggests that this bias is either coming from medical school itself or is present before students arrive at medical school and is not being stamped out by their training.

    • National Study of Physician Awareness and Adherence to Cardiovascular Disease Prevention Guidelines. Mosca, L. et al. 2005.

      • Highlights:

        • "Fewer than 1 in 5 physicians knew that more women than men die each year from CVD."

        • Conclusion: "Gender disparities in recommendations for preventive therapy were explained largely by the lower perceived risk despite similar calculated risk for women versus men. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women." Translation: Doctors assessed women as having a lower probability of illness than they should have, and thus they need to be educated on these issues so they stop letting women die.

    • Gender-biased diagnosing of women's medical complaints:contributions of feminist thought, 1970-1995Munch, S. 2004.

      • Highlights:

        • Working on getting a pubmed login. Here's the abstract: "With the advent of second-wave feminism during the 1970s, a significant body of literature emerged describing sexist practices in women's health care. Gender-biased diagnosing-the notion that somatic complaints by female medical patients are more likely to be labeled by physicians as psychosomatic-became a concern that garnered considerable attention in Europe and the United States because of the increased health risks it posed for women. This article examines the impact of feminist knowledge on this topic during the quarter century spanning 1970-1995. Analysis of the literature reveals feminist perspectives played a critical role in uncovering and problematizing gender bias in women's health care."

    • The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. Hoffman, D. et al. 2001.

      • Highlights:

        • "But while there is some evidence that men are less likely to seek medical care for their pain at early stages (or until it interferes with their ability to work), there is no evidence that they are in need of more aggressive care than women when they enter the health-care system for pain relief.79 Rather, study findings suggest that women report more severe pain symptoms than men because they suffer from more severe pain-related diseases. For example, in a telephone survey of those with rheumatoid arthritis, research- ers found that women reported more severe symptoms than men and that this difference was due to 'more severe disease rather than a tendency by women to over-report symptoms or over-rate symptom severity.'" 

        • "Given that women experience pain more frequently, are more sensitive to pain, or are more likely to report pain, it seems appropriate that they be treated at least as thoroughly as men and that their reports of pain be taken seriously. The data do not indicate that this is the case. Women who seek help are less likely than men to be taken seriously when they report pain and are less likely to have their pain adequately treated."

        • "In her study of the interplay of pain, gender, and culture, Bendelow found that women were frequently thought to be equipped with a “natural capacity to endure pain,” in part linked to their reproductive function- ing.  This attitude does appear to be somewhat common among certain groups, as conveyed by offhand remarks such as, “if men had to bear children, there wouldn’t be any.” Bendelow found that “the perceived superiority of capacities of endurance is double-edged for women — the assumption that they may be able to ‘cope’ better may lead to the expectation that they can put up with more pain, that their pain does not need to be taken so seriously.” 

        •  "The feminist literature is rife with examples and criticism of women’s voices not being heard or considered credible in the male-dominated healthcare system. Sherwin describes physicians as frequently “patronizing, detached, dis- respectful, ... and unwilling to trust the reports of their women patients.”

        • "The health-care provider’s bias toward psychogenic causes of women’s pain is problematic on two levels. First, women are more likely than men to have their pain attributed to psychogenesis whether or not that is in fact a cause of their pain. Second, for those women whose pain is exacerbated by emotional disorders, the health-care provider’s bias against psychological contributors to pain may lead them to undertreat the pain."  

        • "It is necessary to begin educating healthcare providers and those who train them to expose biases that lead to the undertreatment of women. Some research has shown that efforts at educating and en- lightening health-care providers regarding women’s health needs has positive effects.  Moreover, the bias against psy- chological or emotional pain contributors adversely affects both women and men."  

        • "Kate Nicholson, a disability lawyer who is writing a book about her experiences living with chronic neuropathic pain, and who commented on an earlier version of this manuscript, expressed concern that acknowledging gender differences in pain response might lead to gender stereotyping. She made a point of trying to report her pain to healthcare providers factually and unemotionally, and recalled one female pain specialist’s comment to her, “You are not crazy; you’re not like my other patients.” Additionally, she recalled a male acquaintance’s adamant demand from emergency room staff to give him something for his acute pain(“YouSOB’s,you are giving me something for pain and you’re giving it to me right now!”). He got the pain medication. Yet Nicholson was aware that if she had done something similar, “I’d have been perceived extremely differently, in all likelihood.”

    • Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. Pope, JH et al. April 2000.

      • Highlights: 

        • "Women (especially younger women) with heart disease are far more likely than men to be misdiagnosed.  Research on cardiac misdiagnoses reported in the New England Journal of Medicine looked at more than 10,000 patients (48% women) who went to their hospital Emergency Departments with chest pain or other heart attack symptoms. Investigators found that women younger than 55 were seven times more likely to be misdiagnosed than their male counterparts. The consequences of this were enormous: being sent away from the hospital doubled the risk of dying." Description from Heart Attack Misdiagnosis in Women

    • "The Role of Sex and Gender in Pain Perception and Responses to Treatment" in Psychosocial Factors in Pain: Critical Perspectives by R.J. Gatchel and D.C. Turk. 1999.

      • Highlights:

        • "Given that women experience pain more frequently, are more sensitive to pain, or are more likely to report pain, it seems appropriate that they be treated at least as thoroughly as men and that their reports of pain be taken seriously. The data do not indicate that this is the case. Women who seek help are less likely than men to be taken seriously when they report pain and are less likely to have their pain adequately treated." Description from: The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.

    • Differences in Clinical Communication by Gender. Elderkin-Thompson & Waitzkin. February 1999.

      • Highlights:

        • "[This] prospective study of patients with chest pain found that women were less likely than men to be admitted to the hospital. Of those hospitalized, women were just as likely to receive a stress test as men, but of those not hospitalized, women were less likely to have received a stress test at a one month follow-up appointment." Description from: The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.

        • Elderkin-Thompson and Waitzkin reviewed evidence from the American Medical Association’s Task Force on Gender Disparities in Clinical Decision-Making. Physicians were found to consistently view women’s (but not men’s) symptom reports as caused by emotional factors, even in the presence of positive clinical tests.

    • Gender Differences in Clinical Evaluation: Narrowing the Gap with Women’s Health Clinical Skills Workshop. Kwolek et al. 1998.

      • Highlights:

        • Shows that efforts at educating and enlightening healthcare providers regarding women’s health needs has positive effects.

    • Gender Variations in Clinical Pain Experience. Unruh, A.M. May 1996.

      • Highlights:

        • Physicians have found women to have more “psychosomatic illnesses, more emotional lability and more complaints due to emotional factors” than men.

    • Gender Differences in the Management of Acute Chest Pain: Support for the 'Yentel Syndrome'. Johnson, et. al April 1996.

      • Highlights:

        • The authors attributed differences in treatment of men and women to the “Yentl Syndrome,” which is the idea that women are more likely to be treated less aggressively in their initial encounters with the healthcare system until they “prove that they are as sick as male patients.” Once they are perceived to be as ill as similarly situated males, they are likely to be treated similarly

    • Communicative Ethics in Medicine: The Physician-Patient Relationship by Smith, J. in Feminism in Bioethics. ed by S.M. Wolf 1996.

      • Highlights:

        • “Women who do speak assertively are often taken to be domineering rather than dominant, emotional rather than rational, biased rather than authoritative, and complaining rather than assertive.”

    • The Undertreatment of Pain in Ambulatory AIDS Patients. Breitbart et al. 1996.

    • Problems of Communication, Diagnosis, and Treatment Experienced by Women Using the New Zealand Health Services for Chronic Pelvic Pain: A Quantitative Analysis. Grace, V.M. November 1995.

      • Highlights:

        • "[V.M. Grace] found that women with pelvic pain expressed difficulty communicating with their general practitioner about their pain, and some difficulty communicating with their gynecologist. A significant number of the women “did not think the doctor (GP) really understood what they said and left the doctor’s office feeling that there were things about their pelvic pain that they hadn’t talked about.” These women had received seventy-three different diagnoses to explain the cause of their pain, and reported that their physician implied “nothing was wrong” if no physical cause of pain could be identified. More than half of the women said that on occasion they felt that the doctor was not taking their pain seriously or that the doctor expected them to put up with their pain." Description from: The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. 

    • Pain and Its Treatment in Outpatients with Metastatic Cancer. Cleeland et al. March 1994.

      • Highlights:

    • American Medical Association Opinion 9.122 - Gender Disparities in Health Care, March 1992. 

      • "A patient’s gender plays an appropriate role in medical decision making when biological differences between the sexes are considered. However, some data suggest that gender bias may be playing a role in medical decision making. Social attitudes, including stereotypes, prejudices, and other evaluations based on gender role expectations, may play themselves out in a variety of subtle ways. Physicians must ensure that gender is not used inappropriately as a consideration in clinical decision making. Physicians should examine their practices and attitudes for influence of social or cultural biases which could be inadvertently affecting the delivery of medical care.

        Research on health problems that affect both genders should include male and female subjects, and results of medical research done solely on males should not be generalized to females without evidence that results apply to both sexes. Medicine and society in general should ensure that resources for medical research should be distributed in a manner which promotes the health of both sexes to the greatest extent possible."

    • American Medical Association Report: Gender Disparities in Clinical Decision-Making, March 1992. 

      • Highlights:

        • "The Council on Ethical and Judicial Affairs recommends that physicians examine their practices and attitudes for influence of social or cultural biases which could be inadvertently affecting the delivery of medical care."

        • "Remedial action. Instances in which a physician's treatment decision appears to turn inappropriately on the patient's gender deserve further scrutiny. If evidence of systematic gender bias in clinical decision-making is found, then appropriate review or corrective proceedings should be undertaken."

        •  "An analysis of individual dialysis patient data from the years 1981 through 1985 revealed that females undergoing renal dialysis are approximately 30% less likely to receive a cadaver kidney transplant than males. Controlling for age did not significantly reduce sex as a factor in the likelihood of receiving a transplant. Men were more likely to receive a transplant in every age category. The discrepancy between sexes was most pronounced in the group aged 46 to 60 years old, with women having only half the chance of receiving a transplant as men the same age."

        • "[S]tudies have shown that women and men with similar smoking practices are at essentially equivalent risk for lung cancer. ... Once smoking status and other medical considerations were taken into account, men still had 1.6 times the chance of having a cytology [a diagnostic test to find lung cancer] done."

        • Catheterization for Coronary Bypass Surgery. "The study showed that once researchers controlled for the variables of abnormal test results, age, types of angina, presence of symptoms, and confirmed previous myocardial infarction, men were still 6.5 times, more likely to be referred for catheterization than women, although men have only 3 times the likelihood of having coronary heart disease than women. Of those patients whose nuclear scan test results ultimately turned out abnormal, women were more than twice as likely to have their symptoms attributed to romantic, psychiatric, or other non-cardiac causes as men." 

        • "Data which suggest that a patient's sex plays an inappropriate role in medical decision making raise the question of possible gender bias in clinical decision making. Gender bias may not necessarily manifest itself as overt discrimination based on sex. Rather, social attitudes, including stereotypes, prejudices and other evaluations based on gender roles may play themselves out in a variety of subtle ways. For instance, there is evidence that physicians are more likely to perceive women's maladies as the result of emotionality."

        • "Perceiving men's utilization practices as normal and attributing overanxiousness to women's concerns about their health may be doing a disservice to both sexes. One study concluded that 'women's greater - 4 - interest in and concern with health matters and their greater attentiveness to bodily changes may be part of a set of behaviors which do contribute to women's lower mortality rates.'"

        • "Societal value judgments placed on gender or gender roles may also be disadvantaging women in the context of receiving certain major diagnostic and therapeutic interventions, such as kidney transplants and cardiac catheterization. Perhaps a general perception that men's social role obligations or the value of their contribution to society is greater than women's fuels these disparities. For instance, altering one's work schedule in order to accommodate health concerns may be viewed as more difficult for men than women. Overall, men's contribution to support of the family may be considered more critical than women's. A kidney transplant is much less cumbersome than dialysis. Coronary bypass surgery, for which catheterization is a prerequisite, is a more efficient and immediate solution to the problem of coronary artery disease than continuous antianginal drug therapy. However, judgments based on evaluations of social worth or preconceptions about the probable roles of men and women are inexcusable in the context of medical decision making."

    • Gender Stereotyping and Nursing Care. McDonald, D. and Bridge, R.G. October 1991. 

      • Highlights:

        • "Nurses were given vignettes describing a particular patient and situation, and were asked to estimate the minutes needed for specific nursing interventions for each patient. In their estimations, the nurses planned significantly more analgesic administration time (as well as ambulation and emotional support time) for male patients than for female patients." Description from: The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.

    • The Influence of Gender on the Frequency of Pain and Sedative Medication Administered to Postoperative Patients. Calderone, K. 1990.

      • Highlights:

        • Abstract: This study examines whether the frequency of pain and sedative medication administered to postoperative coronary artery bypass graft (CABG) patients differs according to patient gender. It was hypothesized that nurses medicate patients with pain medication more frequently if they are men than if they are women. It was also hypothesized that nurses medicate female patients with sedative medication more frequently than male patients. The hypotheses in this study were based on a review of the literature indicating that health care professionals hold stereotypic views of women as emotionally labile and more apt to exaggerate complaints of pain than men. The medication records of 30 male and 30 female patients between 44–71 years of age, who had undergone recent CABG surgery, were evaluated in this study. Male and female patients were matched on the basis of age, number of grafts completed in surgery, and location of graft donor sites. All data were obtained through the use of medical records to allow for control of patients' current and past medical history. The frequency of pain and sedative medication administered to these patients from 12 hours postop to 72 hours postop was compared. The results revealed that male patients were administered pain medication significantly more frequently than female patients, and that female patients were administered sedative medication significantly more frequently than male patients. Also, patients 61 years or younger received pain medication significantly more frequently than those patients 62 years and over.

    • Analgesic Medication for Elderly People Post-Surgery. Flaherty & Grier 1984.

      • Highlights:

        • Elderly women are less likely to receive opioid analgesics than men post-surgery.

    • Patterns of Postoperative Analgesic Use with Adults and Children Following Cardiac Surgery. Beyer JE, et al. 1983.

    • Women and Pain: Another Feminist Issue. Lack, D.Z. 1982.

      • Highlights:

        • "[This] older study also found that of 188 patients treated at a pain clinic, the women were older and had experienced pain for a longer duration prior to being referred to the clinic than the men. In addition, the researchers found that women were given 'more minor tranquilizers, antidepressants, and non-opioid analgesics than men. Men received more opioids than did women.'" Description from The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.

    • Alleged Psychogenic Disorders in Women — A Possible Manifestation of Sexual Prejudice. Lennane, K.J. & Lennane, R.J. 1973.

      • These researchers have argued that a “bias toward psychogenic causation for disorders in women has occurred even in well defined painful biological processes: ‘Despite the well documented presence of organic etiologic factors, the therapeutic literature is characterized by an unscientific recourse to psychogenesis and a correspondingly inadequate, even derisive approach to their management.’”

    • Covert Sex Discrimination Against Women as Medical Patients. Downer, C. 1972.

      • Being that this was written in the 1970s, the discussion is about how men dominate the medical field and how that is what causes disparities of treatment for women. However, now doctors, especially gynecologists, are often women and those women doctors show bias against women in a similar way to male doctors, so male dominance in the medical field can no longer be the entire answer.  

    • 'Psychogenic' Pain and the Pain-Prone Patient. Engel 1959. 

      • In this very commonly cited paper on 'psychogenic pain and the pain-prone patient' the majority of the case histories presented are those of women. 

  • Legal Issues Surrounding Medicine's Gender Bias

    • Laws and Regulations Enforced by OCR, Office for Civil Rights, retrieved November 2015.

      • Relevant section: "OCR also enforces the following: Section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116), which provides that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d et seq. (race, color, national origin), Title IX of the Education Amendments of 1972, 20 U.S.C. 1681 et seq. (sex), the Age Discrimination Act of 1975, 42 U.S.C. 6101 et seq. (age), or Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794 (disability), under any health program or activity, any part of which is receiving federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments. OCR has enforcement authority with respect to health programs and activities that receive Federal financial assistance from the Department of Health and Human Services (HHS) or are administered by HHS or any entity established under Title I of the Affordable Care Act or its amendments."

    • State Public Accommodation Laws, National Conference of State Legislatures March 2015.

    • "Five states—Alabama, Georgia, Mississippi, North Carolina and Texas—do not have a public accommodation law for nondisabled individuals. All states with a public accommodation law prohibit discrimination on the grounds of race, gender, ancestry and religion." 

    • Nondiscrimination Protection in the Affordable Care Act: Section 1557 Fact Sheet, National Women's Law Center, June 2013.

      • Great fact sheet that lays out who's covered by this law (short answer: if you get federal funds, you're subject to it, and the vast majority of doctors/hospitals receive federal funds) and what it protects against: "sex discrimination includes, but is not limited to, discrimination based on pregnancy, pregnancy-related conditions, marital or familial status, gender identity, and sex-stereotyping."

    • Discrimination in the Doctor Patient RelationshipHarvard Law Blog September 2012.

      • Highlights:

        • "For example, the Civil Rights Act of 1964 prohibits physicians and hospitals receiving federal funding, including Medicare and Medicaid (so read: nearly everyone), from discriminating against patients on the basis of race, color, religion, or national origin.  Some states have expanded on this to cover medical personnel and health care facilities beyond the funding “hook” and to include additional protected categories. At the height of the HIV/AIDS epidemic, for example, a number of states prohibited licensees from categorically refusing to treat infected patients when the licensee possessed the skill and expertise necessary to treat the condition presented.  Some states also have laws and licensing requirements applicable to the medical context that prohibit discrimination on the basis of gender, sexual orientation, marital status, disability, or medical condition." This implies gender discrimination isn't prohibited at the federal level in terms of a doctor taking you on as a patient.