The Health Gap |Health
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By Maya Dusenbery29th May 2018
Women are more likely to wait longer for a health diagnosis and to be told it’s ‘all in their heads’. That can be lethal: diagnostic errors cause 40,000-80,000 deaths in the US alone.
Compared to many other diseases, diagnosing a brain tumour is fairly straightforward. Promptly detecting it comes down to being concerned enough about the early symptoms – which range from fatigue to seizures to personality change – to get an image of the brain. Either the tumour is there, or it isn’t.
But in 2016, the Brain Tumour Charity released a report onthe treatment of brain tumour patientsin the United Kingdom. It found that almost one in three of them had visited a doctor more than five times before receiving their diagnosis. Nearly a quarter weren’t diagnosed for more than a year.
Women, as well as low-income patients, experienced longer delays. They were more likely than men to see 10 or more months pass between their first visit to a doctor and diagnosis –and to have made more than five visits to a doctor prior to diagnosis.
You might also like these other stories in theHealth Gap:
•Why doctors dismiss women’s pain
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One 39-year-old woman quoted in the report recalled: “One of the GPs I saw actually made fun of me, saying ‘what did I think my headaches were, a brain tumour?’ I had to request a referral to neurology. I went back repeated times to be given antidepressants, sleep charts, analgesia, etc. No one took me seriously.”
To diagnose a brain tumour, a doctor simply must be concerned enough to order imaging – but it takes doctors longer to do this for women than men (Credit: Getty Images)
A growing body of research is exploring how “implicit” bias – unconscious biases that are usually not linked to consciously held prejudiced attitudes – contributes to disparities in medical treatment. “We want to think that physicians just view us as a patient, and they’ll treat everyone the same, but they don’t,” says Linda Blount, president of the Black Women’s Health Imperative. “Their bias absolutely makes its way into the exam room.”
One of the most pervasive implicit biases in the medical system regards gender.
Brain tumours are only one example. A 2015 study revealed alonger lag time from the onset of symptoms to diagnosisin female patients in six out of 11 types of cancer. It isn’t that women wait longer to seek medical attention – the delay occurs after they’ve first visited their GP. A 2013 study concluded thatmore than twice as many women as men had to make more than three visitsto a primary care doctor in the UK before getting referred to a specialist for suspected bladder cancer. So did nearly twice as many with renal cancer.
More than just a frustration for patients, these delays cause unnecessary deaths. Each year, an estimated40,000 to 80,000 people die due to diagnostic errorsin the US alone.
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In reporting my bookDoing Harm, I heard from dozens of women with a range of conditions who, at some point during their search for a diagnosis, were told that their symptoms were due to anxiety, depression, or that all-purpose catch-all: “stress”.
Recorded cases show that in six out of 11 types of cancer, women experienced a longer lag time from symptom onset to diagnosis (Credit: Getty Images)
Everybody was telling me there was nothing wrong with me
Jackie’s experience is typical. She first fell ill at age 16, and for years, she suffered from chronic kidney problems, fevers, fatigue, and terrible menstrual and joint pain. She saw a primary care doctor, a urologist, and a pulmonologist. “Everybody was telling me there was nothing wrong with me,” she says.
With tests revealing nothing amiss, Jackie’s primary care doctor decided that she must be depressed and prescribed antidepressants. They didn’t help at all, but Jackie was “accepting whatever the doctors said”.
The tendency to attribute women’s physical complaints to mental illness has its roots in the history of ‘hysteria’ – that mythical female disorder that, over the centuries, was blamed on a ‘wandering womb’ or sensitive nerves and eventually, post-Freud, came to be seen as a psychological problem. The terms have changed over the last century, but the concept – that the unconscious mind can ‘produce’ physical symptoms – has remained alive and well in medicine.
There is a high risk of misdiagnosis inherent in this concept, whether it’s called hysteria, somatisation, or ‘medically unexplained symptoms’ due to stress.
Back in 1965, British psychiatrist Eliot Slaterwarnedthat too often a label of hysteria allowed doctors to believe they’d solved the mystery when, in fact, usually they hadn’t. After following up with 85 patients who’d been diagnosed with ‘hysteria’ at the National Hospital in London throughout the 1950s – including by Slater himself – he discovered that, nine years later, more than 60% had been found to have an organic neurological disease, including brain tumours and epilepsy. A dozen of them had died.
Both misdiagnoses and diagnostic delays cause unnecessary deaths (Credit: Getty Image)
Women have long been considered the typical patients with psychogenic symptoms, so it’s no wonder that they are especially likely to find their symptoms dismissed as “all in their heads”. In a 1986 study, for example,researchers looked at a group of patients with serious organic neurological disorderswho’d initially been diagnosed with hysteria. They identified the characteristics that made a patient vulnerable to such a misdiagnosis. One was having a prior diagnosis of a psychiatric disorder. Another was being a woman.
The fact that women have higher rates of mood disorders is, itself, likely one reason that it’s so common for women to get a psychogenic label. In the US, women are about twice as likely to have a diagnosis of depression or an anxiety disorder as men.
Studies suggested that as many as 30-50% of women diagnosed with depression were misdiagnosed
But while women may truly have a higher risk, the difference in prevalence rates may be at least partly a consequence of overdiagnosis in women and underdiagnosis in men. Studies in the 1990s suggested thatas many as 30-50% of women diagnosed with depression were misdiagnosed. Furthermore, depression and anxiety are themselvessymptomsof other diseases, which often gounrecognisedin women. And, of course, the stress of suffering from an undiagnosed – and therefore untreated – disease often takes its mental toll. As onearticlepoints out, “Ironically, medical misdiagnoses of physical conditions may induce depressive reactions in female patients.”
Once listed in their chart, a psychological disorder heightens the risk that any other physical symptoms a patient has in the future will be automatically dismissed as psychogenic.
Women are especially likely to find symptoms dismissed as ‘all in their heads’ (Credit: Getty Images)
I heard from one woman, a middle-aged Italian immigrant to the US with a history of depression, whose worsening abdominal pain was dismissed as menstrual pain for three years. It wasn’t taken seriously even when she brought up the fact that she had a family history of colon cancer. And it wasn’t taken seriously even when she began having rectal bleeding. When she finally pushed for a colonoscopy, it revealed stage-three colon cancer.
Just a few months longer and it would have been at stage four and incurable.
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After a few years, Jackie finally got one correct diagnosis. A friend – a well-off white woman – urged Jackie to go see her doctor in a wealthy suburb. He quickly diagnosed her with endometriosis, and surgery alleviated much of her pelvic pain.
But other problems persisted and eventually worsened. After moving to a new city for graduate school, it took another few years to find another set of doctors who would take her symptoms seriously. “I had a lot of, ‘You’re just hysterical,’ ” she remembers. “One of the more common things, especially in emergency rooms, was ‘You’re just drug seeking.’”
As a woman of colour, Jackie was facing more than gender bias. Implicit biases on the basis of race, class, weight, sexual orientation, and trans status all affect clinical care as well.
There is particularly robust evidence showing that US patients of colour, black patients especially, are undertreated for pain. A 2012 meta-analysis of 20 years of published research found thatblack patients were 22% less likely than whitesto get any pain medication and 29% less likely to be treated with opioids.
One study found that healthcare providers believe that black patients don’t feel as much pain as whites (Credit: Getty Images)
White children with appendicitis are almost three times as likely as black children to receive opioids in the emergency room
Experts point to a stereotype – widely held by healthcare providers yet utterly false – that black patients are more likely to abuse prescription painkillers. (In fact, white Americans have the highest rates of prescription drug abuse.) But the disparity extends to children, suggesting it’s not just about the assumption of drug seeking. A 2015 study found thatwhite children with appendicitiswere almost three times as likely as black children to receive opioids in the emergency room.
A 2016 study suggested that healthcare providers may underestimate black patients’ pain in part due toa belief that they simply don’t actually feel as much pain. When 200 white medical students and residents were quizzed on a series of claims about biological differences between the races, like “blacks’ skin is thicker than whites,” a full half thought one or more of the false statements were true. And, when they later read case studies of two patients reporting pain, those who had endorsed more false beliefs thought the black patient felt less pain, and undertreated them accordingly.
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The biggest danger of having your symptoms dismissed is that once doctors believe they are ‘all in your head’, they stop searching for another explanation
Not being taken seriously enough to be treated is frustrating enough. But the biggest danger of having your symptoms dismissed is thatonce doctors have settled on the conclusion that they are ‘all in your head’ – or made up in order to get painkillers – they stop searching for another explanation.
Consider the experience of patients with rare diseases, who go more than seven years, on average, before being correctly diagnosed. Along the way, they visit four primary care doctors and four specialists and receive two to three misdiagnoses.
While some delay in diagnosing an uncommon disease may be inevitable, this staggering seven-year gap is not simply because it takes that long for doctors to crack a challenging case. According to a Eurordissurveyof 12,000 rare disease patients in Europe, those who were initially misdiagnosed experienced longer diagnostic journeys. And, while being misdiagnosed with the wrong physical disease doubled the time it took to get to the right diagnosis, getting a psychological misdiagnosis extended it even more – by 2.5 up to 14 times, depending on the disease.
Given women’s vulnerability to a psychogenic misdiagnosis, it is perhaps not surprising that they reported significantly longer delays than men.
For example, it took an average of 12 months for men to get diagnosed with Crohn’s disease, an autoimmune disease of the gastrointestinal tract, compared to 20 months for women. Men were diagnosed with Ehlers-Danlos syndrome, a group of genetic disorders that affect the connective tissue, in four years. For women: 16 years.
It takes an average 12 months for men to receive a diagnosis of Crohn’s disease; for women, 20 months (Credit: Getty Images)
“Being a woman should have no influence on a physician’s clinical ability to diagnose a disease,” the authors of the report wrote. “It is, therefore, difficult to accept that overall women experience much greater delays in diagnosis than men. The more rapid diagnosis of men illustrates that the capacity to do so exists.”
As for Jackie? Midway through graduate school, she finally caught a break. She had been sick for months with a fever that the doctors, despite soaking her in antibiotics, could not break. “A primary care doctor – a woman of colour – believed me, and she collected all of my medical records and literally took them home with her and started trying to piece them together like it was a puzzle.”
She suspected that Jackie might have lupus. A test confirmed it. Jackie thought her battle to be taken seriously was over. In fact, as a black woman managing a chronic disease that frequently landed her in the ER with excruciating pain, there would many more encounters with dismissive healthcare providers in her future.
But at least, after 10 years of searching, she finally had a diagnosis — and, with it, the assurance that it had never been ‘all in her head’. Something really was wrong with her. And now, it could get better.
This story is part of theHealth Gap,a special series about how men and women experience the medical system – and their own health – in starkly different ways.
Do you have an experience to share? Or are you just interested in sharing information about women's health and wellbeing? Join our Facebook group Future Woman and be a part of the conversation about the day-to-day issues that affect women’s lives.
This is an adapted excerpt fromDoing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick.Copyright © 2018 by Maya Dusenbery.Published by HarperOne, an imprint of HarperCollins Publishers.
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FAQs
What is it called when doctors can't diagnose you? ›
What is an undiagnosed disease? An undiagnosed disease is one or more medical problems that doctors haven't been able to identify a cause for. Often, this means the underlying disease is rare — which is why no one was able to identify it.
What to do when your doctor says nothings wrong? ›If you feel your primary care doctor doesn't take your symptoms seriously, ask for a referral to a specialist or go to a different practice for a second opinion. A fresh set of eyes can be extremely helpful.
Is women's mental health taken seriously? ›Serious mental illness is more common among women than men — but women with serious conditions are often overlooked in psychiatric research, treated less effectively with psychiatric drugs, and face discrimination and stigma by medical professionals who diagnose them and oversee their care.
What is an example of gender bias in medicine? ›For example, after undergoing coronary artery bypass surgery, women received more sedatives rather than pain treatment. Studies from the 2000s showed that physicians dismissed women's pain as inexplicable because they refused to believe the complaints; some physicians even blamed the female patients for their pain.
What are the signs of medical Gaslighting? ›- Not allowed to read your own medical records or have information hidden from you.
- Blamed for your symptoms or condition.
- Discouraged from doing your own research into your conditions.
- Dissuaded from getting a second opinion.
- Irritable Bowel Syndrome. 1/14. This condition causes pain in your belly area and changes in bathroom habits that last at least 3 months. ...
- Celiac Disease. 2/14. ...
- Appendicitis. 3/14. ...
- Hyperthyroidism. 4/14. ...
- Hypothyroidism. 5/14. ...
- Sleep Apnea. 6/14. ...
- Lyme Disease. 7/14. ...
- Fibromyalgia. 8/14.
If the doctor is being dismissive, push back. Engage them as you would a partner. Let them know you appreciate their expertise, but remind them that you are the foremost expert on your own body. Work together to reach a diagnosis and treatment plan.
How do you get doctors to take you seriously? ›- Write down your symptoms and concerns. ...
- Ask questions. ...
- Bring someone to your appointment with you. ...
- Don't be afraid to repeat yourself. ...
- Consider seeking a second opinion. ...
- Remember that your symptoms are real.
If the doctor is condescending or makes you feel foolish, it's not a healthy partnership. Friends and family often ask me to recommend a doctor. Typically it's because for some reason they aren't happy with the current one or have developed a new medical condition and need an expert.
Who suffers most from mental illness? ›Women are nearly twice as likely to suffer from major depression than men. However, men and women are equally likely to develop bipolar disorder. While major depression can develop at any age, the average age at onset is the mid-20s.
What is the most common mental illness in females? ›
The most common mental health issue in women is depression. Research has shown that twice as many women experience depression during their lives as men. Because of its prevalence, it's important to understand its symptoms, diagnosis, and treatment.
Which gender has better mental health? ›Today, women are three times more likely than men to experience common mental health problems.
What is medical misogyny? ›Medical sexism uses medical means or medical ends to uphold, assert, or achieve a gendered hierarchy of femaleness or femininity subordinated to maleness or masculinity.
Why is women's pain not taken seriously? ›Researchers found that when male and female patients expressed the same amount of pain, observers viewed female patients' pain as less intense and more likely to benefit from psychotherapy versus medication as compared to men's pain, exposing a significant patient gender bias that could lead to disparities in ...
Should a female have a male doctor? ›No matter your gender or their gender, it is likely you'll be able to get the same quality of care. “I am certain that none of us physicians would want a patient to neglect to mention a concern about their health because they felt uncomfortable,” Dr. Sherrard says.
What is medical ghosting? ›Ghosting is a visual artifact that occurs in magnetic resonance imaging(MRI) scans. These artifact are a consequence of environmental factors or the human body (such as blood flow, implants etc.).
What not to tell your doctor? ›- Anything that is not 100 percent truthful. ...
- Anything condescending, loud, hostile, or sarcastic. ...
- Anything related to your health care when we are off the clock. ...
- Complaining about other doctors. ...
- Anything that is a huge overreaction.
- Don't label patients. ...
- Don't tell patients the pain is 'in our heads. ...
- Don't tell us to just 'live with the pain.
Cancer. Cancer refers to the uncontrolled growth of abnormal cells in the body. This can affect almost any organ or tissue including lungs, breast, colon, skin and ovaries. Due to the complexity of the disease and the variety of forms it can take, developing a cure has proven difficult.
What is the rarest disease of all time? ›Stone Man's Disease
This disease is also called fibrodysplasia ossificans progressiva (FOP). The heart, diaphragm, tongue, and other extra smooth and eye muscles are the only bodily muscles that do not develop into bones when a person is suffering from this rare disease.
What are the signs symptoms that your nervous system is malfunctioning? ›
- Persistent or sudden onset of a headache.
- A headache that changes or is different.
- Loss of feeling or tingling.
- Weakness or loss of muscle strength.
- Loss of sight or double vision.
- Memory loss.
- Impaired mental ability.
- Lack of coordination.
Specifically, it uses the phrase “professional judgment” often. In other words, the doctor may talk about their patients to others when they believe the discussion they're having is in the best interest of their client.
What is inappropriate behavior for a doctor? ›Inappropriate behavior includes such things as: Belittling or berating statements. Use of profanity or disrespectful language. Inappropriate comments written in the medical record.
What are the unacceptable behaviors as doctors? ›Screaming. Swearing. Angry outbursts. Negative or demeaning comments about patients, physicians or other health professionals.
Why do I feel sick but doctors say nothing's wrong? ›A hypochondriac is someone who lives with the fear that they have a serious, but undiagnosed medical condition, even though diagnostic tests show there is nothing wrong with them. Hypochondriacs experience extreme anxiety from the bodily responses most people take for granted.
What to do if a doctor disrespects you? ›Say nothing and let it be. Calling someone on their insulting behavior, if you aren't sure it was intended, can create more problems later if you embarrass them or make them angry. Say something, but not in a confrontational manner.
How do you talk to a difficult doctor? ›- Communicate clearly. ...
- Avoid unnecessary interruptions during rounds. ...
- Speak up when necessary. ...
- Don't tolerate abuse. ...
- Try the direct approach. ...
- Interact with them more.
“Medical gaslighting is the experience of patients feeling like their complaints are dismissed, discounted, or discredited,” says Kim Gorgens, PhD, Clinical Professor and Director of Continuing Education at the Graduate School of Professional Psychology at the University of Denver.
What is unethical for a doctor to do? ›Working while impaired by alcohol or drugs. Becoming romantically involved with patients or family members of a patient. Cherry-picking patients. Breaching patient confidentiality (violating HIPAA regulations)
Why are doctors so passive aggressive? ›Physicians who feel put upon and are unable to see the options and choices they have for dealing with stress and frustrations may use passive-aggressive behaviors to release anger and frustration and to feel more self-empowered.
What is the number one mental illness? ›
Depression. Impacting an estimated 300 million people, depression is the most-common mental disorder and generally affects women more often than men.
What is the number one mental illness in the world? ›- Depression affects more people than any other mental disorder and is also one of the world's leading causes of disability. Although it is a treatable disease, six out of every ten people who have depression in Latin America and the Caribbean do not seek or do not receive the treatment they need.
What is the number one cause of mental illness? ›childhood abuse, trauma, or neglect. social isolation or loneliness. experiencing discrimination and stigma, including racism. social disadvantage, poverty or debt.
What does PTSD look like in a woman? ›Women with PTSD may be more likely than men with PTSD to: Be easily startled. Have more trouble feeling emotions or feel numb. Avoid things that remind them of the trauma.
What are the three biggest mental illness? ›Of those, the three most common diagnoses are anxiety disorders, depression and post-traumatic stress disorder (PTSD). These three conditions make up around 30 percent of all diagnoses of mental illness in America.
Which gender is mentally tougher? ›Some studies do show that males tend to have a statistically significantly higher level of mental toughness than females of the same age.
What gender has the most depression? ›Women are nearly twice as likely as men to be diagnosed with depression. Depression can occur at any age. Some mood changes and depressed feelings occur with normal hormonal changes. But hormonal changes alone don't cause depression.
Which gender is happier? ›But research also shows that women are more likely to experience intense positive emotions — such as joy and happiness — compared to men. So it seems that women's more intense positive emotions balance out their higher risk of depression.
What is blatant misogyny? ›Social psychology research describes overt misogyny as "blatant hostile sexism" that raises resistance in women, as opposed to "manifestations of benevolent sexism" or chivalry that lead women to behave in a manner perpetuating patriarchal arrangements.
Is Gynophobia misogyny? ›Gynophobia should not be confused with misogyny, which is the hatred of, contempt for, or prejudice against women or girls. While gynophobia is anxiety-based and involves a fear response, misogyny is a harmful learned cultural attitude.
What are the root words of misogyny? ›
“MISOGYNY” SEEMS a straightforward word. In dictionaries, it is “hatred of women”. In its etymology are the Greek verb misein, to hate, and gyne, women.
What is the most common pain woman? ›- Fibromyalgia. ...
- Migraines. ...
- Irritable Bowel Syndrome. ...
- Chronic Pelvic Pain. ...
- Arthritis. ...
- Temporomandibular Joint Disorder. ...
- Challenges for Female Patients.
Medical gaslighting occurs when a physician or other medical professional dismisses or trivializes a person's symptoms. They may mistakenly determine that pain or other symptoms are not real or simply a result of stress or depression. When this happens, it may take years, if ever, to receive a proper diagnosis.
What is an example of medical gaslighting? ›For example, medical gaslighting occurs when healthcare professionals downplay or blow off symptoms you know you're feeling and instead try to convince you they're caused by something else—or even that you're imagining them.
Can a male patient refuse a female nurse? ›Yes of course. Not that the patient is discriminating, but of course there are some that are. But it is also a patient's right to ask or prefer to receive care from a gender specific nurse.
Do male patients prefer male doctors? ›Our data indicate that both female and male patients tend to prefer a same-gender PCP, with this preference more pronounced among male patients.
Do men have a doctor like a gynecologist? ›Physicians who specialize in men's sexual and reproductive health care — including the diagnosis and treatment of disorders of the male sex and reproductive organs — are called urologists. You can visit a urologist if you're experiencing any problems with your sexual or reproductive health.
What does non diagnostic mean in medical terms? ›nondiagnostic (not comparable) Not diagnostic. (medicine) Unsatisfactory for diagnosis, not characteristic of a particular disease.
What is failure to diagnose? ›Failure to diagnose occurs when a physician fails to diagnose a patient's condition. Misdiagnosis results from a doctor making an incorrect diagnosis. Lastly, a delayed diagnosis takes place when a medical professional significantly delays a correct diagnosis.
What does lack of diagnosis mean? ›: failure to recognize or correctly diagnose a disease or condition especially in a significant proportion of patients.
What is the difference between misdiagnosis and not diagnosing? ›
Misdiagnosis is a wrong diagnosis – for instance, if someone is diagnosed with cancer but they actually have a benign cyst. Overdiagnosis, on the other hand, is a “correct” medical diagnosis.
What is the word for unknown diagnosis? ›Describes a disease of unknown cause.
Is there a difference between diagnostic and diagnosis? ›After scientists discover the causative agent of an emerging infectious disease, such as Borrelia burgdorferi or Ehrlichia chaffeensis, they develop, evaluate, and refine diagnostic tests over time. Diagnosis, by contrast, rests on a patient's history and symptoms and observed physical and laboratory findings.
What is the difference between diagnosis and diagnostic? ›Diagnosis is defined as the process of recognising an injury, condition, or disease from the signs and symptoms the individual is displaying. Diagnostic tests are used to ascertain a diagnosis. Blood tests, health history, physical assessments, and other procedures may be used to help make a diagnosis.
What is the most common diagnostic error? ›In practice, the most common cognitive error for doctors is the premature closure of the diagnostic process, in which the physician may not even consider the correct diagnosis as a possibility. Many times doctors assign common benign diagnoses to patients with uncommon serious diseases – a possibly fatal error.
Why is it so hard to get a diagnosis? ›The main reason it can be hard to reach a diagnosis is simply because a disease or disorder is so rare that it is unrealistic for a doctor to be familiar with every one of the thousands of rare conditions.
What is an improper diagnosis? ›What Is Misdiagnosis? A misdiagnosis of your injury or sickness means the doctor guessed wrong or misread your test results. Their wrong diagnosis might: Make your medical condition worse. Delay a correct diagnosis.
What are the hardest diseases to cure? ›cancer. dementia, including Alzheimer's disease. advanced lung, heart, kidney and liver disease. stroke and other neurological diseases, including motor neurone disease and multiple sclerosis.
Which disease is very difficult to diagnose but can be detected with MRI? ›Dementia
While no diagnostic test alone can diagnose dementia, MRI scans are used for Alzheimer's or other dementias to track the change of the disease over time. Because of its ability to track changes, MRI has been pivotal in dementia research.
According to a recent study, nearly 12 million outpatient U.S. people are misdiagnosed each year. This is 5% of adults or 1 in 20. According to the Society for the Improvement of Diagnosis in Medicine (SIDM), between 40,000 and 80,000 individuals die each year due to misdiagnoses.
What is the most common reason for misdiagnosis? ›
Patients not recalling symptoms accurately is one of the main causes that lead to misdiagnosis. There are also times when patients may not mention certain things that they don't think are important enough to warrant a doctor's attention – such as headache pain or fatigue.
What are the odds of being misdiagnosed? ›The actual percentages of misdiagnoses and missed diagnoses vs correct, accurate diagnoses, are difficult to determine, although experts put the rate at around 5% for outpatients. 2 Missed and misdiagnoses are rarely reported because there is no real mechanism for reporting them.