Gender-biased diagnosing is the idea that medical and psychological diagnosis are influenced by the patient's gender. Several studies have found evidence of differences in diagnosis for individuals with similar ailments but of different sexes. Female patients face discrimination through the denial of treatment or miss-classification of diagnosis as a result of not being taken seriously due to stereotypes and gender bias. For women of color, gender bias intersects with racial bias, potentially leading to greater disparities in medical treatment. Many historical medical studies were done on men thus overlooking many issues that were related to women's health. This topic alone sparked controversy and questions about the medical standard of our time. Popular media has illuminated the issue of gender bias in recent years. Research on diseases affecting women more was less funded than those affecting men and women equally.
Medical bias The possibility of gender differences in experiences of pain has led to a discrepancy in treating female patients' pain over that of male patients. The phenomenon may affect physical diagnosis. Women are more likely to be given a diagnosis of psychosomatic nature for a physical ailment than men, despite presenting with similar symptoms. Women sometimes have trouble being taken seriously by physicians when they have a medically unexplained illness, and report difficulty receiving appropriate medical care for their illnesses because doctors repeatedly diagnose their physical complaints as related to psychiatric problems or simply related to female's menstrual cycle.
Clinical offices that rely on healthcare routines become less distinct due to biased medical knowledge of gender. There is a distinct differentiation between gender and sex in the medical sense. Because gender is the societal construction of what femininity and masculinity are, whereas sex refers to the biological characteristics that differentiate female and male. The way of lifestyle and the place in society are often considered when diagnosing patients.
An example of a specific condition from which an extreme gender bias and differential medical attention and treatment can be noted is that of Cardiovascular disease. Of this condition, Coronary heart disease is the most prevalent; with women more often than men reported as fatalities. For example, women who are experiencing a heart attack are seven times more likely to be misdiagnosed and released from the hospital during the heart attack. This difference is often because women generally experience different heart attack symptoms, like flu-like symptoms, than men. Due to sex based medical prerogatives, women tend to be more concerned with their primary and secondary sex health characteristics; i.e., gynecological health and breast health especially in terms of cancer; as opposed to heart health. Furthermore, mortality rates of women have increased since 1979; whereas men's conversely have displayed a decline. This can be attributed to differential treatment, specifically; preventative measures, refined diagnostic techniques and advanced medical and surgical capabilities that are directly catered to men's health. One proposed explanation of gender bias pertaining to cardiac concerns and treatment is that men are more likely report or assume symptoms to be cardiac related than women, i.e., stress, (in stressful situations, personal situations or as a controlled variable); however these hypothesis were found to be inconsistent. When addressing women's health in relation to cardiovascular health, sexed based differences are imperative in acknowledging in order appropriately diagnose and treat symptoms. Specific diagnostic criteria for assessing women's cardiovascular health include: evaluating for high levels of triglycerides/low levels of HDL cholesterol (after menopause), diabetes, smoking, metabolic syndrome, gestational diabetes, and pre-eclampsia.
Sex Differences and Clinical Trials Men and women are biologically different. They differ in the mechanical workings of their hearts and in their lung capacities, resulting in women being 20-70% more likely to develop lung cancer. The differences between men and women are also seen at the cellular level. For example, the ways immune cells convey pain signals are different in men and women. As a result of these biological differences, men and women react to certain drugs and medical treatments differently. One example is opioids. When using opioids for pain relief, women and men have different reactions. Surveys of the literature also conclude that there is a need for more clinical trials that study the gender specific response to opioids.
Although there is evidence pointing to the biological difference between men and women, historically women have been excluded from clinical trials and men have been used as the standard. This male standard has its roots in ancient Greece, where the female body was viewed as a mutilated version of the male body. However, the male bias was furthered in the United States in the 1950s and 60s after the FDA issued guidelines excluding women of childbearing potential from trials to avoid any risk to a potential fetus. Additionally, the thalidomide tragedy led the FDA to issue regulations in 1977 recommending that women should be excluded from participating in Phase I and Phase II studies in the US. Studies also excluded women for other reasons including that women were more expensive to use as test subjects because of fluctuating hormone levels. The assumption that women would have the same reaction to the treatments as men was also used to justify excluding women from clinical trials.
However, more recent studies have shown that women respond differently to a variety of common drugs than men, including sleeping pills, antihistamines, aspirin and anesthesia. As a result, many drugs may actually pose health risks to women. For example, a 2001 study conducted by the Government Accountability Office about drugs removed from the market between 1997 and 2000 showed that "Eight of the 10 prescription drugs posed greater health risks for women than for men."
Pain bias In recent decades, there has been increasing attention given to the disparity between the treatment of pain in females compared to males. Chronic pain is more prevalent in women than in men, and women report more severe, frequent, and prolonged cases of pain; however, they are less likely to receive adequate health treatment. Over 90% of women with chronic pain believe that they are treated differently by healthcare professionals because of their gender.
Providers are also more likely to under-estimate female patientsʻ pain compared to males' pain. Studies show that physicians often perceive women's complaints as emotional responses rather than physiological pain. Women are often referred to psychiatrists for treatment, and prescribed sedatives or psychotherapy medications. In addition, women are less likely to be prescribed painkillers after surgeries, according to several studies conducted in the 1980s. 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.
There are still gendered attitudes towards reporting uncontrolled pain to a healthcare provider. An exploratory study in 2020 found that women are more likely to advocate for themselves and use more varied self-advocacy strategies. However, this finding is contradictory, as women actually receive less pain treatment and experience worse health outcomes than men.
Western cultural recognition of pain bias As the issue of pain bias becomes more popular, media coverage of the topic has also increased. In 2014, the National Pain Report conducted an online national survey of almost 2,600 women with a variety of chronic pain conditions. 65% felt that their pain was being given inadequate attention because they were female, and 91% believed that the health-care system discriminated against women. Nearly half of the women were told that their pain was psychological, and 75% were told they must learn to deal with the pain. In 2015, The Atlantic published an article about a woman's experience with acute abdominal pain. She had to wait almost two hours at the emergency room before receiving treatment, but she endured the pain longer than necessary due to a misdiagnosis. In the United States, women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain, while men only wait 49 minutes. A 2019 article published by The Washington Post references a 2008 study that supports the statements made in 2015 The Atlantic article.
Consequences of bias A study from NIH regarding aversion to medical attention shows 33.3% of participants receiving "unfavorable evaluations", largely deriving from skepticism in physician care. Experience and historical misdiagnosis/misrepresentation in healthcare leads to apprehension towards medical care such as avoidance to medical attention for a prolonged period of time. Oftentimes this results in medical conditions worsening or going untreated, potentially leading to higher rates of mortality. This may exhibit itself as iatrophobia or an extreme fear of healthcare. Though primarily an Anxiety disorder, it derives from fear of malpractice or death, it affects 12% of adults and 19% of children.
Even when they are not discouraged from seeking healthcare, women oftentimes do not receive adequate care for their medical issues. 1/10 women must see their primary healthcare provider ten or more times before they are able to receive treatment, especially for issues relating to menopause. However, some women are unable to find medical help despite repetition of visits; a study published in the British Medical Journal found that over half of women with chronic pain reported not receiving effective care for it, even after visiting 6+ different medical facilities.
The dismissal of symptoms women often face from their providers can be dangerous as well, with symptoms indicative of a severe condition being ignored or misattributed to something less serious. 13,000+ women and AFAB nonbinary people from Victoria, Australia reported having severe symptoms dismissed by health providers. These accounts came from people across all ages, indicating that this dismissal is not specific to one age demographic. Moreover, a study conducted by Harvard Health found that women are significantly less likely to be sent to a cardiac specialist when exhibiting symptoms of heart disease than men, demonstrating either a lack of competency when it comes to women's health, or a purposeful bias preventing women from receiving adequate medical care.
Psychological diagnosis Studies have shown that gender bias exists in many psychological areas. Primarily, it can appear within the caregiver assigning the diagnosis, particularly if that caregiver is male. A Polish study conducted in 2016 gave clinical therapists identical case files, with the one difference being gender of the patient. While female therapists tended to diagnose the same regardless of gender, male therapists were more likely to assign a more severe diagnosis and recommend professional treatment if they were told the patient was female.