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Thought Leadership

Diagnosis delayed: Ending the gender bias in healthcare

By Onyx Health | 23rd May 2022

Read Time: 4 minutes

 

The male domination of the medical profession isn’t just an institutional inequality issue; it has serious consequences for women’s health. Gender-based disparities in diagnosis and care have been a recurrent theme throughout my career and the personal experiences of my friends and family. A growing body of research is now exploring how unconscious biases contribute to gender inequalities in medical treatment and women’s experiences of healthcare.  

Women often experience significant delays in diagnosing long-term female conditions, such as endometriosis1, but this extends well beyond the boundaries of what is traditionally considered women’s health. The term women’s health often contains a gender-coded bias and the assumption that this is limited to reproductive, perinatal, menopause health and female dominant or specific cancers such as breast or cervical cancer.  

However, the reality is far more expansive. Health conditions such as cardiovascular disease, diabetes, and strokes manifest differently in women.  

Silenced and dismissed – women aren’t heard in healthcare 

In the 2021 York University, National Institute for Health and Care Research (NIHR) sponsored study Women’s priorities for women’s health: a focus group study.1 It highlighted that women believe healthcare professionals did not always hear them; they shared experiences of feeling brushed off and felt clinicians diminished their symptoms and concerns. There was a clear perception that women’s health problems were not always taken seriously. Clinicians had preconceived expectations of an appointment dependent on the women’s age and blamed the pill, pregnancy or menopause when women presented with symptoms1. As one participant put it 

“It gets brushed off like it’s not a big thing because everyone has to do it, so… it’s as if you’re being dramatic if there is a problem.” 

“There’s a tendency for health professionals to confuse what’s common with what’s normal. So, you go to them with a problem, and their answer is ‘oh, but’ ‘that’s really ‘common’…. And that doesn’t mean that it’s OK or that it’s normal and my body should be doing this.”1 

Added to this bias is that women perceive asking for a more sympathetic female clinician makes them look awkward.1 There are significant barriers to women getting the outcomes from the healthcare system they need. 

The diagnosis deficit– the potentially fatal consequences of ignoring women’s symptoms 

One of the biggest issues women experience is the drastic disparity in diagnosis rates and subsequent treatment for health conditions compared to men. In 2019 Westergaard et al. showed that even where there is equal and uniform access to healthcare, there is a marked difference between the diagnosis of diseases affecting men and women. For 770 disease types considered as part of the study, they showed an overall gap of four years in diagnosis between women and men, which can have potentially fatal consequences.2 

A good example of this is bladder cancer, where women are more likely than men to be diagnosed at an advanced stage. This creates gender inequalities in relative survival, as women have a substantially worse 5-year relative survival than men (57% vs 44%, respectively).3  This is because haematuria (blood in the urine), a key indicator of the disease, is often interpreted differently by general practitioners depending on the patient’s gender and internal biological makeup rather than a more serious underlying condition.   

Similarly, women face an increased risk of presenting non-focal symptoms during acute stroke or transient ischemic attacks, such as confusion, impaired consciousness, headache, and generalised weakness4. This also includes symptoms such as chest pain and palpitations, which can mistakenly be interpreted as a conversion disorder or a migraine attack.4 It has been hypothesised that this is, at least in part, due to misdiagnosis with subsequent delays. 

There are systemic reasons for this, which stem from the lack of female representation in clinical trials. As we have previously discussed on the OH blog, clinical trials have predominantly been carried out on male populations. This has led to a bias toward the male presentation of symptoms and the normalisation of a male archetype in treatment diagnosis. This patriarchal bias is deeply ingrained in the system and must be fundamentally challenged to give women’s health the equal standing it deserves.5 We need a paradigm shift in women’s health 

This problem can’t be solved with a quick fix and requires a long-term cultural shift. It’s OK to for women speak up or seek a second opinion if their health is on the line; we shouldn’t be treated as difficult patients. However, women having a great voice is only part of the story. We need a structural, systemic change in how the medical establishment views women’s health issues. Clinicians need to be better allies to women, more receptive to their concerns, and more clinically attuned to how their specific symptoms are different from the male norm. It’s time women’s health was put on an equal footing with men’s health; our nation’s future depends on it.  

 

References: 

1. Essex H, Cream J, Hanratty B, Jefferson L, Lamming L, Maharani A, et al. Women’s priorities for women’s health: a focus group study [Internet] December 2021. https://www.york.ac.uk/media/healthsciences/images/research/prepare/reportsandtheircoverimages/Womens%20Priorities%20for%20Womens%20Health%20-%20a%20focus%20group%20study.pdf Accessed May 2022 

2. Westergaard D, Moseley P, Sørup FKH, Baldi P, Brunak S. Population-wide analysis of differences in disease progression patterns in men and women. Nat Commun. 2019;10(1):666. Published 2019 Feb 8. doi:10.1038/s41467-019-08475-9 

3. Hollenbeck BK,  Dunn RL,  Ye Z,  et al. . Delays in diagnosis and bladder cancer mortality. Cancer 2010;116:5235–42. 

4. Ali M, van Os HJA, van der Weerd N, Schoones JW, Heymans MW, Kruyt ND, et al. Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis. Stroke (2021). https://doi.org/10.1161/STROKEAHA.120.034040Stroke. 2022;53:345–354 

5. Perez, Caroline Criado.  Invisible Women. Vintage: London 2019.  

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