Mind the gen­der pain gap

En­trenched sex­ist views on pain pre­vent many women from ac­cess­ing qual­ity health­care

Mail & Guardian - - Comment & Analysis - Kiri Ru­piah

As with pay, op­por­tu­ni­ties and pro­mo­tions, women get short shrift when it comes to their pain be­ing taken se­ri­ously. Women in pain get less treat­ment, wait longer for med­i­cal at­ten­tion and gen­er­ally get in­fan­tilised about their own wel­fare.

From an early age, women are taught to ob­serve ba­sic gen­dered so­cial codes — even at their own ex­pense. Be po­lite. Wait your turn. Don’t call at­ten­tion to your­self.

But with phys­i­cal pain, those codes evap­o­rate — the body has a loud, stark way of ask­ing for at­ten­tion.

The “gen­der pain gap” has a num­ber of se­ri­ous con­se­quences. Women in acute pain are left to suf­fer for longer in hos­pi­tals and they are more likely to be mis­di­ag­nosed as hav­ing men­tal health prob­lems — even when clin­i­cal re­sults show their pain ex­ists. Re­search shows that women are con­sis­tently al­lo­cated less time than men by hos­pi­tal staff be­cause men’s com­plaints are seen as more au­thor­i­ta­tive and rooted in logic.

Women’s suf­fer­ing has long been the source of con­jec­ture and ridicule; it is min­imised and ul­ti­mately coaxed into si­lence.

In a 2001 study in the United States, The Girl Who Cried Pain: A Bias Against Women in the Treat­ment of Pain, pub­lished in The Jour­nal of Law, Medicine & Ethics, Diane E Hoff­mann and Anita J Tar iden­tify ways gen­der bias tends to man­i­fest in clin­i­cal pain man­age­ment. 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’”, the study con­cludes — a phe­nom­e­non called the Yentl syn­drome.

This syn­drome is the dif­fer­ent pro­to­cols med­i­cal per­son­nel fol­low when treat­ing women and men for heart at­tacks. Med­i­cal re­search has fo­cused pri­mar­ily on the symp­toms of men’s heart at­tacks, and many women have died as a re­sult of mis­di­ag­no­sis be­cause their symp­toms of­ten present dif­fer­ently.

The name is from the 1983 film Yentl — adapted from an IB Singer story and star­ring Bar­bra Streisand. The main char­ac­ter has to mas­quer­ade as a man to get an ed­u­ca­tion.

The phrase was coined in 1991 by Dr Ber­na­dine Healy, in The Yentl Syn­drome, pub­lished in The New Eng­land Jour­nal of Medicine.

Healy, a car­di­ol­o­gist and the then direc­tor of the United States’ Na­tional In­sti­tutes of Health, cited coro­nary care as a par­tic­u­larly telling in­di­ca­tor of Yentl syn­drome. A woman has to ex­pe­ri­ence a full-scale heart at­tack be­fore she can get treat­ment equal to a man’s.

One rea­son for this dis­par­ity may be that doc­tors see women as be­ing more ir­ra­tional than men, and there­fore dis­miss their com­plaints about pain as be­ing all in their heads, rather than phys­i­cally man­i­fested.

In the 1982 study Women with Pain, pub­lished in Chronic Pain: Psy­choso­cial Fac­tors in Re­ha­bil­i­ta­tion, J Crook and E Tunks found that women with chronic pain are more likely to be mis­di­ag­nosed with men­tal health con­di­tions than men, be­cause doc­tors dis­miss women as hys­ter­i­cal. On the other hand, when men say they’re in acute pain, doc­tors take their pain as hav­ing a “le­git­i­mate” source.

Another dis­turb­ing trend med­i­cal re­search has found is that the more “at­trac­tive” med­i­cal staff per­ceive a pa­tient to be, the less ag­gres­sive treat­ment they re­ceive.

In the 2016 re­search pa­per Beau­ti­ful Faces in Pain, Thomas Had­jis­tavropou­los found that, be­cause of a “beau­ti­ful is healthy” stereo­type, doc­tors as­sume peo­ple who look “bet­ter” are health­ier and re­quire less treat­ment. This can have dis­as­trous re­sults for peo­ple pre­sent­ing with symp­toms that may not man­i­fest phys­i­cally or that re­quire MRIs or CT scans.

Be­cause of sex­ist staffing hi­er­ar­chies, es­pe­cially in a field in which men are per­ceived to be more com­pe­tent, men are more likely to be the ones mak­ing de­ci­sions about pa­tients.

Is it pos­si­ble that they underestimate women’s pain as a re­sult of this “at­trac­tive­ness” bias?

The dis­in­cli­na­tion to take women’s pain se­ri­ously is not new. It is deeply rooted in the his­tory of mod­ern al­lo­pathic medicine. Di­ag­noses of hys­te­ria, a rem­nant of Vic­to­rian-era medicine, at­trib­uted many com­plex women’s health is­sues to psy­cho­log­i­cal dis­or­ders.

There are in­nu­mer­able women’s sto­ries of how pain, in­clud­ing men­strual cramps and even pain in child­birth, was dis­missed as fab­ri­cated or ex­ag­ger­ated.

The med­i­cal fra­ter­nity has long prided it­self on pro­vid­ing im­par­tial care, based on its reliance on sci­en­tific fact. But re­searchers and ac­tivists sug­gest that sex­ism may be per­pet­u­ated in hos­pi­tal wards and op­er­at­ing rooms just as much as any­where else in so­ci­ety.

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