Women suffer when gender bias interferes in medical field
Three new offerings share some personal ‘doctor stories’ and examine how sexism in daily life affects health care initiatives
A woman receives a breast cancer diagnosis and opts for a mastectomy — only for her doctor to object: “But you aren’t married.”
A young girl suffering from endometriosis, a condition in which uterine cells migrate to other areas of the body, is informed by her doctor that childbirth will ease the pain. “I’m only 11,” she later tells her support group, baffled.
A woman complains of vomiting uncontrollably, up to 100 times a night. She is offered antidepressants. When it finally occurs to a doctor to examine her further, to discover and perform surgery on her barely functioning gallbladder, she is on the verge of death.
These aren’t tales from the dark ages of medicine. They are ordinary modern realities documented in Maya Dusenbery’s well-researched, wonderfully truculent new book, “Doing Harm,” one of a cluster of new investigations into gender bias in medical treatment that also includes “Ask Me About My Uterus,” by Abby Norman, and “Invisible,” by Michele Lent Hirsch.
To put it kindly: These books are a mixed bag. Dusenbery, editor of the website Feministing, is the most capable writer of the bunch, and “Doing Harm” is an orderly blizzard of studies and statistics examining sexism at every level in medicine, from medical school admissions on up. Journalists Norman and Hirsch, on the other hand, offer up more personal takes — valuable if ungainly melds of memoir and reportage marked by excellent intentions and awkward prose.
In “Ask Me About My Uterus,” Norman recounts years of unexplained pain later discovered (by her) to be endometriosis. In “Invisible,” Hirsch looks at how chronic sickness reshapes the personal and professional lives of young women — while invoking the Job-like torments of her own
20s, when she endured thyroid cancer, hip surgery, Lyme disease and a rare condition called mast-cell activation syndrome, which could cause her to go into anaphylactic shock at any time.
Taken together, these three books tell an alarming story about how difficult it is for women to access quality care; particularly those women suffering from poorly understood autoimmune disorders.
This is hardly breaking news. One member of the feminist collective that produced the 1971 women’s health manual “Our Bodies, Ourselves” said that “everyone had a ‘doctor story’ — that is, a tale about male physicians who were sexist, paternalistic, judgmental or simply unable to provide the information women needed.”
These new “doctor stories” cut deep, especially in a moment when “believe women” has become a rallying cry. They feel linked to other instances of women’s voices being suppressed and belittled — in the accounts of assault and harassment emerging in the #MeToo moment, for example, or in the recent studies showing how frequently men interrupt women in meetings and how rarely women are quoted as experts. This is a crisis of authority, Dusenbery argues. Women are regarded as unreliable narrators who can’t even be trusted to speak for themselves or to testify to their own pain.
In “Doing Harm,” this cultural distrust of women — ancient and ingrained — is shown to govern quality of care at every stage of treatment. Women with abdominal pain wait in emergency rooms for 65 minutes compared with 49 minutes for men, and young women are seven times more likely to be sent home from a hospital while in the middle of a heart attack. Doctors rarely communicate (or understand) how drugs from aspirin to antidepressants affect women and men differently. Autoimmune disorders have been understudied because, as Hirsch points out, three-fourths of the patients are women and it is considered a woman’s ailment, never mind that 37 million people are afflicted, as estimated by the American Autoimmune Related Diseases Association. (In comparison, 15 million Americans have cancer.)
Women are consistently undertreated for pain, as one influential paper showed: Male patients are given pain relief while women, who are more likely to have their pain rated as “emotional,” are given sedatives. This also extends to children; a study of postoperative pain management found that boys were more likely to receive codeine and girls the gentler acetaminophen.
For women of color, especially black women, the situation is even more parlous. Black patients are 22 times less likely to get any kind of pain relief in emergency rooms. And Dusenbery reports on a disturbing 2016 study of more than 200 medical students who were presented absurd, madeup statements on race and medicine. Half gave credence to statements like: Black people have less sensitive nerve endings than white people.
Addressing such entrenched inequities requires more than bringing more women doctors into the fold. As Norman learns the hard way in “Ask Me About My Uterus,” women doctors are not immune from implicit bias. Nor will a greater number of women doctors make up for the fact that, to this day, men are the default objects of study for research. A 2005 study found that almost 80 percent of animal pain studies used only males. A 1986 study on the influence of obesity on breast and uterine cancer infamously failed to enroll any women in the study.
According to Virginia Woolf, writing about the sick body (“this monster,” “this miracle”) requires the courage of a lion tamer and the spirit of a philosopher.
Not all these books meet that exalted standard. But all three, despite their grim stories and projections, leave the reader galvanized, not despairing. Each of them ends on a similar note — calling for women to keep sharing their “doctor stories,” keep putting pressure on medical professionals to study women’s health and, in the meantime, for women themselves to learn how to advocate for their own care. Even as they recognize the burden that sick women must carry (Dusenbery: “Women should not be required to be more knowledgeable about women’s health than their doctors are”), they are each, in their own flawed, complicated way, the very intervention they seek.