Gender Bias in Health Care

This article discusses the very real adverse health consequences of gender bias in healthcare. Though women represent more than 50% of the population, due to our gender we are more likely to die from a heart attack, be under treated for pain and we are 75% more likely to experience adverse drug reactions. As nurses, we are in a prime position to recognize bias when it occurs, advocate for our patients and provide education as we move forward to more fair and equitable healthcare.

Gender Bias in Health Care

NOT JUST HURT FEELINGS

Back when I was working on a master’s in molecular biology, I compared my exam results with a male student (I was the only female in the class). I discovered that though he and I had given the same answer, I had been given a lesser grade. When I approached the professor, he patted me on the head and told me to stop worrying. After taking my grievance to the department chair, my grade was changed, but I will never forget how it made me feel. Maybe I was wrong? Maybe I was making a big deal out of nothing? It hurt, but I got off easy - now we are discovering that being the victim of gender bias can hurt more than your feelings, it can kill you.

“You’re just stressed out. You’re just another anxious, young, type-A female student. Take a deep breath. Maybe you need antidepressants or anxiety medicine.” In an interview with the Today show, Laurie Edwards shared some of the things she was told in her journey to being diagnosed with a chronic and rare lung disease. She had been told for years her symptoms were all in her head.1

In another story, Annalise Mabe went to a male OB-GYN to check on a health issue. After disclosing her symptoms and past history, she said her physician, “was really judgmental and said things like, ‘You are wild and crazy, huh?’” She says the doctor made jokes and assumptions about her sleeping around, despite the fact that she had actually been through a sexual assault. “He discounted my input and suggested that I was getting my information from WebMD.” She told him she had already had a full annual exam and he said, “No, you didn’t” and proceeded to give her one.2

DEFINITION

Gender bias is defined as “prejudice in action or treatment against a person on the basis of their sex.”3 Gender bias results in situations where patients are assessed, diagnosed and treated differently and at a lower quality level because of their gender than others with the same complaints. It can also manifest as an assumption that males and females are the same when the sexes have differences that need to be addressed.4

Research shows that health care professionals treat women with the same amount of bias as the general population, despite the healthcare mandate that everyone be treated with dignity and respect. Presumably a doctor should be trying to save a patient’s life regardless of gender.2

EVIDENCE

  • Women are 3 times less likely than men to receive knee arthroplasty despite comparable indications.3
  • Heart disease is the number 1 killer of women. Women are twice as likely as men to die in the year following an MI. Only 40% of women receive a heart attack risk check as part of routine care.1 In a study of 500,000 heart attack patients from 1991-2010, it was found that women are less likely to survive when treated by male physician. There is no physical reason women should die at higher rates than men. When women receive the same therapies as men, odds for survival are the same.6
  • During routine visits, young women are more likely to be told to lose weight. Young men who are actually overweight are more likely to be put on preventative therapy.4
  • Women are 75% more likely to have an adverse drug reaction than men.1
  • It takes an average of nine years for women to be diagnosed and treated for endometriosis – healthcare providers think patients are exaggerating their pain.5
  • Women receive less effective pain relief than men, are given less pain medications and more mental health referrals. Medically unexplained conditions like fibromyalgia correlate with professionals being unwilling to believe in women’s pain. When pain is the only reported symptom, women have to work hard to be taken seriously, believed and understood.7
  • In a study of medical coding, charts describing women were assigned a lower level of service than men in patients with asthma and rheumatoid arthritis.8
  • Lab studies? Mostly male animals have been used.4
  • Patients, regardless of gender, fare better under the care of women physicians.2
  • Other areas of gender bias include: peripheral arterial disease, behavioral health, stroke, chest pain, organ donation and transplantation, trauma patient triage. For a more in-depth analysis, please read the Alspach article in Critical Care Nurse.3

WHY DOES GENDER BIAS EXIST?

A wide variety of reasons for gender bias exist3:

  • Underestimation of women’s risk
  • Differences in symptoms between genders
  • Differences in self-perception
  • Willingness to discuss symptoms
  • Style or manner of discussing symptoms
  • Unconscious prejudice or stereotyping
  • Overt discrimination based on gender

We don’t really know which of these factors plays a greater role. The answers to solving gender bias quite possibly lie in solutions.

SOLUTIONS

The Times Up movement announced in February of 2019 the launch of Time’s Up Healthcare. The goal is to tackle discrimination, harassment and inequality across the health care industry. Backers include the American Nurses Association, Mayo Clinic, and multiple medical schools, though the American Medical Association is notably absent.5

Recommendations

  • Recognize the problem: awareness of the existence of implicit biases is an important first step toward minimizing their potential effect. JAMA. We need qualitative and quantitative assessments of our healthcare culture.
  • Conduct more research with women: The NIH now requires female subjects in clinical trials, but research funded by private medical companies is exempt. However, more and more journals will not publish research unless it includes female subjects.9
  • Educate healthcare professionals: The NIH is doing educational outreach to physicians and pharmacists about gender bias, medical journals are requiring researchers to include females in studies. When male physicians work in hospitals where they have more female colleagues, they are better at treating female patients and the gender disparity drops.6, 9

WHAT CAN WOMEN DO?

  • Ask if the drug you’ve been prescribed has been studied in women
  • Ask how accurate the medical test you’ve been ordered is for women
  • Listen to your gut, get a 2nd or 3rd opinion, and be willing to walk away if you aren’t getting the care you think you need.

References

  1. Gender bias in health care may be harming women’s health: What you need to know.
  2. New paper examines how gender bias in health care can be deadly
  3. Is there gender bias in critical care?
  4. Exploring gender bias in healthcare
  5. Time’s up sets its sights on gender bias and harassment in health care
  6. Patient-physician gender concordance and increased mortality among female heart attack patients
  7. “Brave Men” and “Emotional Women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain
  8. An online experiment to assess bias in professional medical coding
  9. A framework for integrating implicit bias recognition into health professions education
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SafetyNurse1968

About SafetyNurse1968, BSN, MSN, PhD

Patient Safety Columnist / Educator

Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is also a mother of four who loves to write so much that she would probably starve if her phone didn’t remind her to take a break. Her work experiences as a hospital nurse make it easy to skip using the bathroom to get in just a few more minutes on the computer. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses.com. You can also get free Continuing Education at www.safetyfirstnursing.com. In the guise of Safety Nurse, she is sending a young Haitian woman to nursing school and you can learn more about that adventure: https://www.gofundme.com/rose-goes-to-nursing-school

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Specializes in ICU, Home Health and Hospice.

Very informative article! I recently had a patient in homecare who had her knee replaced after YEARS of practically begging for it. It took them several years to even X-ray it. She said she always felt ignored. Meanwhile, a male patient I know who is obese is basically being handed a knee replacement and has not been asked to lose weight first.

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Specializes in Cardiology.

Im a young male (33) who is overweight and Ive been told to lose weight. I haven't been offered anything other than a consult with a nutritionist/dietician and to exercise. Heart disease is also the #1 killer for men btw.

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Specializes in Gastrointestinal Nursing.

This has been going on for decades. About 10 years ago, I asked an Anesthesiologist why on their pre-surgical orders have different guidelines for men than women in regards to EKG. She told me that is is just how it is. The criteria was different regarding ages for routine EKGs preop. Men got one at a younger age than women. Made no sense to me.

Very good article, thank you!

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This is a great article, thank you!

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Specializes in Education, Informatics, Patient Safety.
On 10/2/2019 at 7:36 AM, OUxPhys said:

Im a young male (33) who is overweight and Ive been told to lose weight. I haven't been offered anything other than a consult with a nutritionist/dietician and to exercise. Heart disease is also the #1 killer for men btw.

I hear you. It sounds like you are having a frustrating experience with healthcare. The point of the article was to show disparities that exist towards women. These statistics certainly don't negate the individual experience that each person has.

On 10/2/2019 at 7:22 PM, Brenda F. Johnson said:

This has been going on for decades. About 10 years ago, I asked an Anesthesiologist why on their pre-surgical orders have different guidelines for men than women in regards to EKG. She told me that is is just how it is. The criteria was different regarding ages for routine EKGs preop. Men got one at a younger age than women. Made no sense to me.

Very good article, thank you!

Thanks for pointing this out - I will look into it - I keep thinking "we've come so far" and then I read stories like these and I feel a bit overwhelmed. We can't give up though. What ideas do you have for creating positive change?

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Specializes in Education, Informatics, Patient Safety.
On 10/1/2019 at 6:25 PM, Emm_RN said:

Very informative article! I recently had a patient in homecare who had her knee replaced after YEARS of practically begging for it. It took them several years to even X-ray it. She said she always felt ignored. Meanwhile, a male patient I know who is obese is basically being handed a knee replacement and has not been asked to lose weight first.

Thank you so much for reading my article and sharing a personal story. It's stories like these that make the numbers feel a bit more real. What ideas do you have for changing up this reality?

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I almost didn't read your article because I was being biased and expecting another "woe is me because I'm a woman" article that I often find annoying. However, I greatly appreciate your very straightforward presentation of a clear issue in our system. Unfortunately I do not have an answer to these problems, but I will now be more aware as I continue through my education and career.

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On 10/2/2019 at 4:22 PM, Brenda F. Johnson said:

This has been going on for decades. About 10 years ago, I asked an Anesthesiologist why on their pre-surgical orders have different guidelines for men than women in regards to EKG. She told me that is is just how it is. The criteria was different regarding ages for routine EKGs preop. Men got one at a younger age than women. Made no sense to me.

Very good article, thank you!

Men are at risk of a heart attack at an earlier age than women.

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On 10/1/2019 at 9:02 AM, SafetyNurse1968 said:

Patients, regardless of gender, fare better under the care of women physicians

The source you cite does not support a conclusion this broad. It's an article linking to studies of gender concordance in treatment of acute MI (already noted elsewhere, but here's the direct link: https://www.pnas.org/content/115/34/8569 ), and to a study specifically of hospitalized medicare patients treated by male vs female hospitalists (which is, for whatever it's worth, a very interesting study that appears to perform enough factor analysis to point to a real difference in practice and outcomes between male and female hospitalists for that population - here's a direct link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255 ). Other specialties and patient populations are not studied or mentioned.

More broadly, disparities in healthcare access, outcomes, etc, are an opportunity to study the factors that may cause those disparities, develop improved education and practice guidelines, and improve access and outcomes in this way. While pointing out these disparities is of course necessary and welcome, I worry a bit when I see conclusions that aren't supported by the data cited. I agree wholeheartedly with the OP's call for research. If you want to improve outcomes, you gotta do the factor analysis and report the results accurately.

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Specializes in Education, Informatics, Patient Safety.
On 10/11/2019 at 10:51 AM, Cowboyardee said:

The source you cite does not support a conclusion this broad. It's an article linking to studies of gender concordance in treatment of acute MI (already noted elsewhere, but here's the direct link: https://www.pnas.org/content/115/34/8569 ), and to a study specifically of hospitalized medicare patients treated by male vs female hospitalists (which is, for whatever it's worth, a very interesting study that appears to perform enough factor analysis to point to a real difference in practice and outcomes between male and female hospitalists for that population - here's a direct link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255 ). Other specialties and patient populations are not studied or mentioned.

More broadly, disparities in healthcare access, outcomes, etc, are an opportunity to study the factors that may cause those disparities, develop improved education and practice guidelines, and improve access and outcomes in this way. While pointing out these disparities is of course necessary and welcome, I worry a bit when I see conclusions that aren't supported by the data cited. I agree wholeheartedly with the OP's call for research. If you want to improve outcomes, you gotta do the factor analysis and report the results accurately.

Thank you for pointing out my error. I appreciate your thorough response.

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