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Friday, Mar 31, 2023

The Gender Health Gap: the scandal of sexism in medicine

The Gender Health Gap: the scandal of sexism in medicine

Dr Marieke Bigg’s new book on the gender health gap is inspired by her own experiences of medical inequality, she explains to Claire Cohen

I experienced a moment of extreme emptiness,” recalls Dr Marieke Bigg of her moment of realisation at the gynaecologist. “It came from the gaping void in my vocabulary. It came from my sense of utter disconnection from the process unfolding at the other end of the inspection table. It came from not knowing what was wrong with me. From not even knowing what my doctor was looking for.”

Her diagnosis? Medically speaking, pretty inadequate (“Might be endometriosis, he suggested, and casually offered me keyhole surgery”). But Bigg, a 30 year-old sociologist, has used her experience — one that will unfortunately be familiar to many women — to write a ground-breaking new book, This Won’t Hurt, about the medical sexism and gaslighting that women experience every single day.

“Part of my interest was academic, but then it was also personal,” she says. “I had a few quite jarring experiences trying to get the gynaecological care I need and that got me reflecting on my experience of medicine more generally and of my body out in the world.

“Women feel unheard, misunderstood and dismissed in situations where they go and see a medical professional. It’s a sense that your experience is not being taken seriously, is not being heard and isn’t being investigated.”

It was even more personal, given that Bigg is the daughter of two medics — a Dutch GP mother and an English anaesthetic nurse father. She was raised between Salisbury and the Netherlands, and now lives in Hackney with flatmates.

“The more I looked into this issue,” she says, “the more my feelings became those of frustration, anger and just feeling dumbfounded at the extensiveness of this among women.”

Dr Marieke Bigg

The numbers back this up. Last year, a survey of 2,000 UK women by health platform Livi found that over half (57 per cent) felt they hadn’t been diagnosed correctly by a healthcare professional. It takes an average of eight years to diagnose endometriosis — a painful condition where the womb lining grows elsewhere in the body, and which affects one in 10 women. Sufferers report being fobbed off; told that their symptoms are “just life” or they have “bad periods”. You only need scroll through the social media hashtag #shitmydoctorsays to find countless examples of women being made to feel as though they are exaggerating their pain, or dismissed entirely.

From the woman who suffered for two years with a severe birth injury being told by a male GP “you just need to find joy”; to the woman diagnosed with stage 4 breast cancer after being sent away three times by a GP who said “it’s probably just hormones”; and the woman who, when she told her doctor she’d come off the Pill because it was making her feel miserable, was told, “Oh yes, lots of women say that, but I don’t believe them.”

Of course, men can also be misdiagnosed and we know that they tend to be more reluctant to visit the doctor than women. But there’s a wealth of evidence that points to women being more likely to receive the wrong diagnoses than men, being twice as likely to get a mental health diagnosis for a physical problem than men, waiting far longer for diagnoses of heart disease, cancer and dementia, and being denied pain relief in A&E more often than men.

A study by men’s health platform Manual, in 2021, revealed that Britain has the 12th highest female gender health gap globally — meaning that women have poorer health outcomes across their lives than men, something they attributed to “the misdiagnosis of women’s symptoms”.

“This medical dismissiveness towards their problems means that rather than pointing to inadequate medical support, women tend to blame themselves,” Biggs writes.

The problem, she says, starts right at the top of medicine and trickles down into your GP’s consulting room. There’s a lack of research and funding for women’s health — which isn’t seen as “sexy” or a potentially Nobel Prize winning area. The majority of researchers and those on funding bodies are male, which impacts what gets green-lighted in the first place. The “default” human body on which trials are conducted is male — because of apparently hard-to-read fluctuating hormones women were often excluded from clinical drug trials until the 1990s, something which has been slow to change.

As Bigg puts it, “men are represented more than women at every single level. This power imbalance determines who is heard and which bodies matter. Sexism is woven into the fabric of medicine as we know it.”

One consequence of that, she thinks, is that our definition of “women’s health” is too often tied to our reproductive usefulness. “That becomes very explicit in your thirties as you move towards the childbearing window, “ she says, with clear frustration. “My gynaecologist seemed more interested in when I was having any children — I’m single — than investigating my health issues.”

Indeed, it would be a mistake to imagine that medical gaslighting applies only to gynaecological conditions. From heart problems to cancers, dementia, brain tumours and autoimmune conditions, there are many diseases where women make up the majority of sufferers yet are diagnosed later than men. In 2016, for example, the Brain Tumour Charity warned that women were being called attention-seeking or “tired” by doctors, leading to late diagnosis of tumours. Other studies have shown that women are less likely to be given pain relief while waiting in A&E.

Heart disease is perhaps the biggest: killing twice as many women in the UK annually as breast cancer. Yet, an Imperial College London study found that, over the past two decades, 12,000 women have been denied appropriate care because of a gender bias, with many dying as a result. Women in the UK are 50 per cent more likely to receive a wrong initial diagnosis than men, with heart attacks dismissed as panic attacks, indigestion or heartburn.

“Women don’t present in the same way as men, with the classic chest pain,” says Bigg. “A lot of the symptoms are very similar to menopause — hot flashes or sweating. So women are often dismissed by doctors and the longer it takes for them to diagnose a heart attack, the more detrimental it will be. Without a doubt, medical gaslighting is putting women’s lives at risk and causing unnecessary deaths.”

She is, however, wary of demonising male doctors. “My mum is a GP, but when I talk about this, she gets quite defensive. But what I try to tell her is that it’s not a personal criticism. I’m not attacking male doctors. I’m very grateful that there are people trying to care for us. I’m saying that this inequality is baked into the system and that unless we take responsibility for trying to change that, we’re complicit.”

So what does change look like? In her book, Bigg highlights individual pioneering scientists and applauds the appointment, last year, of Dame Lesley Regan as the Government’s first Women’s Health Ambassador. But she admits that systemic change is too slow. “There are really simple things that could be done tomorrow. Starting with health checks for women throughout their lives, rather than just when having children, or sending cervical cancer tests to women’s houses. The internet and Femtech apps have so much potential to support women’s healthcare, but nothing can replace the need for medical help.”

In the meantime, she hopes that by arming women with this knowledge, they can better advocate for themselves. “Just having these experiences of being dismissed validated I hope will give women the confidence to push to be taken seriously and see another doctor if they need to,” she says. “That’s all you can do. It’s medicine that needs to change, not women.”


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