Medical misogyny is an urgent challenge for healthcare delivery in Australia. Here’s the problem and how to address it.
If you are a woman, especially one marginalised due to gender identity, sexual orientation, language, cultural or ethnic background, age, weight or appearance, you are more likely to face health inequities. Inequities can include access, quality and safety of healthcare, and health outcomes, as well as disparities in diagnosis.
Across all genders, misdiagnosis occurs in about 10-15 per cent of cases, and is frequently linked to breakdowns in communication. Women often feel unheard or like their symptoms are being dismissed, leading to delayed or incorrect diagnoses.
How women talk about their health and symptoms, and how clinicians react and engage in diagnostic communication with women and girls impacts the diagnostic safety of all women. Those who identify as women include cis – and transgender, intersex, non-binary, genderqueer and gender nonconforming people.
Historically, the whole gamut of symptoms women presented with – from pelvic pain, to headache, bouts of laughter or sadness – was attributed to ‘hysteria’, a term used to stigmatise women across the ages.
You might think that we have moved past hysteria as the diagnosis for anyone presenting with a uterus in 2023. But women experiencing pelvic pain, a common symptom of endometriosis, routinely have their pain discounted as ‘normal’ period pain. This leads to considerable delays in diagnosis, with some women going undiagnosed for over 10 years, resulting in years of suffering and potential fertility issues.
Women also often present with what are clearly physical symptoms only to be diagnosed with ‘stress’ or ‘mental health issues’. For these so-called ‘difficult’ patients, remnants of historical hysteria are alive and well in the 21st century.
Biased medical research and clinical assumptions about women relating to their appearance, weight and pain, also contribute to disparities in diagnosis and health outcomes. Women who have heart attacks can be misdiagnosed because they often do not display ‘typical’ (read male) symptoms. And even when they display typical symptoms and their heart attack is diagnosed correctly, they are less likely to receive the treatment they need.
Women who feel ill and have experienced substantial weight loss have died of undiagnosed Addison’s Disease. This tragedy occurs because they are seen as young, skinny and tanned and their weight loss is deemed unremarkable.
Women who are deemed overweight and are reporting pain are told to lose weight rather than have their symptoms thoroughly investigated. The stakes are even higher for transgender and nonbinary people, who face numerous barriers to healthcare access, including discrimination, stigma and lack of knowledge among healthcare providers.
It’s heartening to finally see women’s health inequity garner national attention after decades of anecdotal and scientific evidence. In 2022, the Australian Government established the National Women’s Health Advisory Council, recognising systemic medical misogyny as a critical problem and urgent challenge for healthcare delivery in Australia.
To address the cracks in the health system – across policy, delivery, research and education, we need to start with women. We need systems that listen to, value and respond to the knowledge that women have gained through struggling with health inequity, facing medical misogyny and dealing with undiagnosed disease.
Making use of women’s accumulated wisdom could look like:
Raising awareness of the challenges women encounter: we need greater public awareness of the risks and difficulties women face when seeking diagnosis and the importance of communication on both sides of the diagnostic encounter. Further research is urgently needed to identify practical steps to address bias in diagnostic processes and communication.
Healthcare delivery centring on listening: listening and attending to patients’ emotions can help to overcome threats of medical gaslighting, where patients feel doctors dismiss their concerns, contributing to a breakdown of trust.
Health research involving patient advocates and consumers: involving women with lived experience of delayed and inaccurate diagnosis as co-researchers in studies will provide invaluable insights into disparities in diagnosis and diagnostic error. Such collaboration will help researchers prioritise the issues that matter most to patients.
Medical education featuring women’s real life stories: this will help medical students understand illness from a woman’s perspective, highlighting the disparities in diagnosis that women can face.
By making use of women’s experiences and the difficulties they have faced in a strategic and empathetic way, the healthcare sector will be able to promote policy, care delivery, research and education that acknowledges and caters for the diverse experiences and needs of women.
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