Navigating the Healthcare Maze: The Public Health Crisis Faced by Women
It's no secret that the medical landscape is a challenging terrain, but for women and minorities, it often feels like navigating a minefield. Women, and particularly women of color, often encounter a complex web of skepticism, dismissal, and sometimes, overt discrimination. Central to this issue is the phenomenon of 'medical gaslighting,' a term that refers to the dismissal or minimization of a patient's symptoms, pain, or concerns by health professionals.
What is gaslighting?
At its core, medical gaslighting is a form of psychological manipulation where a patient is led to doubt their own experiences and perceptions of their health. This can manifest in various ways - from outright denial of symptoms to trivializing them. And while it's an issue that can impact anyone, women and minorities have been disproportionately affected.
By the Numbers: A Glimpse into the Prevalence of Medical Gaslighting
While concrete statistics on medical gaslighting are challenging to pinpoint, anecdotal evidence and several studies suggest a concerning trend:
- A significant number of women with chronic pain conditions have reported instances of being told their pain was "all in their head" or "exaggerated." Being a chronic pelvic pain specialist, I have heard thousands of the same story all revolving around patients being dismissed by their doctors. Instead off addressing their concerns they give medical advice that borderlines on malpractice due to flippant and non-evidence based nature of it.
- Women experiencing menopause often report feelings of dismissal or lack of adequate information when seeking medical guidance. This is despite numerous studies having shown the significant positive impact that hormone replacement therapy has for patients undergoing menopause. Despite this only 10% of doctors deliver this life saving care. Many people seeking menopause care are told to suffer in silence.
- Strikingly, women are seven times more likely to be misdiagnosed and discharged in the middle of having a heart attack. Their symptoms, which can differ from those of men, are frequently minimized or misinterpreted.
A Look Back: The Gendered History of Medicine
Have you ever wondered why this is the case? It's imperative to trace back the roots of this issue to the history of medicine itself. Historically, medical knowledge, research, and practices were dominated by white, cisgender, heterosexual men. Consequently, they became the "standard" patient, with everyone else considered a deviation or an outlier.
For decades, the medical field operated under a one-size-fits-all approach. Until the 1990s, women were largely excluded from clinical trials. It wasn't just an oversight but a deliberate choice. The NIH, for example, banned women from most clinical research until 1993, citing concerns about potential effects on reproductive health. This exclusion had perilous consequences, leading to misinformed treatment recommendations, misdiagnoses, and tragically, avoidable deaths.
The Women's Health Policy Act of 1993 marked a turning point, mandating the inclusion of women in clinical research. However, even today, women represent less than a quarter of participants in many trials.
Moreover, even in fundamental medical research—often termed "basic science"—studies were primarily conducted on male animal subjects. The reason? Female biology was considered "too complex" due to hormonal fluctuations. THUS THE FOUNDATIONS OF WHAT HAPPEN IN WOMEN’S BODIES STILL ISN’T KNOWN.
Why Research Matters?
If we examine the role of science and policy - they go hand and hand together. Although we like to believe that science is apolitical and objective- the scientists doing the research are political and bring their own individual bias and beliefs when interpreting data. If you look at the societal context of women in history, it was one of oppression and dismissal. We were treated as second class citizens without bodily autonomy of function outside of reproduction. That is the cultural lens that the field of gynecology was built on. James Marion Sims, who is considered the Father of Gynecology, made many of his medical advancements by exploiting and torturing Black enslaved women - performing surgical experiments on their bodies without anesthesia (despite anesthesia existing at the time) or their consent. This spirit of promoting a lack of bodily autonomy and performing procedures despite harrowing cries of pain exists today still in medicine most notably with the continued dismissal of women’s and minority’s pain. Check out the Retrievals by the NYT if you want a glimpse into the very stories I listened to every day for the last three years.
The Road Ahead: Disruption by Technology
If you've ever felt that the healthcare system isn't working for you, it's essential to understand that, historically, it wasn't built for you. But there's hope on the horizon.
The increasing integration of technology in healthcare offers a glimmer of hope for democratizing health. Personalized medicine, powered by AI and big data, promises treatments tailored to individual needs, irrespective of gender or ethnicity. Wearable tech, telemedicine, and patient-driven online communities provide platforms for patients to voice their experiences and seek validation.
In essence, while the historical framework of healthcare has its biases, the future is being reshaped. As technology continues to advance, it holds the potential to level the playing field and make healthcare truly inclusive.
As we recognize the structural biases embedded in the healthcare system, it's crucial to advocate for reforms, trust our own experiences, and embrace the technological solutions that promise a more inclusive future for all. While the road to equitable healthcare is long, with technology as an ally and with collective awareness and action, we can move towards a system that truly serves everyone.
