Just as the breast cancer awareness movement has its pink ribbons, the American Heart Association's Go Red for Women campaign is using cute red dress pins (and singer Toni Braxton) to wake women up to their No. 1 killer. Trouble is, plenty of doctors still downplay signs of trouble when they see a woman who's, say, going through a divorce or other frazzling event. New research from Weil Medical College of Cornell University suggests that primary care doctors are more likely to attribute shortness of breath, chest pain, and other heart disease symptoms to stress when they see such symptoms plaguing stressed-out women than they do when they see the same signs in stressed-out men.
It seems that doctors are so used to diagnosing stress-related conditions in women that they may delay ordering the proper tests to diagnose underlying heart disease. In the study, family physicians and internists diagnosed heart disease in 15 percent of anxious women and 56 percent of anxious men who had strikingly similar risk factors and symptoms. The doctors prescribed heart medications to just 13 percent of women, compared with 47 percent of men, and referred only 30 percent of women to cardiologists, compared with 62 percent of the men. (These were mock scenarios, so no patients were actually hurt in the study.) Interestingly, the gender bias disappeared when stress and anxiety weren't included in the vignettes that the doctors read. So maybe docs have gotten better about recognizing heart disease in women when they're not tripped up by the Hollywood stereotype of a woman on the verge of a nervous breakdown. Also complicating the picture: Women sometimes experience different heart disease symptoms than men, as I previously reported, and are slower to seek medical attention.
I wonder if this problem extends beyond heart disease to other ailments. Does telling a doctor about the loss of a loved one or being on an antianxiety medication put you at greater risk of having physical discomfort written off as all in your head? Do doctors too easily connect the dots between stress and pain when it comes to women?
I did a little digging and found that gender bias, in general, still exists in the doctor's office. One recent study found that orthopedic surgeons are twice as likely to recommend total knee replacements to men than to women, possibly because they take men's pain complaints more seriously. Although I didn't find other studies showing the stress/gender-bias connection, I did find this blog written by a woman who suffers from panic attacks. After experiencing a large tear in her perineum during childbirth, she said a hospital nurse dismissed her pleas for pain medication, telling her that she was just having another panic attack.
Unfortunately, medical practitioners (like the rest of us) have their own biases when they see patients. Most probably aren't aware that their diagnostic calls are based on these preconceived notions. So it's up to you, as the patient, to press your case.
1. Go with your gut: If your instincts tell you that your body isn't working right, do a little Internet research on your own before your appointment and write down a few key points that could suggest a cause for your symptoms.
2. Don't OD on the Web research: Try to resist the temptation to overresearch. Bringing in hundreds of pages of computer printouts will overwhelm you and frustrate your doctors—and it could feed into the gender bias. Women are already more likely to bring in reams of information, according to the Pew Internet Project. While a little education can certainly be a good thing, your doctor might be more likely to dismiss your complaints if you walk in convinced that you have one or more illnesses. Better to just state the facts and let your doctor do the interpreting.
3. If you get the sense that your doctor is talking down to you, switch doctors. Being called "Honey" or "Sweetie" is a dead giveaway. Some subtler signs: Your doctor doesn't make eye contact, cuts you off, or doesn't fully address your questions.