Gender bias in medical diagnosis

What is gender bias?

Gender bias refers to a preference for one gender over another. It is often based on prejudices and stereotypes.

Gender bias can be conscious, and something someone is aware that they have. Gender bias can also be unconscious, or something a person is not aware of. This is known as implicit bias.

In addition to gender, which refers to how a person feels inside, people can also be treated unfairly because of their gender. Sex is based on biological characteristics, such as a person’s reproductive organs and chromosomes.

Historically, people have used the biological differences between the sexes to perpetuate gender stereotypes. This includes the idea that women are not as smart as men because of differences in brain size.

This means that, even if a person was not assigned female at birth, people may make assumptions about them based on perceived femininity, or gender expression.

Learn more about sex and gender here.

How does gender bias affect medical diagnosis?

Most research on gender bias in healthcare focuses on men and women. Overall, it shows that gender bias reduces the speed, accuracy, and effectiveness of medical diagnoses. The impact is most severe for women. However, it has an effect on men, too.

Here are some examples of gender bias in medical diagnosis:

Chronic pain

Overall, women experience more chronic pain than men. Despite this, a 2018 review of 77 articles shows that medical professionals are more likely to dismiss women patients as too sensitive, hysterical, or as time-wasters.

Some of the studies also show that doctors are more likely to diagnose women with a psychological cause for their pain, rather than a physical one, compared with men. While chronic pain is complex and can involve psychotherapy as part of treatment, this does not explain this difference.

Other studies found that women received:

• less pain medication
• less effective pain medication
• more antidepressant prescriptions
• more referrals to mental health services

The researchers also note a general trend that doctors do not believe in women’s pain, or that females are “used to internal pain” because of menstruation and childbirth.

While men also experienced mental health difficulties as a result of chronic pain, doctors are more likely to describe them as stoic or strong.

Gender bias in chronic pain diagnosis can result in women receiving little medical support, incorrect diagnoses, and avoidable damage to their mental health.

Men may also be less likely to seek or receive a diagnosis for chronic pain, or to get treatment for mental health conditions that occur as a result.

Bleeding disorders

Bleeding disorders are conditions that prevent the blood from clotting effectively. Examples include hemophilia and Von Willebrand’s disease (VWD).

These conditions affect both males and females. In the past, however, doctors believed they only affected males. This myth may still have an impact on bleeding disorder diagnosis today.

According to 2020 research, women with moderate hemophilia receive a diagnosis 6.5 months later than men, on average. Women with severe hemophilia face delays of 39 months. For women with VWD, the delay between symptom onset and diagnosis is 16 years.

There is no medical reason for these delays. In fact, females are more likely to notice the symptoms of a bleeding disorder than males, as many experience heavy periods.

Autoimmune conditions

According to a survey from the American Autoimmune Related Diseases Association (AARDA), 62% of people with an autoimmune disease had been labeled “chronic complainers” by doctors, or told they were too concerned with their health.

This figure applies to all the people AARDA surveyed. However, 75% of people with autoimmune conditions are women. This means that this dismissive attitude disproportionately affects women.

In cases of lupus, women make up 90% of patients. Although men receive lupus diagnoses at a later age than women, on average, it takes them less time to receive a diagnosis once they present with symptoms. The criteria that doctors use to diagnose lupus may be the reason for this.

Mental health

Women are nearly twice as likely as men to have a mental health condition. According to the World Health Organization (WHO), this is due to risk factors for mental illness that disproportionately affect women, such as:

• gender-based violence
• lower social status
• lower average income

However, while gender inequity is a key cause of mental illness worldwide, gender bias in medical diagnosis can also cause doctors to focus more heavily on mental health conditions as a cause for symptoms in women than in men.

For example, doctors are more likely to diagnose depression in women than men, even when they have identical symptoms and depression symptom scores.

Additionally, a 2020 review shows that, even after controlling for higher rates of mental health conditions in women, women still receive a disproportionate number of mental illness diagnoses. They also receive more prescriptions for mood-altering drugs.

This bias in diagnosing depression may mean that women, men, or both are not receiving appropriate treatment due to assumptions doctors make about their gender.

Learn more about how mental health conditions affect men.

COVID-19

Early evidence suggests that gender bias has also affected the management of the COVID-19 pandemic. A preprint of a 2020 analysis found that women with confirmed cases of COVID-19 were less likely than men to receive chest X-rays and blood tests.

Research on COVID-19 is still evolving. However, a 2020 article notes that most studies on COVID-19 have failed to take sex and gender into account. As a result, there is a gap in research about how gender bias has affected the diagnosis of COVID-19.

Heart disease

There are sex-based differences in how the symptoms of heart disease present in males and females. However, a lack of education on these differences can lead to doctors ignoring or misdiagnosing heart disease.

Doctors are more likely to regard the symptoms that affect females as “atypical” compared with the symptoms that often affect males. They are also less likely to refer females for diagnostic tests and treatment.

The same is true of heart attacks. Females are less likely to experience “classic” heart attack symptoms, and are less likely to receive treatment. The American Heart Association (AHA) says this is because doctors use a diagnostic criteria that is geared towards males.

Marginalizing the symptoms that females experience puts them at risk.

A 2018 study found that females presenting with a heart attack were more likely to die when a male doctor treated them, compared with a female doctor. This effect lessened the more male doctors interacted with female patients and colleagues.

Learn more about how heart disease affects women.

What causes gender bias in medical diagnosis?

Gender bias is a result of sexism. Sexism is prejudice or discrimination based on sex or gender. In many cultures, sexism has historically meant that men have more power and influence than women and other marginalized genders.

The same is true in medicine. Until the 20th century, the study and practice of Western medicine was dominated by men. While this is no longer the case, systemic sexism still exists within medicine, according to a 2019 report from the WHO.

Here are some of the ways that sexism has influenced medical care, both in the past and present:

Gender blindness in research

In the past, many scientific studies excluded female participants in order to eliminate the possibility of female sex hormones influencing the results. Scientists also excluded females of childbearing age from trials to prevent the risk of drugs affecting a potential pregnancy.

Although some of these practices had good intentions, medical professionals now know less about how diseases and drugs affect women, resulting in the need to suspend drugs that doctors previously thought were safe for men and women.

In the United States, organizations such as the U.S. Food and Drug Administration (FDA) are encouraging researchers to include women in their clinical trials.

Underrepresentation

Today, 70% of the world’s healthcare professionals are women.

Despite this, women are underrepresented in medical journals and leadership positions, limiting the influence women can have on medical research and best practices. Globally, women occupy lower-paid roles with less authority and status.

Many academic institutions are also working to increase the representation of women and marginalized genders among their faculty, and have enacted policies to combat discrimination.

Institutional sexism

Many countries do not have laws to protect people against gender-based discrimination.

As a result, women healthcare workers and patients do not always have support when they experience harassment, abuse, or violence. They may also have no way to challenge sexist practices and policies that disadvantage them.

Summary

Gender bias in medical diagnosis harms peoples’ physical and mental health. It primarily affects women and marginalized genders worldwide. This leads to a higher burden of illness among these groups.

Gender bias also harms the health of men. For example, the positive prejudice that men are strong and brave can cause people to avoid seeking medical help because they are afraid that this is a sign of weakness.

It is important for medical institutions and professionals to actively work to eliminate gender bias in medical diagnosis, as well as in research, workplace practices, and treatment protocols.