The fear of misdiagnosis for medical conditions looms over most of us in the Google age. Are you certain it isn’t a brain tumour, doctor? Google says I could die any minute. I think this mole is about to kill me.
We’re all armchair psychiatrists and internet experts – or so we like to think – but is it at all surprising when we, especially women, aren’t getting the life-saving treatment we need? Perhaps it’s even essential.
There is a “heart attack gender pay gap”, the British Heart Foundation said this week, and it is resulting in the needless deaths of two women every day because they are not receiving equal treatment to men.
Commonly thought of as a “man’s disease”, women are actually twice as likely to die from coronary heart disease than from breast cancer, and yet are 50 per cent more likely than men to receive an incorrect initial diagnosis when experiencing a heart attack. Following diagnoses, women are 2.7 per cent less likely to be prescribed statins and 7.4 per cent less likely to be prescribed beta blockers than men.
These figures are appalling. Not only are doctors misdiagnosing and mistreating these conditions, but patients are also less likely to believe they’re suffering a heart attack because their symptoms aren’t the same as those we have been taught to typically associate with the emergency.
Ask most people, and they’ll cite chest pain and pain in the left arm as the signs of a cardiac arrest; women experience chest pain too, but they are also more likely to experience other symptoms unrelated to chest pain, such as shortness of breath, nausea or vomiting, back or jaw pain, dizziness and sweating.
For a long time, women’s health issues have been systematically sidelined. We know that it takes an average of seven years for sufferers to get a diagnosis of endometriosis, a condition in which the womb lining grows outside around the ovaries and fallopian tubes, causing immensely painful periods. Doctors routinely dismiss women’s cries for help as just a heavy period. On top of untreated pain and the risk to fertility, lost earnings during this wait for diagnosis amount to an average of £41,000.
Of course, the discrepancy isn’t always biased towards men. Breast cancer is one of the most highly funded diseases in the world, receiving far more than any other cancer. It is thanks, in part, to powerful campaigns and the problematic but wildly successful "pinkification" of the condition. And yet prostate cancer now kills more people – something many are quick to point out when the topic of medical gender bias arises.
But this doesn't change the fact that women are routinely missing out or seeing delays to treatment for life-altering, life-threatening conditions – and sexism has everything to do with it. Our bodies are different from men’s on a cellular level, meaning disease presents itself differently – and scientists have yet to catch up.
Women are around 30 per cent more likely than men to have symptoms of a stroke misdiagnosed, women make up the majority of sufferers of life-threatening autoimmune diseases (including multiple sclerosis and thyroid diseases) but they take almost five years on average to diagnose.
It takes longer to diagnose women with cancer than it does men; a quarter of women with brain tumours spend a year returning to their doctor before being diagnosed; women in A&E are less likely to be treated when complaining of acute pain than men, less likely to be prescribed the most effective painkillers than men: our pain is dismissed as hypochondria.
Women are also more likely to get dementia and cardiovascular disease – two of the top three leading causes of death in England and Wales. One in four pregnancies end in miscarriage and yet the reasons for this are often unknown. There remains a continued lack of understanding of the purpose or routes to female sexual pleasure.
Women often rely on forums to explain lesser-known pregnancy symptoms, and many GPs are still not trained in breastfeeding support. There is still no male contraceptive pill despite it having been scientifically possible for years, and research into the mental health implications of the female pill remains extraordinarily slow. Studies into erectile dysfunction outnumber those into PMS by five to one, despite only 19 per cent of men suffering from the former and 90 per cent of women, from the latter.
It is an exhausting, relentless list. And the sheer scale of the problem defies any simple solution. At the heart of it, we are faced with an entire body of medical research that has been based on the male perspective.
Consider this. It wasn’t until 1993 that US law required clinical trials for disease and treatment to include women as well as men, or to compare the effects on the female and male body of such illnesses.
Things do change, but they change slowly. In 2016, a group of MPs and health campaigners set up a parliamentary group on women’s health to demand new guidelines for female treatment. Their conferences seek to empower women to speak up about health issues with professionals, address the barriers to diagnoses and the inequalities in healthcare. In short, we are still at the stage of raising awareness, but tangible progress will depend on real action.
If we are going to chip away at that depressing list of failings in women’s medical care then urgent funding and focus is needed. Women’s lives, our work, our freedoms are still valued less than men’s; real change can be made much faster, but governments need to be woken up now to the gravity of the situation.
This is not gender politics, this is a matter of life and death. As serious as a misdiagnosed heart attack.
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