As a middle-aged doctor, last week I watched the news that half of women believe the NHS treats their health as a second-class problem with disbelief.
Why did only half of the women believe that? I think it should be 100 percent of them. Because the shameful thing is that, in terms of their health, women really are treated like second-class citizens, and study after study shows that they consistently receive worse medical care than men.
This needs to change, and as a husband and father of daughters, as well as a doctor, my fear is that this is not changing fast enough.
Take heart disease, for example: Compared with men, women who suffer a heart attack are more likely to be misdiagnosed and less likely to receive appropriate treatments, such as angiography to open blocked blood vessels.
It’s no surprise that women are more likely to die from a heart attack than men; Don’t just take my word for it: a consensus statement bringing together all the relevant data, published last month in the journal Heart by leading British cardiologists, concluded that ‘Cardiovascular disease remains the leading cause of death among women in the UK United. Women are underdiagnosed, undertreated and underrepresented in all areas of cardiovascular disease.’
Women really are treated like second-class citizens, with study after study showing they receive worse healthcare than men, writes Professor Rob Galloway (file image)
I don’t think this is primarily due to overt sexism, but rather an ingrained culture of medical education and research. I remember with anguish the case of a 75-year-old man who died of a heart attack when I was a junior doctor. I’m sure he would have survived if he had been a him.
He arrived at the ER with fatigue and vague pain in his chest and back, but not the typical crushing pain described in medical textbooks. He also didn’t have the usual risk factors we were taught, like smoking or high blood pressure.
We discharged him with a diagnosis of ‘atypical chest pain’ and advised him to take paracetamol. Two hours later, he suffered a heart attack and died.
His atypical symptoms were actually only atypical in men. And their risk factors were unique to women or more relevant to women; for example, being postmenopausal and not receiving hormone replacement therapy and having an autoimmune disease such as rheumatoid arthritis, a history of gestational diabetes or depression.
All the risk factors, but not the ones I was taught. And their gender-biased attention didn’t end there. After the heart attack, the two members of the public who had called the ambulance did not perform CPR. When the paramedics arrived, it was too late.
A new survey by St John Ambulance showed that one in three Britons are afraid to perform CPR on women because they are worried about touching their breasts. This would explain why only 68 percent of women receive CPR from the public; 73 percent of men do it. It is revealing that survival from cardiac arrest is higher in men than in women.
David Bowen, national clinical lead for resuscitation at St John Ambulance, told me: “We must dispel the myth that it is inappropriate to perform CPR on women.”
The disparity between men and women is certainly not limited to cardiovascular disease: many studies have shown that women who present to the ER with pain are more likely to wait longer for pain relief and less likely to be discharged with pain medication.
A recent study published in the journal Proceedings of the National Academy of Sciences, based on notes from more than 20,000 emergency room patients, found that men were 20 percent more likely than women to be discharged with analgesia, even if their pain scores were the same. Female doctors showed this bias as much as male doctors.
There are also often errors in the diagnosis of diseases that only women can suffer from. Take endometriosis, a disease that affects millions of women around the world. It takes an average of seven years to get a diagnosis: seven years of excruciating pain, often dismissed as “bad periods” or stress.
And then there is the enormous problem of medical research, which in the past was often only carried out on men. Treatments used for women are often based on the assumption that the findings apply equally to them. But the female body is not simply a small version of the male; Different hormones, genetics and anatomy make the patient different.
The sleeping pill zolpidem used to be prescribed to both men and women at the standard 10 mg dose, according to clinical trials involving predominantly male subjects. But research after the introduction of the drug showed that it was metabolized more slowly in women.
This meant they had higher levels of the drug in their system the morning after taking it, leading to drowsiness and a higher risk of car accidents. The false assumption that “one dose fits all” literally puts many women’s lives at risk.
In 2013, 20 years after the drug’s introduction, the U.S. Food and Drug Administration recommended lowering the dose for women to 5 mg.
Gender-biased teaching and years of research based on male models of illness mean that for 50 percent of my patients, I am less likely to give them the correct diagnosis and the correct treatments.
The final result? You know your body better than anyone and that should give you the confidence to challenge me and my colleagues if you feel like we’re not doing it right. Demand the attention you deserve; Don’t assume we know what is best.
@drobgalloway