Being Heard

Samphire Team
|
October 7, 2022

As children, we think healthcare is simple for the patient:

symptom → doctor → specialist → tests → diagnosis → medicine → all better!

Many children grow into adults still think healthcare is this simple. Even doctors often feel this way, refusing to discuss symptoms that don’t fit into this neat box.

But many children who grow into female adults are quickly forced to realize that healthcare is not this simple. Like chronic illness patients, who must learn how to navigate and advocate for their own care, women quickly come to understand that the system is not designed for them.

For women, every step of this apparently simple process is studded with obstacles.

  • Symptoms Women’s experiences of symptoms often differ dramatically from the presentation taught in medical schools, leading doctors to misunderstand, dismiss, or misdiagnose the symptom. (This is partly due to general male bias, and partly due to the stark underfunding of research into women’s health.)
  • Doctor Research has shown that, on average, doctors are much more likely to dismiss or ignore a woman’s symptoms, especially if they are self-reported or difficult to “prove” (such as pain conditions). Women are much more likely than men to receive psychiatric care than pain medication when presenting with pain.
  • Specialist People with uteruses who present with abdominal symptoms of any kind are highly likely to be shunted into the category of “gynecological problem,” even when this is inappropriate and leads to delayed or even incorrect treatment.
  • Diagnosis If women do get to the stage of referral or testing, they will discover that many of the most common women’s health conditions are impossible to diagnose via objective testing.
    PMDD (premenstrual dysphoric disorder), a leading cause of loss of DALYs (disability-adjusted life years) in women, has no objective biomarkers. This means that no blood test, MRI, CT scan, etc., will be able to diagnose this condition, making it easy for practitioners to dismiss the patient’s experience of their symptoms.
    CFS (chronic fatigue syndrome), a disabling condition which is approximately 75-90% female, similarly has no objective biomarkers.
    In fact, 70% of sufferers of chronic pain conditions are female, and chronic pain conditions generally run into this obstacle of objective biomarkers.
  • Medicine Even if they ultimately manage to receive the correct diagnosis, women are often not prescribed medications to treat their conditions.
    The standard of care in the UK for PMDD is “patient education”—not medicine. Imagine being prescribed a pamphlet instead of a pill!
    Similarly, other female-dominant conditions, such as CFS, or even plain old dysmenorrhea (period pain), have next to no available treatment options.

This failure to receive medication is partly due to a lack of research and funding. Even when studies are run, they under-enroll female participants. There are devastating ramifications when women are prescribed medication: 80% of all drugs taken off the market in the US around the turn of the century were pulled because of side effects only or exclusively present in women. This is a clear result of the fact that women of reproductive age were excluded altogether from clinical trials until 1993—these drugs were not even tested on female mice.

It is clear how the final stage of this frustrating, difficult-to-navigate story is not “all better.” For some patients, the healthcare system is easy to navigate and solves their health concerns. For many, and especially for women, doctors do not get you to a place where you feel “all better.” The system as it stands is simply not designed for women. It was designed for men.

Usually the vision of the world we present to children is oversimplified and inaccurate. But it is frustrating to live in a world where many adults are still able to believe in this childish perspective, because they have never been forced to learn otherwise. There are so many areas of life in which women are forced to grow up faster than men—sexual assault, self-defense, reproduction. The healthcare system is yet another. What if healthcare could look for women like it does for men? Some women would still suffer, of course, but it would not be because of their gender.

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