As a middle-aged male doctor, I watched with disbelief at the news last week that half of women believe the NHS treats their health as a second-class problem.
Why did only half of women believe that? I think this should be 100 percent of them. The shameful fact is that women are truly treated like second-class citizens when it comes to their health, with study after study showing that they consistently receive worse medical care than men.
This needs to change and – as a husband and father of daughters, but also as a doctor – I fear that this is not changing quickly enough.
Take heart disease: Compared to men, women who have a heart attack are more likely to be misdiagnosed and less likely to receive appropriate treatments, such as an angiogram to open clogged arteries.
No wonder 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 heart doctors, concluded that ‘Cardiovascular disease remains the number one killer of women in Britain. Women are underdiagnosed, undertreated and underrepresented in all areas of cardiovascular disease.”
Women are truly treated like second-class citizens, with study after study showing they receive worse medical care than men, writes Professor Rob Galloway (file image)
I don’t believe this is primarily due to overt sexism, but to a deep-rooted culture of medical education and research. I remember with dread the case of the 75-year-old who died of a heart attack when I was still a doctor. I’m sure she would have survived if she had been a he.
She had come to the emergency room with fatigue and vague pain in her chest and back, but not the typical crushing pain described in medical textbooks. She also didn’t have the usual risk factors we were taught, such as smoking or high blood pressure.
We discharged her with a diagnosis of ‘atypical chest pain’ and advised her to take paracetamol. Two hours later she had a heart attack and died.
Her atypical symptoms were actually only atypical for men. And her risk factors were either unique to women or more relevant to women – for example, being postmenopausal and not taking HRT and having an autoimmune disease such as rheumatoid arthritis, a history of gestational diabetes or depression.
All risk factors – just not the ones I was taught. And her gender bias didn’t stop there. After her heart attack, the two members of the public who called the ambulance did not perform CPR. When the ambulance crew arrived, it was too late.
A new survey from St John Ambulance shows that one in three Britons are afraid to resuscitate women because they are afraid of touching their breasts. This would explain why only 68 percent of women receive CPR from civilians; 73 percent of men do that. Significantly, survival after cardiac arrest is higher in men than in women.
David Bowen, national clinical lead for resuscitation at St John Ambulance, told me: ‘We need to break the myth that it is not appropriate to perform CPR on women.’
The inequality between men and women certainly does not only apply to cardiovascular disease: many studies have shown that women who go to the emergency room with pain are more likely to wait longer for pain relief and are less likely to be discharged with painkillers.
A recent study 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 when their pain scores were the same. Female physicians showed these biases just as much as male physicians.
It also often fails in diagnosing conditions that only women can develop. Take endometriosis, a condition that affects millions of women worldwide. 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 major problem of medical research, which in the past was often only conducted on men. Treatments 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 create a different patient.
The sleeping tablet zolpidem was previously prescribed to both men and women in the standard dose of 10 mg, based on clinical trials involving mainly male subjects. But research after the drug’s introduction 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 the lives of many women at risk.
In 2013, twenty years after the drug was introduced, the U.S. Food and Drug Administration recommended lowering the dosage for women to 5 mg.
Gender-skewed education and years of research based on male disease models mean that I am less likely to provide the right diagnosis – and the right treatments – for 50 percent of my patients.
The end result? You know your body better than anyone and that should give you the confidence to challenge me and my fellow colleagues if you think we’re not doing it right. Request the care you deserve; Don’t assume that we know best.
@drrobgalloway