I'm not crazy, I'm sick: The gaslighting of women by doctors

Since yesterday was Women’s Day (I hope you all had a good one), I thought I would take the opportunity to write about something which has been occupying my mind for a while – the relationship between women and medicine.

After serious surgery last year, I came across a book called Doing Harm: The truth about how bad medicine and lazy science leave women dismissed, misdiagnosed and sick by Maya Dusenbery. This phenomenal book reveals how the vast majority of medical research is done on male bodies and thus often inappropriate when it comes to treating women with similar conditions. Dusenbery calls the fact that medical science knows less of “every aspect of the female biology compared to male biology” the  knowledge gap.

However, what really interested me was what she called the trust gap.

Dusenbery points to research that has proven that doctors don’t take women’s complaints as seriously as those of men. For example, studies revealed that women wait, on average, 65 minutes compared to men’s 45 minutes to get treatment for abdominal pain in the emergency room in America.

They were also less likely to be given strong painkillers such as opiates despite having the same pain scores as male patients. Other research proved that women were seven times more likely to be sent home in the middle of a heart attack than men.

In her book Ask me about my uterus: A quest to make doctors believe in women’s pain, Abby Norman talks about the years she tried to convince doctors to take her debilitating pain seriously. It was only when she took her boyfriend with her to validate her experience that the doctor ordered test which revealed widespread endometriosis.

She is sadly not unique.

A friend of mine recently told me how she had a long, difficult labour without any pain relief. After eight hours she eventually had a suction assisted birth, which necessitated an episiotomy (a surgical cut of the perineum) with multiple layers of stitches.

Unsurprisingly, she felt very sore afterwards and asked for some pain relief. Intravenous paracetamol was prescribed.  The next morning, only hours after the birth and episiotomy, the doctor came to see her. She watched as he looked at her chart, took out his red pen and drew a line through the instruction for IV paracetamol. “That’s enough of that now. It’s total overkill for an episiotomy,” he said firmly.

My friend said she thought afterwards of many things she should have said to him such as: “Have you ever had your perineum cut and stitched up again?” or “Would you really have said that to a man with a similar injury?”

Deborah Copaken, in her book Ladyparts, says that when a woman claims that her pain is seven out of ten, her doctor will assume it is five, while men’s self-reported pain is taken as face value.

This is borne out by research. A recent study found that medical doctors believed that female patients had less pain and were more likely to exaggerate pain. This resulted in men being far more likely to be recommended pain relief, while women were recommended psychological treatment.

In addition  ̶  or perhaps because of this gender bias  ̶  women tend to underplay their physical complaints in fear of being seen as emotional or hysterical. Copaken describes why she minimised her serious medical condition for years: “Society teaches us (women) to minimise our woes and to internalise its sceptical view of our pain so as not to be labelled cry-babies or ‘hysterical’: a meaningless diagnosis of unspecified female malaise, which in the nineteenth or twentieth centuries, could sometimes mean you’d walk out of the doctor’s office minus a clitoris.”

This means that women face a double whammy when it comes to pain management. When asked about her level of pain, a woman will often describe it as a six or even a five, even though it feels like a seven.  Her physician would then either consciously or sub-consciously take that as an exaggeration and classify the pain as a four or three and base pain relief on this wholly inadequate rating.

This trust gap is not only cruel, but also dangerous.

Another friend recently told me how his wife had been unwell for a while. Despite complaining repeatedly to her gynaecologist, her symptoms were dismissed as menopause-related. Months later it became apparent that the doctor had somehow missed the result of a pap smear that indicated cervical cancer. Due to the delay, the cancer had spread, and she is now getting treatment in a race against time for stage 4 cancer.

I think every woman has a story of being dismissed by doctors when they knew something was wrong or were feeling seriously unwell and in pain.

We should not allow this gaslighting.

As my friend’s husband said to me a few days ago:. “If it feels wrong, insist that they take you seriously.”

To the women reading this: next time a doctor suggests that you should go to a psychologists because you are most probably just stressed or that it happens to women “at your age”, find a second opinion from a doctor that is empathetic and kind. Most importantly, if you are ever asked to rate your pain, rate it two numbers higher than you’re actually feeling.

May you have a happy and healthy women’s month!