Dec 18, 2023

LWL | The Silenced Killer

By Dwita Dave

Her doctors told her that she was just “anxious”, “working too hard”, “stressed”, or even that she was being “dramatic”. By the time Ilene Ruhoy, MD, Ph.D., a board-certified neurologist herself, persuaded her doctors to give her a brain scan, there was a tennis ball-sized tumor pushing on her left frontal lobe that had significant edema resulting in a midline shift and threatening uncal herniation. (Ruhoy; Bever) The medical system has failed women’s health. As a result of the lack of research and funding for women’s health, the medical system has ignored women’s symptoms and used the cloak of ‘hysteria’ to undermine their pain, leading to a bias in our medical system and schools. Throughout this essay I will unfold the many ways inequity has taken our medical system hostage, the ways patients simply aren’t being treated, and what we can do about it.

In 2022, the Journal of the American Heart Association reported that “women who visited emergency departments with chest pain waited 29 percent longer than men to be evaluated for possible heart attacks." (Bever) The first 60 minutes after a heart attack is known as ‘the golden hour’, in which you can nearly reverse the effects of a heart attack. This lack of service for women experiencing heart attacks is not just ignorant, but risking lives. (Banco) Additionally, heart disease is the leading cause of death among American women. (CDC) Why aren’t we paying more attention? These women aren’t being treated and as a result, they are dying. One of the key reasons their symptoms aren’t being recognized is due to the lack of research done on women's health. In fact, according to the Harvard Health Blog, “These gender biases in our medical system can have serious and sometimes fatal repercussions. For instance, a

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2000 study published in The New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack. Why? Because the medical concepts of most diseases are based on understanding of male physiology, and women altogether have different symptoms than men when having a heart attack." (Kiesel) With the lack of research, the medical system has created a compounded situation in which medical professionals can’t recognize women’s symptoms, and as a result, they find themselves ignoring women’s symptoms and risking lives.

In May 2021, a nurse from Yale University Reproductive Endocrinology and Infertility Clinic was found guilty of tampering with fentanyl vials meant for patients who were undergoing IVF (In vitro fertilization) procedures. During the IVF procedures, women repeatedly cried out in pain, calling it “gut-wrenching” and “violating”, nonetheless their doctors continued. The case had over 60 plaintiffs involved. It was found that approximately 75% of the fentanyl given to patients at the Yale REI clinic from June to October 2020 had been altered with saline. Some of the vials contained diluted fentanyl, while others contained no drug at all and contained only saline. (Bever; U.S. Attorney's Of ice, District of Connecticut) This indicates two things, not only was the pain of these women ignored, but rather it was normalized. Rather than women’s pain being seen as a legitimate problem, it is portrayed as an overreaction and scoffed at as a result. They are seen as overdramatic, hysterical, in the words of Amy Mason-Cooley, a patient who experienced this inequity, “There’s so much judgment. If you're too calm, then they say, ‘Oh, you're not sick. You don't look sick.’ And then if you're crying and moaning, they say you're exaggerating. I don’t really know what they want from us.”

In the case of Laura Czar, a breast cancer patient who had gone through two excruciating IVF appointments, after her first appointment she thought to herself, “Well, I guess that’s just the way it is?”

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The medical system normalized Czar’s pain, so much so that she made herself rationalize it all. It normalized the pain of all of these women, breeding a dangerous cycle in which women are simply normalizing their pain.

We find that when it comes to reproductive health we find that not only does the medical system hold a dangerous stereotype, but societal stigma runs rampant.

Author Gabrielle Jackson, whose pain had been dismissed for the majority of her life, until she learned that she suffered from endometriosis wrote, “too many women being dismissed by their doctors for years as anxious, “type A” personalities, hypochondriacs or merely difficult. It’s the 21st century’s “hysterical”.” As a result of the lack of research, the medical system finds itself rationalizing women’s pain by rendering women as ‘hysterical’. Moreover, according to a cumulative study done by Hindawi, stated, “Gendered norms about men and women with pain, present in research from different scientific fields, illustrate prevailing hegemonic masculinity and andronormativity in health care.” This means that in healthcare we find a tendency towards the male physiology in the forms of research and overall the knowledge we have of the condition as a whole; drowning out the voice of anyone who isn’t male.

Additionally, we find that this bias runs even more rampant when it comes to women of color. For people like Sharee Turpin, Amy Mason-Cooley, Sevon Blake, the inequity they experienced will remain forever seared in their minds. Sharee Turpin, while experiencing a sickle-cell crisis, had to slip into her ‘Sunday Best’(Bever), she does this to help mitigate any possible bias that the medical team may have of her, or in her words “in hopes that the doctors and nurses won’t peg her as a drug seeker”. As for Mason-Cooley, after an excruciating, and infuriating experience, she filed a complaint against the hospital, and posted her experience in a Facebook, which was shared over 13,000 times before she made it private. (Rao). According to Today, “Others on Mason-Cooley’s Facebook thread posted about

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experiencing pain in the middle of the night and forcing themselves to wait until the morning to go to the hospital, because they knew a 2 a.m. trip to the emergency room for severe pain would only result in accusations that they are addicts. It’s a lot of added stress to deal with when you’re struggling with intense pain.” Black women face two major barriers in healthcare: one because they are women, and the second because they are people of color. It is evident that many layers of bias are plaguing the medical system, both within our nation culturally, as noted through the testimonies and recollections of many and also the bias against women of color which can be traced back to slavery in the United States, to the likes of J. Marion Sims and Thomas Hamilton. Both of whom created ruthless experiments to run on people of color in the name of “research”. Furthermore, the deeper we delve in, the more research on racial bias in pain management is found. In 2016 a study by Princeton University found that half of white medical students and residents held at least one false belief about biological differences between Blacks and Whites, and were more likely to underestimate Black patients’ pain. (Hof man, Bever). Nearly two-thirds of practicing physicians in the US are white, meaning that nearly one-third of all doctors have a ‘false belief’ or ‘bias’ towards African American individuals. This data doesn't cover potential biases held towards women or even other people of color. Another study published in the American Journal of Emergency Medicine from 2019, “analyzed data from 14 previously published studies on pain management and found that Black patients were 40% less likely to receive medication for acute pain compared to white patients, and 34% less likely to be prescribed opioids.” The fact of the matter is, bias has become all too intertwined with our medical system, to the point that patients are struggling to advocate for themselves.

While some may argue that women are more likely to receive better access to home healthcare (NIH), we still find that there remains gender inequality in healthcare, and face wide gaps in research and treatment ability (Khanna).

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Women are confined within societal constructs that dictate the way the healthcare system reacts. However, “Yet, the notion of gender is a construction and can be changed.” (Hindawi). There is still a way to change. The medical system has failed women thus far, but taking a step back and providing healthcare workers with the framework and ability to provide equality in healthcare, might just be the next step. We must start now.

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Works Cited

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https://doi.org/10.1161/JAHA.121.024199. Accessed 11 Feb. 2023.

Bever, Lindsay. "From heart disease to IUDs: How doctors dismiss women's pain." The Washington Post, 13 Dec. 2022,

www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/. Accessed 11 Feb. 2023.

Boseley, Sarah, et al. "Endometriosis: the hidden suffering of millions of women revealed." The Guardian, 28 Sept. 2015,

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Cameron, Kenzie, et al. "Gender Disparities in Health and Healthcare Use Among Older Adults." Journal of Women's Health, vol. 19, no. 9, 2010, pp. 1643-1650, https://doi.org/10.1089/jwh.2009.1701. Accessed 26 Feb. 2023.

CDC, compiler. Lower Your Risk for the Number 1 Killer of Women. CDC, 3 Feb. 2023. CDC, www.cdc.gov/healthequity/features/heartdisease/index.html#:~:text=Heart%20disease%20is%20the%20l eading,in%20every%205%20female%20deaths. Accessed 23 Feb. 2023.

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Czar, Laura, and Rose Minutaglio. "In Pain and Ignored: My Fertility Clinic Horror Story." Elle. Elle, www.elle.com/culture/a40106115/yale-fertility-clinic-rei-lawsuit/?itid=lk_inline_enhanced-template. Accessed 25 Feb. 2023.

Hoffman, Diane E., J.D., M.S., and Anita J. Tarzian, Ph.D., RN. "The girl who cried pain: a bias against women in the treatment of pain." The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics, vol. 29, no. 1, 2001,

https://doi.org/10.1111/j.1748-720x.2001.tb00037.x. Accessed 11 Feb. 2023.

Hoffman, Kelly M., et al. "Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites." PNAS, vol. 113, no. 16, 4 Apr. 2016. PNAS, https://doi.org/10.1073/pnas.1516047113. Accessed 15 Oct. 2023.

Jackson, Gabrielle. "'I'm not a hypochondriac. I have a disease. All these things that are wrong with me are real, they are endometriosis." The Guardian, 28 Sept. 2015,

www.theguardian.com/society/2015/sep/28/im-not-a-hypochondriac-i-have-a-disease-all-these-things-that -are-wrong-with-me-are-real-they-are-endometriosis. Accessed 11 Feb. 2023.

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Khanna, Deeptha. "Women's health: Why is the health of at least half the global population so often overlooked?" World Economic Forum Annual Meeting, 2 Jan. 2023. World Economic Forum, www.weforum.org/agenda/2023/01/women-health-gap-davos-2023/. Accessed 26 Feb. 2023.

Kiesel, Laura. "Women and pain: Disparities in experience and treatment." Harvard Health Blog, Harvard University, 9 Oct. 2017,

www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562# :~:text=Women%20with%20chronic%20pain%20may,pain%20medication%2C%20for%20their%20ailm ents. Accessed 16 Feb. 2023.

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Kindelan, Katie. "Women say pain was dismissed in lawsuit alleging fentanyl switch at fertility clinic." Good Morning America, 19 Nov. 2021. Good Morning America,

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TY - JOURA2 - Gazerani, ParisaAU - Samulowitz, AnkeAU - Gremyr, IdaAU - Eriksson, ErikAU - Hensing, GunnelPY - 2018DA - 2018/02/25TI - "Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic PainSP - 6358624VL - 2018AB - SN - 1203-6765UR -

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https://doi.org/10.1155/2018/6358624DO - 10.1155/2018/6358624JF - Pain Research and ManagementPB - HindawiKW - ER -

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