‘Everybody was telling me there was nothing wrong’

Compared to many other diseases, diagnosing a brain tumour is fairly straightforward.. . . But in 2016, the Brain Tumour Charity released a report on the treatment of brain tumour patients in the United Kingdom. . . . Women, as well as low-income patients, experienced longer delays. They were more likely than men to see 10 or more months pass between their first visit to a doctor and diagnosis –and to have made more than five visits to a doctor prior to diagnosis.

One 39-year-old woman quoted in the report recalled: “One of the GPs I saw actually made fun of me, saying ‘what did I think my headaches were, a brain tumour?’

A growing body of research is exploring how “implicit” bias – unconscious biases that are usually not linked to consciously held prejudiced attitudes – contributes to disparities in medical treatment.

One of the most pervasive implicit biases in the medical system regards gender.

Brain tumours are only one example. A 2015 study revealed a longer lag time from the onset of symptoms to diagnosis in female patients in six out of 11 types of cancer. It isn’t that women wait longer to seek medical attention – the delay occurs after they’ve first visited their GP. A 2013 study concluded that more than twice as many women as men had to make more than three visits to a primary care doctor in the UK before getting referred to a specialist for suspected bladder cancer. So did nearly twice as many with renal cancer.

The tendency to attribute women’s physical complaints to mental illness has its roots in the history of ‘hysteria’ – that mythical female disorder that, over the centuries, was blamed on a ‘wandering womb’ or sensitive nerves and eventually, post-Freud, came to be seen as a psychological problem.

Back in 1965, British psychiatrist Eliot Slater warned that too often a label of hysteria allowed doctors to believe they’d solved the mystery when, in fact, usually they hadn’t. After following up with 85 patients who’d been diagnosed with ‘hysteria’ at the National Hospital in London throughout the 1950s – including by Slater himself – he discovered that, nine years later, more than 60% had been found to have an organic neurological disease, including brain tumours and epilepsy. A dozen of them had died.

Studies in the 1990s suggested that as many as 30-50% of women diagnosed with depression were misdiagnosed. Furthermore, depression and anxiety are themselves symptoms of other diseases, which often go unrecognised in women.

“Being a woman should have no influence on a physician’s clinical ability to diagnose a disease,” the authors of the report wrote. “It is, therefore, difficult to accept that overall women experience much greater delays in diagnosis than men. The more rapid diagnosis of men illustrates that the capacity to do so exists.”

http://www.bbc.com/future/story/20180523-how-gender-bias-affects-your-healthcare

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