Sex bias in pain management

[Mij]

Data reveal how doctors take women’s pain less seriously than men’s
A study of hospital emergency departments suggests that women have more limited access to painkillers and medical care.

Physicians treat men and women differently when it comes to pain — women in hospital wait longer to be seen and are less likely to receive pain medication than men, finds a study comparing how pain is perceived and treated in male and female patients.

The findings, published on 5 August in Proceedings of the National Academy of Sciences1, highlight how our perception of others’ experiences of pain can be affected by unconscious bias.

“Women are viewed as exaggerating or hysterical and men are viewed as more stoic when they complain of pain,” says co-author Alex Gileles-Hillel, a physician-scientist at Hadassah-Hebrew University Medical Center in Jerusalem.

LINK

 

[SNT Gatchaman]

Sex bias in pain management decisions (2024)
Guzikevits, Mika; Gordon-Hecker, Tom; Rekhtman, David; Salameh, Shaden; Israel, Salomon; Shayo, Moses; Gozal, David; Perry, Anat; Gileles-Hillel, Alex; Choshen-Hillel, Shoham

In the pursuit of mental and physical health, effective pain management stands as a cornerstone. Here, we examine a potential sex bias in pain management. Leveraging insights from psychological research showing that females’ pain is stereotypically judged as less intense than males’ pain, we hypothesize that there may be tangible differences in pain management decisions based on patients’ sex.

Our investigation spans emergency department (ED) datasets from two countries, including discharge notes of patients arriving with pain complaints (N = 21,851). Across these datasets, a consistent sex disparity emerges. Female patients are less likely to be prescribed pain-relief medications compared to males, and this disparity persists even after adjusting for patients’ reported pain scores and numerous patient, physician, and ED variables.

This disparity extends across medical practitioners, with both male and female physicians prescribing less pain-relief medications to females than to males. Additional analyses reveal that female patients’ pain scores are 10% less likely to be recorded by nurses, and female patients spend an additional 30 min in the ED compared to male patients. A controlled experiment employing clinical vignettes reinforces our hypothesis, showing that nurses (N = 109) judge pain of female patients to be less intense than that of males.

We argue that the findings reflect an undertreatment of female patients’ pain. We discuss the troubling societal and medical implications of females’ pain being overlooked and call for policy interventions to ensure equal pain treatment.

SIGNIFICANCE
Pain treatment must be provided adequately and impartially. Here, we conduct an analysis of archival datasets of pain management decisions as well as a controlled experiment, testing whether pain management differs by patients’ sex. We present robust evidence showing that physicians’ and nurses’ pain management decisions in emergency departments disfavor female patients compared to male patients. Notably, female patients are less likely than males to be prescribed pain-relief medications for the same complaints. We argue that female patients receive less pain treatment than they should, which may adversely impact their health. The findings underscore the critical need to address psychological biases in healthcare settings to ensure fair and efficient treatment for all.


Link | PDF (Proceedings of the National Academy of Sciences)

 

[Arnie Pye]

We argue that female patients receive less pain treatment than they should, which may adversely impact their health. The findings underscore the critical need to address psychological biases in healthcare settings to ensure fair and efficient treatment for all.

I've read that medical staff often use sedating medication on women rather than give them pain relief.

 

[Trish]

The thing that surprised me in this article was not the stuff about pain, which I have seen before, but the bit about women being made to wait longer in emergency departments.

and female patients spend an additional 30 min in the ED compared to male patients.

 

[Mij]

What about providing adequate needed sedation and pain medication for female medical procedures?

 

[Arnie Pye]

What about providing adequate needed sedation and pain medication for female medical procedures?

That is definitely something that isn't considered important.

How many women have been through years and years of excruciating periods thanks to endometriosis and adenomyosis? And the women who try to get help by asking for investigation, treatment, and pain relief end up with warning flags on their medical records e.g. hypochondriac, drug seeker, time waster. Once these things have been recorded it affects their medical care for the rest of their life.

And anything involving forcing the cervix open in women who've never given birth is torture.

Naga Munchetty has talked about this happening to her when she had a coil fitted.

https://www.bbc.co.uk/news/av/health-57558466

Women who've gone through hysteroscopy have gone through torture too.

https://www.hysteroscopyaction.org.uk/wp-content/uploads/2018/10/sept-2018.pdf

https://www.pslhub.org/forums/topic/68-painful-hysteroscopy/

It turns out the NHS gives bonuses to hospitals that save money by carrying out such procedures without anaesthetic or the use of a proper operating theatre and theatre staff.

Having gone through a hysteroscopy myself, this is a hobby horse of mine. I've gone through various painful medical procedures in my life, but the hysteroscopy was by far the worst and I would rate the pain as a 10. And I will be asking for copies of any paperwork afterwards and complaining if they lie and say the procedure was "well tolerated", which apparently happens a lot.

 

[Mij]

My recent procedure was most likely written up as 'well tolerated'. Pretty sure 'autonomic event' or almost hit the ceiling wasn't mentioned by the female specialist.

 

[rvallee]

and men are viewed as more stoic when they complain of pain

Which is also a problem. When you're stoic, it seems less bad. You have to display the perfect level of suffering, say it in the right words, tailored to the person in front of you, but you can't know what any of those are. So basically you are judged almost entirely not by your appearances, but by someone's subjective perception of how you appear. Something with no means of verification, and therefore of redress. Some clinicians may miss out 99% of the time and they'd never even know about it.

This was published on Reddit and I saw many comments like that. Flat affect, not being expressive, not seeming in pain, they all send a false message that is often poorly interpreted.

This is the most basic stuff that health care is about. And they're doing no better than the very first physicians. It's really absurd when you consider it all, how dysfunctional it all is.

 

[Arnie Pye]

2 moved posts

I didn't want to create a new thread for this, so I'm sticking it in what is possibly the wrong place.

The subject of hysteroscopy crops up on the BBC or other news or health sites from time to time and one appeared on the BBC News site last week.

'Like ripping my insides' - fears hysteroscopy guidelines not enough

Parts of it are a classic example of how gaslighting is so often used on women, and how their pain is minimised by doctors.

Other quotes from the article :

Wendy McLean was due to start her seventh round of IVF when her doctor said she needed a hysteroscopy – a procedure to examine the inside of her uterus.

“It was sold to me as a smear test, basically. A thin narrow camera up through your cervix.

"It’ll take minutes. You won’t need pain relief. You’ll be absolutely fine,” she said.

Wendy, 38, took over-the-counter pain killers before the outpatient procedure at Aberdeen Royal Infirmary in case it was uncomfortable, but this did not prepare her for what happened.

'Clawed, like sharp nails'
“It felt like getting a hot poker, like getting my insides ripped out. I think I described it to somebody before as like being clawed, like sharp nails, just ripping at my insides.”

Wendy said she lost consciousness twice, vomited and asked for the procedure to be stopped.

“It’s indescribable,” she said. “I really felt as though I was in a medieval torture chamber. That's how it felt. It's just that, I can't believe you're doing that to women. I had every indication under the sun for them not to do that.”

How a doctor describes this :

Dr Lucky Saraswat is a consultant gynaecologist in Aberdeen, who trains doctors on how to perform hysteroscopies. She says the procedure can be uncomfortable but that the majority of women can tolerate it. She added that it’s important for patients to know they are in control.

She said: "We just have to help people make an informed choice of how they want to do it.

"Some people wouldn't want to have an anaesthetic, as the anaesthetic is not without risks either. So, a lot of people choose to have it done in outpatient settings. Some will make a choice of having an anaesthetic."

Campaigners claim the new clinical Green Top Guidelines, external minimise the risk of pain that patients may experience.

Dr Geeta Kumar, consultant gynaecologist and vice president of RCOG, said they had listened to patients’ concerns.

“Clear accurate written and verbal information must be provided, both at the time of referral, and at the procedure appointment,” she said.

"These guidelines are not mandatory.”

Some other comments from the article :

According to the Royal College of Obstetricians and Gynaecologists (RCOG), a third of those undergoing a hysteroscopy report pain levels of seven or above out of 10.

When I had a hysteroscopy back in the 90s I remember being told that they could stop the procedure if I wanted. But the doctor didn't mention that I could have it done under anesthetic, and I'm sure the omission was deliberate. I've read elsewhere on the web that this is a common tactic with hysteroscopies. I just thought that I would have to go through it all again at sometime, and it would be just as painful a second time so I just told the doctor to carry on.

I've since read that hospitals doing hysteroscopies without anaesthetic are given bonuses because they've saved money on the use of operating theatres and operating theatre staff.

Despite the comments I bolded above, women are not given full information, are not told the procedure can be done under anaesthetic, are not told that if the doctor tells a woman they can stop it can be done under anaesthetic, are not given pain relief, so how can women be "in control"?

The doctor who says that hysteroscopies can be "uncomfortable" might as well tell patients its like being shot in the gut, because that is uncomfortable too. /sarcasm

 

[Ash]

I didn't want to create a new thread for this, so I'm sticking it in what is possibly the wrong place.

The subject of hysteroscopy crops up on the BBC or other news or health sites from time to time and one appeared on the BBC News site last week.

'Like ripping my insides' - fears hysteroscopy guidelines not enough

Parts of it are a classic example of how gaslighting is so often used on women, and how their pain is minimised by doctors.

Other quotes from the article :





How a doctor describes this :





Some other comments from the article :



When I had a hysteroscopy back in the 90s I remember being told that they could stop the procedure if I wanted. But the doctor didn't mention that I could have it done under anesthetic, and I'm sure the omission was deliberate. I've read elsewhere on the web that this is a common tactic with hysteroscopies. I just thought that I would have to go through it all again at sometime, and it would be just as painful a second time so I just told the doctor to carry on.

I've since read that hospitals doing hysteroscopies without anaesthetic are given bonuses because they've saved money on the use of operating theatres and operating theatre staff.

Despite the comments I bolded above, women are not given full information, are not told the procedure can be done under anaesthetic, are not told that if the doctor tells a woman they can stop it can be done under anaesthetic, are not given pain relief, so how can women be "in control"?

The doctor who says that hysteroscopies can be "uncomfortable" might as well tell patients its like being shot in the gut, because that is uncomfortable too. /sarcasm

Ouch!

Maybe there is already or needs to be a thread on the medical torture of women because they should probably just ‘man up’ like proper women and not use up resources with their need for proper pain management for their medical conditions and procedures.