Why don't doctors trust women? Because they don't know much about us

[MrMagoo]

I've seen this claim a lot in the media over the last 10 years by lazy journalists, the problem is that it simply isn't true. The medications predominantly prescribed to women have had trials that have had participants that are predominantly or entirely women and this has been true for decades.

The rat research line is also irrelevant because rat models translate poorly to human hormone dynamics anyway - the research needs to be confirmed in humans anyway. The best evidence for bias against women is the balance of research funding itself, and the actual experiences of women in medical practise. The fact that experiences still aren't systematically measured is because the medical field simply doesn't want to know how badly they are really doing. If they measured those experiences they'd know how much more they are failing women.

What about medications that aren’t predominantly prescribed to women?
Where drugs are tested on men and women is that data separated?

Women are overmedicated because drug dosage trials are done on men, study finds

Overprescribing women results in widespread side effects, UChicago research suggests

news.uchicago.edu

 

[Snow Leopard]

What about medications that aren’t predominantly prescribed to women?
Where drugs are tested on men and women is that data separated?

Women are overmedicated because drug dosage trials are done on men, study finds

Overprescribing women results in widespread side effects, UChicago research suggests

news.uchicago.edu

Note that the problem wasn't that they didn't include women in the trials, the problem is the trial design itself - they didn't consider trialing lower dosages for women. Also note that age makes a huge difference in dosage as well, with elderly people often needing half the dose of some drugs (eg antidepressants).

The point is that it isn't the numbers of women in the trial that is the problem, it is the design of the trial eg not listening to women that the dosage is too high that is the problem.

It's a systematic problem of "evidence based medicine" where trials are just designed to get approval rather than optimized for the best patient experience (which costs more money)

 

[Jonathan Edwards]

the problem is that it simply isn't true

This is the point the actually matters to this community.

The article is full of falsehoods. That means it will have the opposite of the intended effect. It will allow those who nod their heads and say 'well, there you go' to do so with ease.

This forum is about being critical about claims. It is particularly about not ceasing to be critical when it becomes convenient to cease doing so - the heart of the BPS mindset. Garner, Flottorp, Stone, Wessely, were all trained in how to be critical but when it came to being convenient to do so they suddenly forgot what they knew.

I bet you that pretty much all the literature on bias against women in medicine is full of the same Swiss cheese of holes as PACE or the Cochrane review on exercise. Yet suddenly it is an incontrovertible truth, that doesn't even need evidence.

 

[Amw66]

I just don't see that, having spent my life working on a disease that mostly affects women. I find it hard to see where bias would come in there - it does affect more women.

And as pointed out, most doctors are women now anyway. And when it comes dismissing people they seem to be some of the worst. I worked with both male and female colleagues and the females were at least as likely to diagnose problems as psychological.

In our experience women doctors can be worse than males

 

[Sasha]

What about when I had renal colic and I pointed out to the nurse that the entonox machine was not delivering any gas. She pretended it was, because she had been told to, despite it being switched off, presumably because someone said I was just being hysterical. She was too junior to realise that I knew perfectly well what was going on.

Regardless of any gender bias, what do you think is going on with doctors and all this denial of patients' pain?

 

[V.R.T.]

I understand the point you’re making, though I think it’s worth clarifying the specific dynamics here because this ends up being one of the most common misunderstandings whenever gender bias is brought up in relation to things men also experience.

It’s not that masculinity protects against ableism/medical neglect or that the privileges of masculinity go away once you’re perceived as disabled—those things are always going to have their full impact regardless of gender. Its that masculinity confers the privilege of not having to deal with the specific ways that this ableism intersects with and gets compounded by bias against women.

So men will often chime in to say things like “well I get disregarded and treated as incompetent by doctors too” but the point is that when men experience those things, it’s rarely if ever on account of being a man. And the vast majority of reasons why a man would get disregarded (such as being disabled, racism, or just regular doctor misanthropy) are also things that women experience in conjunction with being disregarded in the way that women are.

For what it’s worth, woman also face the exact same expectation to constantly push through pain and never show that anything’s wrong—when they do express pain or illness, it’s not something that is “allowed” on account of them being a woman. It’s just a wholly negative thing that is expected more of women by default because they are already viewed in the negative light of being less able to handle adversity. “Be a man” only has meaning as a phrase because the implication is that it’s shameful to be weak and fragile like women.

So yes, the medical system is completely broken and men are hardly getting a rosy experience even if they’re not disabled. Their experience is just one that isnt also colored by bias against women. We’re scraping the bottom of the barrel anyways when it comes to medical treatment for poorly understood chronic illnesses, so in some respects it might not seem like a huge difference—but any woman with a chronic illness will tell you that being a woman does change important aspects of how that experience plays out.

I entirely accept that there are specific ways in which women have it worse, and that there are different dynamics for women who are chronically ill.

However, there are specfic dynamics to how the expectation and performance of masculinity play out among men that are subtle and hard to explain if you haven't personally experienced them. And as a man who has gone from being able bodied to severely disabled, I can tell you that the privileges of masculinity do largely go away once you're percieved as disabled, especially with an illness many don't understand or even believe in. And for an autistic man like me they were always unevenly distrubuted based entirely on how I was percivied/how well I was able to mask in a particular interaction. Which doesn't mean people are going to tell a cis man that having a baby will fix it because that's a specific prejudicial thing that women face.

And I don't think it is as simple as 'be a man as opposed to a woman'. I think there is an extent to which both ableism and misogyny (and a lot of homophobia etc) stem from a hatred of perceived weakness, of all the things that fall outside the circle of being 'strong' in the narrow concept of strength in the patriarchal conception of it.

Which is not to say, again that there arent specific tropes about chronically ill women. Of course there are, I've been aware of them my whole life. But there are also specific ways people treat men that they percieve as hypochondriacs or anxious or weak.

I don't think acknowledging these things takes anything away from our ability to discuss the experiences women have. It doesn't mean 'women don't face prejudice' or 'misogyny isn't real'. But patriarchal society confers a specfic set of expectations, rules and codes onto all men which were are punished for not abiding by. And that's very important to acknowledge.

 

[Braganca]

And I don't think it is as simple as 'be a man as opposed to a woman'. I think there is an extent to which both ableism and misogyny (and a lot of homophobia etc) stem from a hatred of perceived weakness, of all the things that fall outside the circle of being 'strong' in the narrow concept of strength in the patriarchal conception of it.

Agree.. it comes down to basics of presentation too. I’ve seen quite a difference in how I’m treated (by male and female doctors) from when I became ill at 36, and their perception of me was “young athletic successful executive” and now at 47.. if I’m in jeans w minimal makeup all they see is “depressed middle aged woman”.

Recently I tried to get around this by wearing a dress, jacket and red lipstick for an appointment. The female doctor wrote “background of ME but otherwise very fit and well”. People are lazy and make snap judgements regardless of being told repeatedly “I’m housebound and mostly bedridden”.

 

[Utsikt]

The bias against women throughout western history is undeniable. You don’t have to look further than the basic civil rights like voting.

Is there a point where we should assume that bias against women is the default?

 

[rvallee]

It's a systematic problem of "evidence based medicine" where trials are just designed to get approval rather than optimized for the best patient experience (which costs more money)

Always just enough to get above the arbitrary threshold, whether legitimately or not. The race to the bottom has, unsurprisingly, led to bottom-level performance, by incentivizing shaking those results up hard enough to get a few blips above the line, and only counting those when preferred.

I guess it feels easier this way. It's not, but this is a vibes thing. It's all about getting a foot in the door. Once you're there, you can stay there indefinitely, never have to bother doing any real work.

 

[MrMagoo]

The bias against women throughout western history is undeniable. You don’t have to look further than the basic civil rights like voting.

Is there a point where we should assume that bias against women is the default?

Only if you ensure you add “not all men” otherwise the debate gets hijacked by “I don’t do that/a woman was as bad/but <insert whataboutery>” there has to be about 75% of any debate of women’s issues overtaken by these diversions so the women don’t get to speak about what’s affecting them. They’re not “special”.

 

[MrMagoo]

Note that the problem wasn't that they didn't include women in the trials, the problem is the trial design itself - they didn't consider trialing lower dosages for women. Also note that age makes a huge difference in dosage as well, with elderly people often needing half the dose of some drugs (eg antidepressants).

The point is that it isn't the numbers of women in the trial that is the problem, it is the design of the trial eg not listening to women that the dosage is too high that is the problem.

It's a systematic problem of "evidence based medicine" where trials are just designed to get approval rather than optimized for the best patient experience (which costs more money)

So it’s still a problem for women, it just isn’t the exact problem that was specified.

 

[jnmaciuch]

However, there are specfic dynamics to how the expectation and performance of masculinity play out among men that are subtle and hard to explain if you haven't personally experienced them.

That gets into standpoint epistemology about dominant narratives which is a much longer conversation that is probably not worth dragging out here

I can tell you that the privileges of masculinity do largely go away once you're percieved as disabled, especially with an illness many don't understand or even believe in. And for an autistic man like me they were always unevenly distrubuted based entirely on how I was percivied/how well I was able to mask in a particular interaction

This is the same misunderstanding that prompted my original reply—privilege is always relational, and the whole point is that it is something that never goes away because its benefits are the set of things that you don’t have to worry about by virtue of being perceived as a man within the set of every other bias you’re also experiencing. Autistic and chronically ill woman (hi) are also going to face the same worse treatment on the basis of being autistic.

The point is that when someone has male privilege, it’s an absence of the additional axis of oppression that being a woman would confer in conjunction with the impact of any other axis of oppression (per Crenshaw’s framework). The fact that autistic men get treated worse than non-autistic men doesn’t mean male privilege goes away, because the relevant comparison at that point is autistic men vs. autistic women. It doesn’t mean that the experience wont be different in some respects by being a man. It means that you’re not also inherently facing bias on the basis of being a man.

And I don't think it is as simple as 'be a man as opposed to a woman'. I think there is an extent to which both ableism and misogyny (and a lot of homophobia etc) stem from a hatred of perceived weakness, of all the things that fall outside the circle of being 'strong' in the narrow concept of strength in the patriarchal conception of it.

yes, of course, femininity disability theory has quite an expansive conversation on this that I couldn’t summarize in one response.

I don't think acknowledging these things takes anything away from our ability to discuss the experiences women have. It doesn't mean 'women don't face prejudice' or 'misogyny isn't real'. But patriarchal society confers a specfic set of expectations, rules and codes onto all men which were are punished for not abiding by. And that's very important to acknowledge.

My original response was trying to explain why “men experience these things too” is a very unhelpful response when discussing specific axes of oppression intersecting with bias against women because that obvious fact is already obvious, it’s just men misunderstanding the conversation and assuming women aren’t or can’t be aware of that obvious fact.

The whole point of the discussion is not to say that men don’t experience certain things. It’s not saying that the ableism that men experience won’t look different, either. It’s saying that when a disabled woman experiences bias it’s the bias against disability compounded with bias against women. And the second part is absent when disabled men experience bias, which IS the privilege we’re talking about (but doesnt mean the bias they do experience isnt real or isnt very bad).

It’s the exact same frustrating dynamic as when disabled people talk about experiencing medical ableism and someone chimes in to say “well I’m not disabled but I get mistreated by doctors too and that’s important to talk about and doesn’t mean that ableism isnt real.” Like yea, no one is operating under the silly impression that the medical system works perfectly for able bodied white men.

 

[V.R.T.]

That gets into standpoint epistemology about dominant narratives which is a much longer conversation that is probably not worth dragging out here


This is the same misunderstanding that prompted my original reply—privilege is always relational, and the whole point is that it is something that never goes away because its benefits are the set of things that you don’t have to worry about by virtue of being perceived as a man within the set of every other bias you’re also experiencing. Autistic and chronically ill woman (hi) are also going to face the same worse treatment on the basis of being autistic.

The point is that when someone has male privilege, it’s an absence of the additional axis of oppression that being a woman would confer in conjunction with the impact of any other axis of oppression (per Crenshaw’s framework). The fact that autistic men get treated worse than non-autistic men doesn’t mean male privilege goes away, because the relevant comparison at that point is autistic men vs. autistic women. It doesn’t mean that the experience wont be different in some respects by being a man. It means that you’re not also inherently facing bias on the basis of being a man.


yes, of course, femininity disability theory has quite an expansive conversation on this that I couldn’t summarize in one response.


My original response was trying to explain why “men experience these things too” is a very unhelpful response when discussing specific axes of oppression intersecting with bias against women because that obvious fact is already obvious, it’s just men misunderstanding the conversation and assuming women aren’t or can’t be aware of that obvious fact.

The whole point of the discussion is not to say that men don’t experience certain things. It’s not saying that the ableism that men experience won’t look different, either. It’s saying that when a disabled woman experiences bias it’s the bias against disability compounded with bias against women. And the second part is absent when disabled men experience bias, which IS the privilege we’re talking about (but doesnt mean the bias they do experience isnt real or isnt very bad).

It’s the exact same frustrating dynamic as when disabled people talk about experiencing medical ableism and someone chimes in to say “well I’m not disabled but I get mistreated by doctors too and that’s important to talk about and doesn’t mean that ableism isnt real.” Like yea, no one is operating under the silly impression that the medical system works perfectly for able bodied white men.

I want to point out that this discussion morphed into one about the experiences men and women have with chronic illness before I posted in the thread. So I'm not sure why I've been singled out. I didn't mean to undermine anyone's experience or derail the conversation. I can see what is broadly what has happened here though.

My point was that being seen as 'a man' is not just a static thing. 'Be a man', 'man up' etc. mean perform the actions associated with masculinity or you will forfeit its privileges. The status of 'man' is something that can be conferred or removed depending on how you and your actions are percived. And because of that there are experiences of prejudice that are unique to being a chroncially ill or autistic man.

I don't think we can call the fact that male pwME dont get treated quite as awfully as female pwME 'privilege' outside of a very rigid academic construct of the word, considering how awful both experiences are.

My entire life was destroyed by ableism and toxic masculinity, essentially. I feel I should be able to share that experience. If this was the wrong place i apologise.

I won't reply further because Ive gone far beyond my available energy reserves.

 

[Trish]

Mods have decided to lock this thread.

The topic of whether women and men are, or are not, treated better or worse by doctors has been discussed several times on the forum already, and while we can all agree both women and men may have particular problems with both male and female doctors, and most people with ME/CFS have experienced bad treatment, the discussion tends to descend into tetchy arguments about which groups are treated worse.