The lack of data on women in medical science might lead to gaslighting female patients. While closing this gap might take several decades, there is something every woman could do to make sure her complaints are not dismissed.
The movie Gaslight, released in 1944, tells a story of a man manipulating his wife into a state where she starts questioning her own sanity. Since then, the term "gaslighting" has been used to describe what is, according to the New Port Institute, "a form of psychological manipulation in which the abuser attempts to sow self-doubt and confusion in their victim's mind."
When it comes to medicine and women's health, gaslighting means dismissing female patients' concerns and complaints. The TODAY and SurveyMonkey poll from 2019 found that 17% of women felt they had been treated differently at the doctor's office because of their gender compared to only 6% of men.
In the same survey, more than a quarter of women with chronic health conditions said a health care provider ignored or dismissed their symptoms. Almost one-third of them said they felt like they needed to "prove" their symptoms to a healthcare provider, and 1 in 4 women with chronic diseases said a healthcare provider did not take their pain seriously.
And while perception can be biased, a number of studies prove female patients are treated differently.
Research from 2018 analyzed 77 studies from high-income countries, including the US, on sex differences in pain. Some studies suggested that women were used to internal pain because of menstruation and childbirth, while others identified pain without an external cause as "a natural characteristic of women's bodies."
Some studies showed that women in pain could be perceived as hysterical, emotional, complaining, not wanting to get better, malingerers, and fabricating the pain as if it were all in her head.
It might be even worse for women of color. A 2018 study of 12 147 outpatients with atrial fibrillation — an irregular heart rhythm — found that black individuals were 25 percent less likely to receive any oral anticoagulant, a medicine necessary to prevent blood clots. Black patients were also 37 percent less likely to receive the newer oral anticoagulant, which is safer and easier to use.
A study from 2022 investigated sex differences in the evaluation of chest pain, a common symptom of heart attack, among young adults presenting to the emergency department. The research found that women were less likely than men to be triaged as emergent, to undergo electrocardiography, or be admitted to the hospital or observation unit.
Where does it come from?
Dr. Susan Wood, the Director of the Jacobs Institute of Women's Health, which is based at the George Washington University, says that a lack of research on women's health was identified several decades ago. Medical gaslighting exists to this day, but it is not necessarily conscious.
"Most physicians and health professionals are in the business of trying to help people. But they have not necessarily been trained on sex and gender differences issues," she said to Healthnews.
For example, research from 2008 looked at the availability and accessibility of gender-specific knowledge in that time medical textbooks used in Dutch medical schools.
In eleven textbooks screened, gender-specific information was scarce or absent and hardly accessible via index or layout, researchers say. And the scarce gender-specific information mainly applied to epidemiological data and reproductive items.
Only in 1993 National Institutes of Health (NIH) Revitalization Act was signed into law, making it illegal not to include women in NIH-funded clinical research trials. However, the act did not apply to independent drug manufacturers.
No wonder it was reported in 2005 that eight out of ten prescription drugs were taken off the US market because they caused statistically greater health risks for women than men.
Dr. Wood says progress has been made in a number of different areas, such as biological research or clinical studies, but translation into medical practice is "something that has been known to take decades."
"We are still in the gaining knowledge phase that we have been in for the last 30 years, and we are still pretty much in the stage of translating it into practice," she says.
What to do?
Dr. Wood, who has been working in the women's health field for 30 years, says that when it comes to serious health concerns like cancer, it is advised to have someone else with you at the doctor's office.
"Someone who can act as your advocate and can ask questions, listen to the answers, so you would have someone else to hear the information that might help your health," she says.
Her advice for a patient who suspects being gaslighted is to educate themselves as much as possible, and seek a second opinion from a health professional who will listen to them and provide all the necessary information.
What could also help, according to Dr. Wood, is looking for organizations, primarily non-profit, that have engagement with the system to try to make it better for women. Some of those organizations focus on women's health, like the Women's Health Network or Breast Cancer Action.
Bella R. Grossman, MD, PhD at Katz Institute for Women's Health, says that if you disagree with your doctor, say so.
"Write down all your symptoms in a log or journal and show it to your physician to see if the two of you can figure out the bigger picture. If you're ignored — for example, your doctor refuses to brainstorm with you or won't run more tests — get a second opinion. Remember, you know your body best. If something bothers you, you need to speak up for yourself," she says.
3. Journal of the American Health Association. Sex and Race Differences in the Evaluation and Treatment of Young Adults Presenting to the Emergency Department With Chest Pain.
4. National Library of Medicine. Gender bias in medical textbooks: examples from coronary heart disease, depression, alcohol abuse and pharmacology.
5. National Library of Medicine. Gender bias in research: how does it affect evidence based medicine?
7. Science. Wanted: Women in Clinical Trials.
8. Katz Institute for Women’s Health. Gaslighting in women’s health: No, it’s not just in your head.