Women still face disparities in health care

As hard as it may be to understand 25 years into the 21st century — and nearly 40 years after March was designated as Women’s History Month — women are frequently overlooked when it comes to medical research and treatment.

Studies have shown that symptoms of cardiovascular disease are treated more aggressively in men than women. Women’s bodies mount a different immune response to vaccines, yet vaccines are still one-shot-fits-all. A 2021 report found that clinical trials in oncology, neurology, immunology and nephrology had the lowest female representation relative to how much these diseases impact women.

In the news right now are emerging lawsuits against Pfizer alleging that its widely used birth control, Depo-Provera, caused usually benign brain tumors called meningiomas. These tumors typically bring on headache, dizziness and depression, and guess what? Some women are finding that it’s taken months or years for them to get a diagnosis. (Pfizer responds that its product has been proven safe over decades of use. Stay tuned.)

I don’t think doctors are necessarily dismissing women’s symptoms on purpose. Most of us humans have some level of built-in “implicit bias,” subconscious feelings, attitudes, prejudices and stereotypes that have been baked into us throughout our lives.

And health care providers are just that: human. Many grew up in families where women were not always given the same opportunities a generation ago that men were. They can be quite unaware that subconscious perceptions, instead of facts and observations, are affecting their decision-making and influencing their care decisions.

I have worked with doctors closely for decades and I have seen women’s concerns not taken as seriously, especially as it pertains to reproductive care. Ovarian cancer is a good example because there’s no screening test for it and the symptoms can easily be interpreted as a digestive disorder, urinary tract infection or menstrual pain. By the time most women receive a diagnosis, their cancer is already at Stage III or IV. Poor women and women of color are particularly affected.

Women, meanwhile, are often socialized to be nice, never question a doctor, and never want to be perceived as a “problem” if they speak up for a family member. This may result in the patient becoming more and more frustrated because her symptoms being dismissed (“It’s all in your head”) or minimized.

Patients of all genders and backgrounds can help themselves if they’re encountering an experience with what appears to be implicit bias. Here are some suggestions:

1. Don’t go it alone.

Doctors typically spend much more time teaching, reviewing labs and answering questions when an advocate or informed family member is attending the visit. One of my tried-and-true recommendations is to bring someone with you to all appointments, have them take notes and tell them to feel free to ask questions. If they’re not a spouse, you can give your verbal permission for a provider to discuss your care with them.

2. Prepare for your appointments.

An implicit bias may lead a doctor to automatically label a patient as “hypochondriac” based on their presentation or demeanor, without fully considering the possibility of a real medical condition. You can guard against this by researching your symptoms on authoritative websites, such as WebMD.com or CDC.gov, and come prepared with notes and questions.

3. Be assertive, but not rude or angry.

Expressing extreme anger and frustration, or calling into question the provider’s intelligence, education or caring, might actually cause a doctor to want to avoid you, dismiss you as having mental health issues — or even “fire” you as a patient. I counsel all my clients to be persistent but polite and never alienate those caring for you.

4. If all else fails, change doctors.

If you feel like you are being treated disrespectfully and your concerns are not addressed, get a second opinion or switch doctors immediately. You can take that to an extreme, however. I’ve seen patients go “shopping” for a diagnosis until they find a provider who agrees with them. This isn’t helpful, either.

5. Consider hiring a professional patient advocate.

A patient advocate who has training as a nurse or other medical professional can take a dispassionate look at you and your symptoms, speak to your health care provider with some authority and interpret test results and conversations in lay language.

Women have come a long way when it comes to health care, but we haven’t achieved equity yet. Learning to advocate for yourself is one way to make progress.

• Teri (Dreher) Frykenberg, a registered nurse, board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” available on Amazon. Frykenberg offers a free phone consultation to readers. Contact her at Teri@NurseAdvocateEntrepreneur.com.