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Women's Health

The Importance of Being Female: Why Gender-Specific Primary Care Matters

July 15, 2019

Recently, Megan Rapinoe, the record-breaking American professional soccer player whose adept ball-handling skills assisted the US Women’s National Team to their fourth World Cup victory, drew public attention to the gender-based pay discrepancy that exists in the world of professional soccer, which is applicable to most of us only in the sense that we may be female and we may experience a similar discrepancy, although likely not in relation to our fancy footwork. Nationally, across the board, a woman is statistically paid 79 cents for every dollar that a man is paid for doing the exact same job. This is regardless of job type, socio-economic bracket, or worker seniority. Women are also significantly less likely to hold high-level or high-paying jobs than men, and they are less likely to receive promotions to such positions relative to their male counterparts. Until 1988, women could not apply for any commercial business lending without having a male co-signer to vouch for her ability and competence to conduct business. We know a gender-related pay gap exists; we know a gender-related opportunity gap also persists. We know you know this. And we know all y’all know that there is gender inequality for sure in the performance of household chores as well as the management of work-family conflict (we can cite the highly powered scholarly studies that support this, when your oppositely gendered partners rebut). But, did you know that these discrepancies are also pervasive when women receive their medical care?

If you, as a woman, were walking down the street and suddenly collapsed, having a cardiac arrest, you would be 15% less likely than a man to receive CPR from any bystander, which means 15 women out of 100 needing CPR would be allowed to simply die, while all 100 men would at least benefit from an attempt to save their lives. If you were lucky enough to receive this CPR, you would be 25% less likely to survive from the CPR than if you had been male. The research speculation regarding this finding is that this is because women have breasts and rescuers feel odd about performing effective compressions on a female chest as opposed to a male chest.

Innocent bystanders and the general public’s bias and concern about touching your breasts aside, even the providers who have been trained to provide women’s clinical care (including touching their breasts) are less likely to respond appropriately to women. Women are significantly less likely to have been counseled on recognition of the symptoms of a heart attack because they are different from the widely publicized symptoms, which pertain only to men (who were the sole subjects of most clinical trials until well into the 1990s and remain the sole subjects of many clinical trials, particularly pharmaceutical trials even today). Even if a woman does report with symptoms consistent with a heart attack, she is considerably more likely to be dismissed and to have her symptoms attributed to “anxiety” or “agitation,” than to a cardiac source. Women are less likely to undergo tests to check their hearts or receive recommended treatments. A woman having a heart attack is 59% more likely than a man experiencing the EXACT SAME EVENT to be misdiagnosed from the outset. Even if she is diagnosed, she is 50% more likely to die. The vast majority of primary care doctors admit that they routinely rely on the “characteristic symptoms” of heart disease when preventively assessing patients, despite the fact that their entire female patient population would have a completely different clinical presentation.

You might think, because of the pink ribbons and the publicity, that breast cancer is the biggest overall health concern for women and that it is the source of the greatest mortality for women. In fact, heart disease is the leading cause of female death worldwide. A woman is three times more likely to die of heart disease than she is to die of breast cancer, and yet her PCP is more likely to focus female preventive care on a patient’s breasts than on the vital organ that lies beneath them.

Gender bias also plays out significantly in clinical pain management. Women are more likely than men to have their pain inadequately or inappropriately treated. They are significantly more likely to receive anxiety medication and sedatives in response to a complaint of pain, and men are significantly more likely to receive medication intended to treat pain when they report having pain. The results of studies examining physicians’ discrepant responses to and treatment of women as compared to men are applicable not just in the United States but in the world at large. Across the board, women are treated differently, and generally to their detriment.

In clinical trials and studies, women have long been regarded as the smaller counterparts of men. Research conducted on men has and still is extrapolated to apply to women, despite the fact that women’s bodies, metabolic processes, hormonal environments, and physiologic functioning are utterly distinct from those belonging to men. On the one hand, women continue to be treated as distinct from men, more hysterical and hypochondriacal, and on the other hand, the medical model often assumes that they are nothing more than miniature men. Most drug trials are conducted exclusively in male populations; “best treatments” that are then released to market for treatment of a general adult population are actually best treatments only for men, and we often do not have enough information to determine how well a medication might work in a woman’s body or what side effects or adverse effects a woman might experience in response.

When women are diagnosed with a mental illness by a primary care provider, they receive worse medical treatment (receiving less health monitoring and taking more potentially harmful medications) than men. Non-smoking women are three times more likely than men to develop lung cancer and five times less likely to have it diagnosed in a timely fashion. Women are significantly more likely than men to experience a stroke, and they are significantly more likely to have a delayed diagnosis or a missed diagnosis. If a woman survives that stroke, she will have worse quality of life than her male counterpart.

These are not “women’s health” conditions. These are not conditions related at all to any unique female components. Or, are they?

I would argue that all medical conditions occurring in women are women’s health conditions. And, I would argue that all medical professionals providing care to women should be trained specifically in the provision of care to women, just as all medical professionals providing care to children are required to have received specific training in pediatric medicine. The sad reality, however, is that primary care is seen as primary care: everyone gets the same average of 7 minutes per visit face-to-face with their medical provider, and, at the end of the day, the women are more likely to die simply because they are women. In most primary care settings, women are referred out for their gynecologic concerns, because “those parts” are considered “specialized,” and women’s health-specific issues and concerns are routinely neglected or ignored.

It is time to stop fragmenting care. It is time to stop relegating “women’s health” to gynecologic care. It is time to see women as whole people (who are statistically juggling more varied responsibilities than their male counterparts, are carrying more household/family/caretaking demands than men are, and are less likely to prioritize their own need for medical care as a result), and to provide integrated care to women that allows them to receive care for their physical, psychological, and emotional states in a single space that offers distinct expertise in caring for women as biological beings that are not just small men. It is time to craft a model of care that allows women to have knee concerns (in her female knees that are uniquely different from any male’s knees) in the same space that she has uterine concerns, and it is time to both promote and insist upon gender-specific, comprehensive models of primary care.