When women are underrepresented in health care, half of our world’s population becomes at-risk.
If you’re a woman reading this, chances are you’ve experienced that sinking feeling you get when you’re sitting in your doctor’s office expressing your concerns, but you don’t feel heard. The unfortunate truth is that you’re not alone. Women are repeatedly underrepresented in all fields of health care — from medical research to the emergency rooms, putting half of our world’s population at risk.
Many studies over the years reveal that women are less likely than men to receive more advanced diagnostic and therapeutic interventions. Historically this disparity is due, in part, to inadequate medical research that doesn't consider the biology of women.
“When male and female patients tell their stories, healthcare professionals are inclined to interpret, even identical narratives, in different ways because of preconceived notions and assumptions about men and women, known as implicit gender bias. What’s even more troubling is that physicians are more likely to interpret men’s symptoms as organic and women’s as psychosocial, and female patients are assigned more nonspecific symptom diagnosis,” according to (Hamberg - Women’s Health - 2008).
Gender disparities and gender bias in clinical practice
Gender bias is when there is a preference for one gender over another based on beliefs or generalizations. This preference can lead to a negative evaluation of a person based on irrelevant characteristics such as race or gender. Gender disparities in clinical practice result from the unintended, unconscious, or implicit bias that occurs when an individual attributes certain attitudes or stereotyped preconceptions about health, behavior, experiences, needs, and wishes to another person or group of people, according to BMC Medical Ethics. Gender and cultural stereotypes may not be intentional, however, their mere existence influences how information about an individual is processed. This leads to unintended biases in decision-making.
Physicians are expected to follow evidence-based medicine concepts and accomplish performance goals to provide consistently high-quality medical treatment. However, not recognizing and addressing one’s own biases impairs a provider’s ability to fulfill this commitment.
“To fulfill the goal of delivering impartial care, healthcare professionals should be wary of any kind of negative evaluation they make that is linked to membership of a group or a particular characteristic,” according to a study conducted by (FitzGerald and Hurst - BMC Medical Ethics - 2017).
Such implicit biases lead to disparities in the care patients receive and operate to the disadvantage of those who are already vulnerable. According to a study conducted by the Institute of Medicine, these disparities are caused by a variety of sources, including personal bias, prejudice, and stereotyping on the part of health care personnel.
"The mere existence of cultural stereotypes about social groups (e.g. women, men, Blacks, Whites) can influence one’s behavior toward and judgment of individuals from that stereotyped group," according to The National Center for Biotechnology Information.
Evidence-based bias-reducing strategies
Implicit bias among healthcare providers impacts clinical decision-making in ways that perpetuate health care disparities and place patients at risk. Twenty out of twenty-five assumption studies found evidence of bias in either the number of questions asked of the patient, the number of tests ordered, diagnosis, or treatment recommendations as reported by BMC Med Ethics. Provider behavior has been identified as an important contributor to disparities in healthcare.
“Unconscious biases are “habits of mind,” learned over time through repeated personal experiences and cultural socialization; they are highly resistant to change,” according to the Journal of General Internal Medicine.
Implicit gender bias among healthcare providers has been shown to persist from early in medical training and play a role in gender disparities in hiring, advancement, and pay as physicians’ careers progress, according to the Canadian Medical Association Journal. A critical first step in bridging the gender gap in healthcare is to diversify recruitment efforts, and invest in programs that incorporate evidence-based and bias-reducing strategies for medical trainees and practicing physicians.
Such programs are designed to prevent unconscious attitudes and stereotypes that negatively influence the course and outcomes of clinical encounters. Although, successful implementation is not enough. Developing standardized indicators and audits are needed to accomplish a structural embedding of gender equality in clinical practice.
Despite numerous studies and investigations over the years about gender bias and gender disparities in healthcare, inadequate treatment of women and improper diagnoses continue to be regularly reported, even today. Improving the representation of women in healthcare and particularly health tech provides the space for women to drive discovery and innovation, address disparities, and provide role models for the next generation of female scientists.
At Lin Health we deliver care that is hyper-aware of the gender bias in the pain space. The Centers for Disease Control and Prevention reports 56% of people coping with long-term pain are female - and yet only 36.3% of healthcare providers are female according to the Association of American Medical Colleges. Women come to us every day with both intense physical pain and far too often, an additional layer of pain caused by the unintentional, gender-insensitive way they have been treated by the medical system. At Lin, we have a care team that is, most deliberately, overwhelmingly female. We provide a team who is trained to listen to our members’ language about pain and match our voice to theirs. By reversing the statistics on care provider gender bias and by building a culture based on listening to reduce provider bias, we are ahead of the pack. At Lin, we have high hopes that the medical establishment, at least in this regard, will catch up very soon.
Dr. Abigail Hirsch is the founder and CPO of Lin Health, a technology leader in the fast-emerging health-tech industry.