As a middle-aged male doctor, I viewed the news last week that half of women believe the NHS treats their health as a second-class issue with disbelief.
Why did only half of women believe that? I think it should be 100 per cent of them. Because the shameful fact is, in terms of their health, women really are treated as second-class citizens, with study after study showing that they consistently receive worse medical care than men.
This must change and – as a husband and father of daughters, as well as a doctor – my fear is that this isn’t changing fast enough.
Take heart disease: compared with men, women who have a heart attack are more likely to be misdiagnosed and less likely to be given the right treatments such as an angiogram to open up blocked blood vessels.
No wonder women are more likely to die of a heart attack than men – don’t just take my word for it: a consensus statement bringing together all the relevant data, published last month in the journal Heart by leading British heart doctors, concluded that ‘cardiovascular disease remains the UK’s number-one killer for women. Women are underdiagnosed, undertreated and under-represented in all cardiovascular disease areas.’
Women really are treated as second-class citizens, with study after study showing that they receive worse medical care than men, writes Professor Rob Galloway (file image)
I don’t believe this is principally due to overt sexism – but because of an ingrained culture of medical education and research. I recall, with anguish, the case of the 75-year-old who died of a heart attack when I was a junior doctor. I’m sure she would have survived, if she’d been a he.
She’d come to A&E with fatigue and vague pain in her chest and back, but not the typical crushing pain described in medical textbooks. She also didn’t have the usual risk factors we were taught, such as smoking or high blood pressure.
We discharged her with a diagnosis of ‘atypical chest pain’ and advised her to take paracetamol. Two hours later, she had a heart attack and died.
Her atypical symptoms were, in fact, only atypical for men. And her risk factors were either unique to women or more relevant to women – for example, being postmenopausal and not on HRT and having an autoimmune disease such as rheumatoid arthritis, a history of gestational diabetes or depression.
All risk factors – just not the ones I was taught. And her gender-biased care didn’t stop there. After her heart attack, the two members of the public who’d called the ambulance didn’t carry out CPR. By the time the paramedics arrived, it was too late.
A new survey by St John Ambulance showed that one in three Britons is afraid to give women CPR, as they’re worried about touching their breasts. This would explain why only 68 per cent of women receive CPR from members of the public; 73 per cent of men do. Tellingly, survival from cardiac arrest is higher in men than women.
David Bowen, national clinical lead for resuscitation at St John Ambulance, told me: ‘We must bust the myth that it’s not appropriate to do CPR in women.’
The disparity between men and women is certainly not just in cardiovascular illness: many studies have shown that women who go to A&E in pain are more likely to wait longer for pain relief and less likely to be discharged with painkillers.
A recent study in the journal Proceedings of the National Academy of Sciences, based on notes of more than 20,000 A&E patients, found that men were 20 per cent more likely than women to be discharged with analgesia, even if their pain scores were the same. Female doctors showed this bias just as much as male doctors.
There is also often a failure in diagnosing conditions that only women can get. Take endometriosis, a condition that affects millions of women worldwide. It takes on average seven years to get a diagnosis – seven years of excruciating pain, often dismissed as ‘bad periods’ or stress.
And then there’s the huge problem of medical research, in the past often only being performed on men. Treatments used for women are often based on the assumption that the findings apply equally to them. But the female body isn’t simply a petite version of the male; different hormones, genetics and anatomy make for a different patient.
The sleeping tablet zolpidem used to be prescribed to both men and women at the standard dose of 10mg, based on clinical trials that predominately involved male subjects. But research after the drug was introduced showed that in women it was metabolised more slowly.
This meant they had higher levels of the drug in their system the morning after taking it, leading to drowsiness and a higher risk of car accidents. The false assumption that ‘one dose fits all’ literally put many women’s lives at risk.
In 2013, 20 years after the drug was introduced, the US Food and Drug Administration recommended the dosage for women to be cut to 5mg.
The gender-skewed teaching and years of research based on male models of illness mean that for 50 per cent of my patients, I’m less likely to be giving the correct diagnosis – and the correct treatments.
The bottom line? You know your body better than anyone and that should give you the confidence to challenge me and my fellow colleagues if you feel we’re not getting it right. Demand the care you deserve; don’t assume we know best.
@drrobgalloway