Imagine getting up from a chair and suddenly experiencing extreme dizziness, a pounding heart rate and spinning vertigo. Imagine your eyesight shrinking and losing consciousness. Imagine feeling a constant pressure in your chest that may be a heart attack, but when the ambulance arrives the E.M.T dismisses the symptoms as food poisoning. Imagine living with chronic pain in every joint, limb, and digit for years with no relief and being referred to specialist after specialist who says that it’s all in your head.

These are common occurrences for women in America’s healthcare system; many of whose experiences regarding pain are dismissed, misdiagnosed, and ignored. 

Implicit bias effects many kinds of people within American healthcare, and can be based on race, gender, sexual identity, financial stability, previous drug history, history of mental illness, or even lifestyle choices such as having tattoos or dyed hair.

However, when it comes to women's healthcare, women are more likely to experience bias and have their symptoms ignored or dismissed than men. 

In 2001 Diane Hoffmann and Anita J. Tarzian published the seminal study The Girl Who Cried Pain in the Journal of Law, Medicine & Ethics. Hoffman and Tarzian targeted three separate clinical studies on women’s pain to understand how pain is performed by patients vs. how it is perceived. They also focused on how pain may be culturally based, and how medical professionals may differ in how they treat patients based on their gender. The studies found that “[there is] ample evidence that differences between men and women in pain response exists, what is unclear is whether the reasons for these findings are grounded in differences in biology or…in coping or expression, or both” (15).

They found that women are more sensitive to pain, more likely to report pain, and had different coping mechanisms for pain then men. However, observers were more likely to see men as having more pain, and women as more likely to be exaggerating. 

The information in Hoffman & Tarzian’s article was later confirmed by clinical experiments performed by Michael Robinson and Emily Wise in 2003 and reconfirmed in 2023 by Gina Paganini, et al. 

Many of the biases regarding differences in how people perceive pain relate to the idea of female hysteria. The notion of female “hysteria” has long been based in medical science and for centuries had been considered a legitimate medical diagnosis. According to Gabrielle Jackson in her book Pain and Prejudice "“Whenever treatment options are limited because of lack of medical understanding of how a condition works, hysteria narratives start to emerge.” (pg. 161). 

Still today, women make up 70% of chronic pain sufferers, but 80% of all clinical testing for chronic pain is performed on men. 

Men are 2-3x's more likely to be referred to a cardiologist after suffering symptoms of a heart attack, while women were more likely to be prescribed anxiety medications and sent home. 

Heart disease affects more men globally, but women are 30% more likely to die from heart disease than men. 

P.O.T.S (Post-tachycardia Syndrome) is a disease that medicine has known about for almost 50 years, and 85% of P.O.T.S patients are women, yet their time to diagnosis is 2x's that of male patients (4-5 years). 

Implicit bias in medical care effects all patients, because it creates barriers to adequate care and reduces trust in the medical establishment. According to Julia Golden, who authored Gender Bias in the Treatment of Chronic Pain one of the best things patients can do is establish a strong relationship with a trusted medical professional. Someone who can understand how you as an individual reacts to pain and describe their symptoms. 

The problem with this is that many chronic pain patients are in no shape to advocate for themselves and may not have a relationship with a medical professional to advocate on their behalf. Much of that work falls onto their families or friends. In the absence of those advocates, chronic pain patients are left on their own to secure a diagnosis and treatment. 

The most effective way to address this issue would be to establish an in-hospital 3rd party advocacy network for patients. These would consist of senior medical professionals that could be requested by patients to review their medical records and act as an advocate for the patient. They could also help provide alternative ideas for care, make referrals to specialists (if needed) and offer new insights for treatment of patients with more difficult to diagnose conditions. 

Patient advocacy groups are not new. There are several national level patient advocacy networks. However, many of these networks require a diagnosis in order to receive services, and many can only help navigate the billing side of the healthcare system. They do not have the resources to act as a "second opinion" for patients in real-time. 

For chronic pain patients it can take years to receive an adequate diagnosis and even longer for a pain management plan. 

Creating a system to reduce gender bias in healthcare is possible but will require both support and investment from hospital networks and medical professionals. 

We would like to see a 3-step process to reduce implicit bias in patient care by: 

1-) Establishing an in-hospital patient advocacy network. 

2-) Creating a streamlined way to report instances of implicit bias experienced by patients. 

3-) Have hospitals provide more implicit bias training to doctors and residents. 

If you are a chronic pain sufferer, or you would like to see more being done to reduce implicit bias in the healthcare system, please sign our petition. Once signatures are collected it will be forwarded to the National Institue of Health, The American Medical Association and Congress to help address implicit bias in medical care. 

If you would like to read more feel free to review this list of sources regarding gender bias in women's healthcare. 

Sources: 

Hoffmann, Diane E. and Tarzian, Anita J. "The girl who cried pain: a bias against women in the treatment of pain." Journal of Law, Medicine & Ethics Vol. 29 Issue. 1 (2001): 13-27 

https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1144&context=fac_pubs

Golden, Julia. "Gender bias in the treatment of chronic pain." Social Accountability: Giving Voice to the Voiceless (2020). 

LUC_SW_Journal_Praxis_Volume_20_October_2020.pdf

Jackson, Gabrielle. Pain and Prejudice: How the Medical System Ignores Women—And What We Can Do About It. Greystone Books Ltd, 2021. 

Paganini, Gina A., et al. "Women exaggerate, men downplay: Gendered endorsement of emotional dramatization stereotypes contributes to gender bias in pain expectations." Journal of Experimental Social Psychology Issue.109 (2023): 104520. 

https://www.sciencedirect.com/science/article/pii/S002210312300077X

Robinson, Michael E., and Emily A. Wise. "Gender bias in the observation of experimental pain." Pain 104.1-2 (2003): 259-264

Gender bias in the observation of experimental pain - ScienceDirect