Doctors don’t hate women, but we can be idiots when it comes to their health

I see the Sydney Morning Herald and The Age are researching, writing and promoting a series entitled “Medical Misogyny”. The starting point of the argument is that medical culture has for a long time seemingly ignored the health plight of women, with resultant delayed diagnoses, poorer care, and even perhaps unnecessary deaths.

And that is definitely true. Classic example: the heart attack.

Medical culture has ignored the health plight of women but it’s not misogyny.Credit: Marija Ercogovac

Let me start with a quick primer for you. As the aorta exits the heart, carrying all that lovely red, newly oxygenated blood around your body, two little arteries peel off, vital to your continued existence. The coronary arteries wind around your heart, delivering that oxygen-rich blood to your cardiac muscle. As we age, eat too much, smoke, or inherit bad genes, globs of fat and calcium lodge in the walls of those arteries, and if they eventually block it, the muscle it serves starts to die – that’s a heart attack.

Several things can happen. The muscle can become irritable, the electrical system breaks down and the heart effectively stops beating: you’re dead. That could be a good thing – aged 95 and you die peacefully in your sleep – or it could be really bad because you were in the supermarket, buying food for the kids. Often, though, you feel unwell, get chest pain, go to hospital and things are likely to be either partially or completely fixed. If the doctors realise what is going on.

And that’s where gender can get tricky. We doctors all remember vividly the classic heart attack red flags. The patient has noticed that when he walks up a hill too fast, he gets a little tight in the chest, settles down with a brief rest. Today though, the tightness has come on at random. And “tightness”? Actually, it’s quite painful, plus I feel nauseous. The pain starts to spread – down my left arm, and strangely, into my jaw. I feel like something really bad is about to happen (“a sense of impending doom”, say the old textbooks). I’m getting my wife to call an ambulance. You’ll be in coronary care in 45 minutes because the second the triage nurse hears “chest pain” in a slightly overweight sweaty-looking 65-year-old male, it’s all hands on deck.

But if the he is a she, it could be very different. I don’t have chest pain when I walk up hills, but I do feel a little odd. Hard to describe, but it goes away after a minute or two if I stop. Today, though, I’ve got that funny feeling at random. Something about my chest? Or the breathing? I take off the bra. Still not right. I’m sweaty and feel faint. Three hours later, I’m still in the back row of the ED waiting room.

I don’t know why it’s different, but I do know that it is. Smaller coronary arteries for women, I remember a cardiology professor saying to me, but there must be other things – maybe differences in neurological wiring. The trouble is, we the medical profession have been slow to react to this. Hence, the female nurse has shot the guy with chest pain into the acute section of ED but shoved the girl with funny symptoms to the back of the queue.

There are many, many other medical situations where doctors and nurses are better at listening to, understanding and diagnosing medical ailments in men rather than women. Part of it is probably a ripple down from the early 19th century. Yes, we are starting to understand how the body works, what goes wrong, how to fix it. The men were the breadwinners, disaster for a family if they died; they got heart attacks, they had factory accidents. You could always find another wife. So, when we worked out that the best way to test treatments was to do randomised trials, it was men we studied.

Also, women are just more complicated and interesting than men. The female pelvis, the menstrual cycle, menopause, the disinclination to punch, stab or shoot annoying people.

So, as a doctor, mea culpa. Work to be done, probably very interesting – I can envisage lots of PhDs. But “medical misogyny”? As a doctor who has spent almost my entire professional life looking after, diagnosing, treating, curing, consoling and farewelling women with breast cancer, I find that phrase deeply, deeply offensive. We’re not misogynists, we’re just idiots.

I’m a bit of an Ancient Greek nerd, so I know where the word misogyny comes from. The gynae bit is obviously women, the miso bit is hatred – the misanthrope, for example. Agnosia means lack of knowledge, ignorance. I’m an agnostic, I don’t know. So my suggestion for the syndrome you are now describing (and good on you, keep doing it) is gynagnosia. I don’t hate women, I just don’t understand them as well as I should.

Nicholas Wilcken is a Sydney-based oncologist.