‘Precious, princess’: Health minister warns GPs to brace for women’s pain inquiry findings

Victorian Health Minister Mary-Anne Thomas is warning doctors to brace themselves for the results of Australia’s first inquiry into women’s pain, saying it revealed “a misogynist view that pain is part of women’s burden”.

Thomas said she was shocked to learn what more than 13,000 women and girls who shared stories with the inquiry experienced, and that many had serious pain dismissed or were “gaslit” by being told they had mental health issues.

Health Minister Mary-Anne Thomas has warned GPs and other practitioners the report into women’s pain treatment will make for difficult reading.Credit: Simon Schluter

Women testified saying things such as, “I just want to get off the merry-go-round of antidepressants and iron infusions” prescribed for pain.

It’s prompted Thomas to warn that the findings will make difficult reading for the medical profession.

“Brace yourself for what the report is going to say about women’s experience with their primary healthcare practitioners,” Thomas said she had told the Royal Australian College of General Practitioners.

“I don’t want to blame them, but it goes to the Medicare rebates, it goes to what they’re taught and what they know and both conscious and unconscious bias that exists within the health profession.”

Thomas said some women felt they were treated as drug addicts when they asked for relief. She was challenged by researchers for suggesting misogyny may be a factor the gender-pain gap.

“‘It’s natural. Therefore, we shouldn’t do anything about it’ – that was presented back to me. I thought, ‘That’s really something’ – because cancer is also ‘natural’.”

In its submission to the 11-month inquiry, the Australian Nursing and Midwifery Federation included incidents of health workers having their own pain treated dismissively and witnessing women receiving gender-biased treatment.

It received more than 800 responses in four days to a member survey on women’s pain.

Of 89 per cent of nurses and midwives who had experienced acute pain, two-thirds felt “dismissed by health professionals”, and 53 per cent said the response was negative.

A nurse on a mixed specialty surgical ward said gynaecology patients who describe “10/10 pain” were given paracetamol as a first-line treatment to “wait and see if it helps”, while other surgical patients “are given two to three lines of analgesia charted immediately at any instance of pain”.

Another told of “multiple colleagues judging young female patients’ subjective pain scores, calling them ‘precious’, ‘princess’ or ‘overreacting’.”

Men were believed and treated sooner and often given more options. One nurse “watched a man with a carpal tunnel be written up for 20 mg of IV [intravenous] morphine, but a woman with a full reproductive system removal gets written up for only a max of 10 mg of IV morphine.

“Women are seen as if they can’t tolerate pain, or they’re weak or as, ‘You bear children, you can deal with great amounts of pain’.”

Sue Matthews, chief executive Royal Women’s Hospital and National Women’s Health Advisory Commitee

“We are treated differently and are often labelled as emotive or anxious,” she said.

The federation’s Madeline Harradence, a member of the Victorian Women’s Health Advisory Council, said nurses and midwives reported a delay in women getting care for chronic pain and getting appropriate care or treatment for very acute conditions.

“A woman who turns up in the emergency department is not believed, they’re having trouble getting in the door,” she said. “[Nurses] are constantly having to advocate for women against those gendered structures.”

Professor Sue Matthews, the Royal Women’s Hospital chief executive and inquiry co-chair, said it was heart-wrenching to hear from women at community forums, focus groups and online.

“The number one issue for women has been they felt dismissed,” said Matthews, also a member of the National Women’s Health Advisory Committee.

“One of the biggest things we’re hearing is that their pain is attributed to mental health issues or lifestyle factors, when it isn’t [due to those].

“Women are seen as if they can’t tolerate pain, or they’re weak or as, ‘You bear children, you can deal with great amounts of pain’ … It’s the invisibility of those women that’s the problem.”

Australian is behind other nations in stratifying research data by gender and including women in trials, she said. More eduction was needed to increase understanding that women’s pain is not “normal”.

Women in acute pelvic pain can receive gender-biased prescription of analgesia in hospital compared with men, nurses told Australia’s first women’s pain inquiry.Credit: iStock

That medical knowledge “doubles every 73 days” means it is very difficult for healthcare practitioners to keep up, Matthews said, and the inquiry would make recommendations about how to support them to do this.

RACGP Victorian Council chair Anita Munoz acknowledged that in parts of the medical system, “there are women who have had bad experiences of not being believed about their pain”, but said inquiries often captured historical as well as contemporary experiences.

Poor understanding of women’s pain was not just a general practice issue, but GPs faced particular challenges because patients often have multiple co-existing problems to be addressed in standard 15-minute appointments.

“GPs and patients bear the brunt of this: we have a more than 40-year-old funding system that financially punishes good GPs for spending in-depth time with patients. The patho-physiology of gynaecological issues and chronic pain is very difficult to do … in the that amount of time,” Munoz said.

‘If it achieves parity with MBS funding that would be good ... the rebate for scanning a scrotum is more than for scanning a female pelvis.’

Marilla Druitt, Royal Australian and New Zealand College of Obstetricians and Gynaecologists

“The Medicare funding system sets up GPs to fail.”

Dr Marilla Druitt, a councillor of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and president of Pelvic Pain Victoria, said she was not at all surprised by what women told the inquiry.

The college’s submission noted “research shows that chronic pain affects a higher proportion of women and girls than men, yet women are far less likely to receive treatment”.

Druitt said it was hard to judge if the use of the term “medical misogyny” by some regarding responses to women’s pain was justified, but if it helped change longstanding women’s health funding problems it might be.

“If it achieves parity with Medicare Benefit Schedule funding that would be good. [For example] the rebate for scanning a scrotum is more than for scanning a female pelvis,” she said.

“I desperately hope that some of what we recommended is accepted.”

The inquiry is due to hand its recommendations to the Victorian Women’s Health Advisory Council by December and will be released in early 2025.

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