“I was just never taken seriously. Never. They just dismiss you as though you’re a menopausal woman who’s put on weight.” – Jenny Piper, who is dying from cancer almost a decade after she presented with a cluster of distressing symptoms.
“The way doctors ask questions is designed to elicit responses from men. The questions we were trained to ask are not suited for [women’s] form of language and description.” – Professor Nada Hamad
“When I trained as a medical oncologist 20 years ago, we were under the impression women were just smaller men.” – Medical oncologist Dr Ophira Ginsburg
Women have struggled through history to be treated as the equal of men. Everything has had to be fought for, from being allowed to vote to being allowed to take part in the workforce. The Age this weekend publishes the first articles in a wide-reaching investigation by a team of reporters into medical misogyny.
This is an area of bias that can damage and indeed play a debilitating part in the life of women. Treating one human differently in their seeking of care and treatment, both physically and mentally, is shameful.
The Age articles paint a damning picture of what women have to endure. This ingrained systemic bias is individual-based, medical process-based and government-based.
Women who seek treatment for their health are coming up against barricades that are simply not there for men. They are, in effect, second-class citizens, less than the sum of a man.
In the past, women were dismissed, fobbed off, as being hysterical (a term never used against a man), as if their nature and body were heir to an inherent weakness of the species.
The introductory quotes above are just a sample from The Age articles. More than 1800 women shared their experiences with us in response to a callout; there were more than 1500 accounts of misdiagnosis or delayed diagnoses.
The common thread in the responses is this: because of their gender, they were not treated seriously. There was, and remains, a deafness and blindness to a situation having a pernicious impact on women. These shortcomings have led to life-threatening, and/or life-changing consequences.
This lack of awareness can be seen in the pledge by the major parties to increase Medicare payments to GPs. It may seem a small matter, but it is intrinsic to the bias mindset.
The Labor government recently unveiled an $8.5 billion plan, which was matched by the Coalition, that city appointments of between 20 to 39 minutes would get a 38 per cent funding boost; shorter consultations would get a 62 per cent boost. This imbalance weighs against women. It needs to be righted.
The Australian Medical Association and the Royal Australian College of General Practitioners are calling on the federal government to commit an extra $1 billion in annual funding to allow for longer GP consultations. We support their call.
Dr Michael Wright, the president of the Royal Australian College of General Practitioners, rightly argues women need to be able to spend more time with their GP and not be disadvantaged because of that.
“These low Medicare rebates for longer consultations are a real barrier for women getting the time they need with their GP,” he said. “These proposals might actually worsen it.”
Last year, a survey of more than 1750 Victorian women found that two in five lived with chronic pain. One-third said their GPs left them feeling unheard, and dismissed their concerns.
Their GPs had been insensitive and disrespectful. For 30 per cent, their mental health had suffered through conditions such as endometriosis, menopause and chronic pain.
In January last year, Victorian Premier Jacinta Allan established an inquiry into women’s pain. It heard from thousands of people. Its final report and recommendations were due to be published early this year.
For Allan, it is personal. She was not diagnosed with endometriosis until her early 30s when she was trying to conceive. “It’s time we stopped treating women’s health like some kind of niche issue,” she said last year. “We deserve to have our pain believed and relieved.”
This should be self-evident.
It would be wrong to see this investigation as an attack on doctors or other professionals working, as they do, so hard for their patients. It is about looking at the problems in the outcomes for women and asking what role the system, from top to bottom, is playing.
It is encouraging then that the Australian Health Practitioner Regulation Agency has begun a probe into increasing reports of gender bias in Australia’s healthcare system.
An agency spokesperson says the reports include accounts of “dismissed pain, insufficient treatment, stereotyping, delayed diagnosis, over and under-prescribing as well as lack of knowledge and training about conditions such as polycystic ovary syndrome, endometriosis, and birth injuries”.
The misogyny also lives in areas outside the consulting room. According to Professor Nada Hamad, senior staff specialist bone marrow transplant haematologist at St Vincent’s Hospital in Sydney, it “exists in the research, it exists in how we’re trained, and exists in how we apply medical information that’s not always relevant to women”.
Two years ago, the medical journal The Lancet commissioned the report Women, cancer and power, which found that 2.3 million cancer deaths in women each year could have been prevented with equitable access to care, improvements in diagnosis and primary prevention strategies.
This state of affairs was pervasive across both genders treating the women. Project lead Dr Ophira Ginsburg said: “So much of the time, terrible discrimination, not being believed, being under-treated or turned away from the emergency room, the people responsible are women, [which] speaks to the patriarchal system [and] implicit, unconscious bias.”
Ginsburg’s last point goes to the heart of the matter. A system built on patriarchy cannot, of and by its nature, give equal rights and service to all of the population. To do nothing is to acquiesce to the abhorrent view, and practice, that women are merely “smaller men”.
Change must start now.