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why are doctors more likely to ignore women's pain?
from understanding how they talk about pain to understanding the barriers that society places on them, it's time to take a hard look at why our health care system is failing women.
mar 9 2023
8 minute read
doctors prescribe less pain medication to women than men, even though women report more severe symptoms; and most chronic pain research is done on men. getty
kelli fleming of brampton, ont. has been in pain for almost her entire life.
when she was six, fleming was hospitalized for hip pain. “i was quite tall as a young child, so they just felt that i grew too quickly,” fleming, now 49, remembers. “but i have that exact same pain in my hips as i did when i was six.”
in her early 20s, she was diagnosed with arthritis , and later fibromyalgia . the pain feels “almost like having an elephant on your legs, while you’re pressed up against a hard surface,” she says. “i can’t lay on any one side for any length of time because the pain just pools, from my hip down to my knee.” if she doesn’t happen to move around while she sleeps, she’ll frequently be woken up in the middle of the night from the pain; that still happens about five nights a week.
and the pain in her back is relentless. “it’s like having a toothache, constantly,” she says. when she has to move, it feels like “chewing ice on a toothache.”
doctor’s advice for pain: lose weight
but for years, just about all of the doctors fleming saw minimized her concerns, she says — even after her diagnoses. occasionally she’d be prescribed medicine, but nothing that worked regularly. and if they didn’t brush her off, they’d provide the most frustrating and humiliating “advice:” that she should lose weight. the pronouncement was an irritating one for several reasons, fleming says. it’s possible that weight loss would have alleviated her symptoms a little bit, but that wouldn’t have left her much better off. she was dealing with pain that was extensive and chronic; there was much more at stake than a number on a scale. worse still, it felt like that “advice” placed blame on her for her illness, and implied she didn’t deserve care until she got thinner.
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it was also just impractical: it was very hard to find exercises that weren’t excruciating. “i would say, ‘you let me know what exercise i can do that won’t affect my knees and my back and arms,'” fleming recalls. “i’ll be there.”
looking back, fleming thinks both her weight and her gender prevented doctors from taking her pain seriously. and she’s far from the only one: one survey of women with chronic pain found that 83 per cent felt their doctors had discriminated against them because of their gender.
“had i been a slimmer woman, or had i been a man, i think my treatment plan — and my life — would have been very different,” she says.
women are more likely than men to be told their symptoms are psychosomatic, or “all in their head” after surgery. getty
colleen norris has heard far too many stories like fleming’s. as a university of alberta professor in the faculties of nursing and medicine who specializes in heart health research, the gender inequities in health care are distressingly clear to her.
“we know between 50 and 78 per cent of women’s [heart attack] symptoms are going unrecognized,” norris told healthing. her research has shown that in alberta, 300 women a year who go to the emergency room with heart cardiac symptoms are sent home, only to return with a heart attack within 30 days.
and while doctors aren’t intentionally disregarding women’s concerns, there are a lot of factors that contribute to these statistics. women are more likely than men to be told their symptoms are psychosomatic , or “all in their head” after surgery; doctors prescribe less pain medication to women than men , even though women report more severe symptoms; and most chronic pain research is done on men , even though 70 per cent of people who suffer from the condition are women.
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how we talk about pain matters
the language we use around pain is a big part of the issue, norris says.
“if someone talks about chest pain, chest tightness, or jaw pain, that’s their language for: something’s going on in the heart,” she says. “if you don’t say ‘i have chest pain,’ [doctors] aren’t going to go into the chest pain protocol. women might say, ‘it’s a real tightness, it’s almost like an indigestion.’ women might use a different language, so we need to understand what that language is.”
the impact of communication styles might seem minor, but given how many patients a doctor may see — a montreal gp told the gazette in 2018 that he sees 1,500 patients in three days — and the short amount of time allotted for an appointment, it can be easy inadvertently ask a question that may receive a very different answer had it been worded differently.
there’s also the female tendency to underplay pain, norris says. “there’s this whole literature on the fact that women put themselves last ,” she says. “this idea of ‘i don’t want to bother the physician.’ women are socialized to take care of other people.”
fleming says she felt a kind of double bind around her situation. as a single mom of two boys, she had to keep looking after her children, and going to work, and performing all the tasks that are expected from moms. but while she felt pressure to keep everything together, she also felt like that ability to get things done worked against her when it came to getting physicians to take her concerns seriously.
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“because i pushed myself through it, a lot of time, my pain was overlooked as an exaggeration,” she said. “people thought that i wouldn’t be able to do all of that and keep going.”
‘i’m still feeling like i should let them do their job’
the limitations of the health care system also exacerbated her situation, fleming says. her gp’s office had a sign that said, “please bring one concern at a time.”
“so i guess i can’t talk about my pain if i’m here with a gallbladder issue,” she says. “one concern at a time? ok, i’ll wait another six months for an appointment.”
she makes sure to note she’s grateful that canadians have access to a subsidized health care system — but she wishes it worked better.
“i thank god every day that we have health care and that we’re able to go to the doctor,” she says. “but the amount of time that people are waiting for service… our system is very, very broken.”
she felt the brief, impersonal appointments she did get essentially boiled down to “you have arthritis, it really sucks,” she said. “i was just another number.”
it can be hard for women to assert their needs in that kind of setting, no matter who they are, norris says. despite her knowledge of medicine and of gender inequities in health, when she visits the doctor, her instinct is still to keep quiet and defer to their expertise.
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“even with everything i know, i’m still feeling like i should let them do their job,” she says. “i can’t imagine [what it’s like for] a woman who doesn’t have my medical education. how do you navigate the system?”
it’s time to do better
norris wants the health care system to do better by women. a big piece of that is research into women’s pain — but there are also all kinds of structural reasons why it might be harder to get that information.
she was recently shadowing staff in a clinic at edmonton’s royal alexandra hospital, doing research into women who had had high blood pressure during pregnancy. a large number of women indicated that they were interested in being part of the study, but then didn’t show up.
“while i was there, the phone rang and it was the woman who was supposed to be there for the study, who said leaving because she couldn’t find parking,” norris says. “you could hear the baby screaming in the back of the car.”
the problem was instantly clear to norris: most new moms are primary caregivers, which means that it becomes difficult for them to do just about anything without childcare.
“i thought, ‘this is why women don’t participate,'” she says. “we need to ensure that we’re meeting people’s needs before we, as researchers, just say, ‘well, i did a clinical trial and women didn’t show up.’ that’s not good enough anymore.”
health care disparities don’t just affect women
women, of course, aren’t the only people who suffer from disparities in the health care system. a 2018 report released by health canada found that people with less income and less education face far less positive health outcomes. recent immigrants and black canadians are more likely than white canadians to live in poverty , meaning they receive less and lower-quality health care. and indigenous people have lower health outcomes across nearly all metrics, including mental health. nearly all trans canadians — 44 per cent — reported unmet health care needs.
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and while these larger systemic changes can be slow, norris hopes that in the meantime, she can help women advocate for themselves when it comes to heath. a huge part of this, she says, is finding a doctor you trust, and who listens to you.
“if you leave [an appointment] and you’re angry, then that’s not the person for you,” she says, adding that many of the women she works with through canadian women’s heart health alliance met with five or six doctors before finding the right person.
“it’s incredible that you have to go that many times,” she says. “but the message is: keep going.”
she also suggests bringing someone with you to an appointment, which helps to legitimize the fact that you are serious.
kelli fleming still lives with pain, but finding doctors who understand her situation and who really listen has been “life-changing,” she says. after going through three or four doctors, her research eventually led her to neupath centre for pain & spine , a clinic in mississauga, ont. where a team of doctors provide personalized care tailored specifically to her goals. rather than waiting months between appointments, she goes weekly.
“when i go in there, they don’t look at me as just a file,” she says. “i’m a person.”
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like norris, fleming wants to help women advocate for their needs within the health care system.
“i really want women to know that there’s other women out there who are suffering in the same kind of silence,” she says. “i want them to keep advocating for themselves and telling their story. and get a doctor who [actually] helps. there are teams who want to help you, so don’t give up.”
maija kappler is a toronto-based writer.
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