Healthcare as a whole comes with pitfalls that are both inherent to the systems that run it and that are a result of the people in those systems. Medical practitioners are human, which means they are subject to the same attitudes and prejudices that have existed since the practice of medicine began. Threaded throughout its history is misogyny and sexism.
Medical misogyny refers to sexism and/or gender bias in medicine, medical practices and medical diagnoses. As far back as Hippocrates and his use of the word “hysteria” (derived from the Greek word meaning uterus) to describe any set of unusual behaviors related to women and health, there is a foundation of distrust and disregard in how women’s care needs are perceived. Combined with the persistence of stereotypes, this first form of gender bias in medicine lends itself to the pervasiveness of a theme in healthcare. Providers aren’t listening to women.
Frequently, women’s pain is dismissed and glossed over as being in our head. Rather than accepting pain symptoms or complaints for what women say it is, they are passed off as emotion or hysteria. The McKinsey Health Institute estimates that while women may live longer than men, they will spend an average of nine years in poor health. This is called the “health span” rather than the “life span.” In HIV, women are underrepresented in clinical trials and dismissed as being hard to reach or hard to work with. Women are often diagnosed later than men with HIV because of attitudes about what is appropriate for women to do with their bodies sexually, and perceptions about who is vulnerable to, and who acquires, HIV. Such attitudes delay testing and receiving information about prevention methods like PrEP. Studies also show that women tend to have a lower adherence to antiretroviral therapy than men.
I could quote study after study, but the real question is why? We are light years away from Hippocrates and 375 B.C, and early experimentation on women. Our understanding of the human body is exponentially broader and things that once would have been considered a miracle are now everyday procedures. Genderspecific roles, and the power dynamics of those roles could be a factor. In addition to why, we should also be asking what we do about it. It comes down to a combination of listening and asking the right questions.
Open communication is foundational to the relationship between a clinician and a patient. Often, people get caught up in listening to respond as opposed to listening to hear and understand. While it is true that providers see hundreds of patients in a month and may have “seen it all,” the underlying nuances of any health condition can only be found through thoughtful questions and active listening. While the volume of patients and the limited time allotted to see them can make that seem impossible, it’s truly not. Practicing a pattern of listening in the same way providers practice medicine makes it possible.
This is part of shared decision making and has been shown to improve health outcomes and satisfaction with care. Showing active listening skills and creating dialogue is how trust is built. The mistrust of clinicians in women to know how their bodies feel leads to delays in treatment, misdiagnosis, and may cloud whether informed consent is actually informed. This leads women to distrust healthcare and those providing the care. Mistrust is lack of faith based on a belief, while distrust is lack of faith based on experience or knowledge. There is a subtle difference between the two, but they build upon and reinforce each other. Responding appropriately to individual concerns and the provision of clear, easily understandable information can influence women to follow a care plan and adhere to medication regimens. Utilizing the five dimensions or Five “A’s” of access framework—approachability, acceptability, availability, accommodation and appropriateness of response—are great ways to build a system of listening to and hearing women. Treating women as individuals is also critical. Small steps that take us away from medical misogyny and toward equitable and quality healthcare for women.
BRIDGETTE PICOU, LVN, ACLPN, is a licensed vocational and certified AIDS Care Nurse in Palm Springs, California. She works for The Well Project-HIV and Women as their stakeholder liaison. Bridgette is a director at large for ANAC (the Association of Nurses in AIDS Care), and a sitting member of the board of directors for HIV & Aging Research Project-Palm Springs (HARP-PS). Bridgette’s goal is to remind people that there are lives being lived behind a three or four-letter acronym.