Discussing Disparities in the Medical Treatment of Women | PCOM
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Discussing Disparities in the Medical Treatment of Women 
LeeAnn Tanaka, DO ’14

April 27, 2023

LeeAnn Tanaka, DO ’14It can be scary to navigate medical symptoms alone. When you arrive at your doctor’s office, you hope they can answer questions regarding your overall health and wellbeing. Unfortunately, as noted below, being called “sensitive” or “dramatic” is common for women, especially women of color. A CNBC article labeled this experience as “medical gaslighting”—where doctors dismiss or minimize complaints and concerns. The danger that follows can be an unnecessary delay in treatment for those who might need it. But why does this happen? LeeAnn Tanaka, DO ’14, a physician at Family Medicine at PCOM, shares more details on the prevalence of this issue and what can be done to address it.

Why are women sometimes dismissed by their doctors?

“There are probably a handful of reasons. A big one is systemic misogyny in medicine and the belief that women, or folks who are not the default, are maybe more ‘sensitive’ to pain. But there’s also the reality that a lot of women express their pain in a way that may be seen as ‘dramatic’ as compared to men by physicians who are not used to hearing from patients in this way. There is a sense that when we are more emotional about it, we are exaggerating or playing it up to some extent.”

What can women do if they feel like they are being dismissed?

“I don’t want women to have to downplay their symptoms, concerns, or pain, but sometimes we have to present it in a way that might come across more palatable for someone who might not be used to the way we express things. I often ask patients to keep a log or a journal noting what symptoms they were experiencing and on which date and time. I do this with a lot of patients for any kind of condition that we’re trying to identify the cause of. This is a way we, as physicians, can get at the root of something. It’s helpful to us in identifying root causes, but it's also a way of expressing what’s happening in a very neutral tone so that hopefully patients are taken seriously.”

Why is “medical gaslighting” worse for women of color?

“There is systemic racism in medicine in America. When you think about, for example, in the field of gynecology, Dr. J. Marion Sims for a longtime was considered the father of medical gynecology. He created procedures and surgeries and did so by performing research on slaves, whom he purchased, with no anesthesia. The theory was that Black people did not feel pain or that their tolerance for pain was greater. So much of the field of medicine for women is rooted in this baseline of racism. There has been a long running identification of this.

Even as recently as 2016, they did a survey of laypeople, resident physicians, and medical students and many of them held some belief that African American people felt less pain, or that their skin was thicker in some way so it was harder to puncture for procedures. Just obvious, grossly untrue facts, that not just laypeople, but people who were in training or training others still held onto. Some of the work to right this wrong is working on education at all levels of medicine and reinforcing that these beliefs are false.”

What else can be done to reduce the racial bias within the healthcare system?

“A lot of it is advocating for our patients when we see people perpetuating it, which I think is hard in a very hierarchical system like medicine. A study came out just recently that Black patients do better when they have Black doctors. Representation of marginalized people in medicine obviously makes it easier to be heard and for people to take their symptoms and pain seriously. Some of it is on us in the medical and education system to make sure we’re educating a true representation of what the population looks like.”

Have you ever felt dismissed by your doctors?

“When I delivered my baby, I was still a resident and had been delivering other people’s babies. Things I had said before were said back to me in labor, and I said to myself, ‘what would possess you to let that come out of your mouth?’. I think at one point, because my daughter came too quickly and I couldn’t receive an epidural as part of my birth plan, they told me, ‘there’s just no time.’ I  said that I didn't think I could do it and they said, ‘but you’re doing it!’. 

What I was really feeling was scared, but what it felt like they had said back to me was ‘tough—we’re doing this now.’ I’m certain I’ve said the same thing to someone in labor, but at that moment, it wasn’t so reassuring.

Sometimes we think we’re being really supportive, but we’re not actually hearing what patients are telling us, which is ‘this is scary, and I’m really worried about this.’ That can be really hard to express, especially in the midst of something as dramatic as labor.

It really changed the way I try to approach people. I am now in the office and no longer in the delivery room, but the way I acknowledge people’s concerns is different. I try to really acknowledge what’s happening to them—their pain, their concern, their worry. I think that ultimately makes a better patient/doctor dynamic and, hopefully, patients feel more heard and we can identify things more correctly to treat them more appropriately.

As women, we’re more likely to be told that it’s in our head. I think the acknowledgment from the physician of ‘I don’t know the cause of this, but we’re going to work to find the cause together,’ and asking if there are specific things they’re worried it might be, can help rule out all of the scary stuff for the patient and us as physicians.”

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