Discussing Disparities in the Medical Treatment of Women April 27, 2023
LeeAnn Tanaka, DO ’14
It 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
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
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
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
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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About Philadelphia College of Osteopathic Medicine
Founded in 1899, Philadelphia College of Osteopathic Medicine (PCOM) has trained thousands
of highly competent, caring physicians, health practitioners and behavioral scientists
who practice a “whole person” approach to care—treating people, not just symptoms.
PCOM operates three campuses (PCOM, PCOM Georgia and PCOM South Georgia) and offers doctoral degrees in clinical psychology, educational psychology, osteopathic
medicine, pharmacy, physical therapy and school psychology, and graduate degrees in
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to medically underserved populations. For more information, visit pcom.edu or call 215-871-6100.
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