Reply: Two centuries of progress with more to go

Two nurses with baby in nursery at Toronto East General and Orthopaedic Hospital, Toronto, ONOne of the students on my Women’s Health class responded to my earlier post concerning inequality between women and men. She commented that she worked in a medical practice where inequality did not seem to be present. She asked me if I was interested in a career in medicine. She also asked me to further explain what I meant about doctors sometimes under-medicating women because they thought that the women’s complaints were just in their head. Here is my response…

I am very happy that you work in an environment that is so enlightened! I have two cousins who are male nurses, and they continue to encounter reverse discrimination because of their work in a “traditionally female” role. As to becoming a doctor or nurse myself, I’m not really interested. I had very bad allergies and some “interesting” health conditions growing up that exposed me to medicine at an early age. Now I keep current on both men’s and women’s health issues for my grandparents, parents, and myself. It’s really fascinating, but not something I would want to do for a living.

I think that living in California, a very progressive state, we forget that there are many areas of our country where inequality and outright discrimination are part of daily life for women or anyone else not in the locally accepted majority.

Unfortunately, I do not remember the source of an interesting article I read concerning how doctors tended to under-medicate women in pain. However, a quick search on Google turned up the following statement, which closely matches the information I read:

The effect of age and gender stereotyping on how patients are medicated for pain was studied by Karen Calderone. Because physicians and nurses saw women as more emotionally labile and prone to exaggerating pain complaints, they were given analgesia less frequently and sedatives more frequently than male patients. These gender distinctions were not related to the patients’ sensory perceptions, only to their overt expressions of pain, with women seen as more expressive. Both men and women under sixty-one years of age received more frequent pain medication than their elders; younger men were medicated most frequently and older women least frequently. (Post)

Discrimination against or derision of women on matters of PMS, pregnancy, abortion, miscarriage, post-partum depression, menopause, mastectomies, and hysterectomies is something that women largely face alone. Males (fortunately in my opinion!) never have to go through any of those conditions, and thus can never fully grasp what it must be like for the woman.

According to a publication by The Johns Hopkins School of Public Health, women who have had planned or spontaneous abortions (miscarriages) are sometimes punished “by delaying treatment, withholding pain medication, or charging higher fees than the actual cost of treatment.” Additionally, some providers “berate women for attempting abortion, for not using family planning, or for having sex in the first place” (“The Need to Plan Care”). The focus of the article was on health care in developing countries, such as those in Africa; however, it was not very long ago in our own country that abortions were illegal. In fact, it would only take a reversal of Roe v. Wade by the Supreme Court to make it so again in this country. With such a reversal, would it be long before similar attitudes could become common here in the U.S. again?

I chuckled at your hypothetical woman who “brazenly exposes her breasts for the sake of equality”. My mother is routinely expected to take off her blouse and slip into a gown for a checkup. My father and I almost never have to. It seems almost a double-standard, though there is probably a logical reason behind it.

Helen Boren, a healthcare professional, believes that “Digital Mammography” technology has not been [researched and developed] enough to the point where it is safe and comfortable for application to living, feeling women patients.” She continues by asking, “what do you think the males of our society would do if they had to undergo TESTICULOGRAPHY under similar conditions?” (Borel). I think that if males had to undergo that, they would avoid the procedure entirely (which is what Ms. Boren chose to do). Sadly, I do not think that enough medical equipment manufacturers adequately consider their patients’ pain threshold when designing equipment. Additionally, I doubt that male designers could ever adequately estimate how sensitive a woman’s anatomy is (and vice versa). In certain aspects, men and women are very different, indeed!

Our textbook mentions the fact that women have been excluded unnecessarily from many health studies. As a result, we do not know fully how some medications work (efficacy) on women or how strongly (dosage). Fortunately, we are seeing more women included in studies now, and better data is becoming available. (Kolander, 15-16)

I empathize with your cancer patient. Medications often come with side effects that can be very frustrating or even make you feel worse than the primary cause for which you sought medical help in the first place. I am glad there are people like you who are there to lend a caring ear to their concerns.

I appreciate your comments and hope that I answered all your questions.

—Will

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