Clean sheets and rigid lines
A flawed body laid bare
I stand trial before him
Imagine turning up at the doctor’s, confused over the sudden sharp pain that has developed in your side. Consider for a second, the self-doubt blooming in your chest to mirror the doubt evident in her creased brows as she questions ‘Are you sure you haven’t eaten anything bad the past few days?’ And just try to grapple with the sense of betrayal you feel as you return a month later, excruciating pain lancing through you, as the scan reveals a grotesque ovarian cyst.
Sure, it may seem absurd that such oversight can ever take place in the present healthcare landscape. Doctors of today are released with an ever greater emphasis on valuing patients’ perception and opinions. Yet I’ve come to notice and hear more cases of women being misdiagnosed in the form of nervous personal recounts of patients and obscure reports. Are the pledges of our doctors mere lip service? Does the problem even exist?
From Vesalius to Da Vinci, our understanding of the human anatomy has been one constructed by men. Till today, we’ve never once had a proper conversation on the consequences of relying on medical literature written for women, about their bodies, in their complete absence. We hesitate to even question the medical knowledge we’ve amassed because our physicians, the experts, so wholeheartedly endorse the information. Regardless of the society you live in, physicians stand on a moral and intellectual pedestal. This makes it natural for us, particularly as women, to second-guess medical claims that inherently clash with what we know to be wrong but who are we to question?
With that in mind, I’m not so surprised anymore that gender biased diagnosis is both rampant and underreported in healthcare.
I confessed that I was in pain
Yet he diagnosed a trembling heart
For the fire scorching between my legs
In a study done in Sweden involving 87 medical students from a Swedish medical university, participants were read a list of patient narratives and told to guess the gender of the patient. The students were also told to explain the reasoning for their categorization. What the study found was that when students assigned narratives to be by female patients, they cited reasons such as being emotional or referencing family commitments. Those assigned to male patients, the students reasoned, were more factual in their description.
On the whole, the students were right only 60% of the time. That’s an uncomfortable margin of error in a field where a single misdiagnosis could cost a patient their life.
The fact that the gender of the medical student didn’t affect their success rate suggests that these implicit biases are not due to the individual but likely the way medical knowledge is being taught. The harms of harboring these biases are manifold. Most obviously, it increases the chances of medical oversight. On the ground, this means that a woman complaining of pain is more likely to be given things such as painkillers and psychoactive drugs instead of running tests for signs of a physical malady. When we begin with the assumption that women are more likely to exaggerate their symptoms, there is a greater tendency to question the necessity of certain treatment procedures. On the flip side, when men request certain treatments, the request is seen as being made due to genuine necessity. A second, perhaps more pernicious, outcome of preempting female hysterics is how doctors present information to their patients. On the basis that women might be less interested in the specifics or the facts of their condition, we might inadvertently be denying them vital information or the chance to understand their bodies. Any supposedly ‘informed’ consent that follows would then be void.
We’d be sealing their fate even before they step into the consultation room.
Echoing whispers in my ears they were
Escaping black print and bright pixels
He claimed were trophies of his unfailing hand
For centuries, the detailed drawings and observations we’ve made of the human body has been based off men or men writing about women. Victorian era contempt and occasional ignorance still color our medical textbooks, even in fields dealing exclusively with female anatomy such as gynecology. This isn’t a problem that we’ve left behind as historical baggage. Even today, a disproportionate number of participants in surgical research and clinical studies are male, twice as many in fact. That means whatever evidence we’ve collected on things such as drug reactions or even physiological responses to interventions is of little use to women. The sleeping medication Ambien stayed on shelves for 20 years before clinicians realized its slow metabolism in women meant they stayed drowsier for longer in the morning. This made them more prone to car accidents as they left for work thinking the effects of the pills had worn off.
Really, the way our doctors consult medical texts for female problems is akin to a linguist looking for Greek words in a French dictionary.
So I returned to the shadows
My pain, my unwanted fugitive
Gaze averted from the red on its lips
Our encounters with our doctors can be some of the most intimate moments we’ve faced. We trust our physicians with our lives, to treat us impartially and objectively at our moment of vulnerability. Being told then that what we’re going through is a figment of our imagination, a product of unnecessary worry, is a blow to our self-confidence. It is demeaning when we are told that the words of a male anatomist are unquestionably more credible than anything I can say about my own body. It’s frightening in the way it robs us of our bodily autonomy so silently and without prior notice.
So we choose instead to be silent, to accept the physician’s words as final even though can’t vocalize the inherent intuition that things aren’t right.
Because we hold our doctors with such high regard, we internalize their judgment of our physical condition. We filter information and withhold symptoms that are possibly vital out of fear that it may jeopardize the quality of treatment we receive. One of the old ladies at the home I visited complained of back ache constantly but each time the nurses waved it off as her dementia looping the memory of a past fall. Eventually, she stopped complaining but she would grimace every once in a while, her fingers fluttering to her back reflexively.
Doctors know how crucial it is for patients to be truthful about their experiences to best diagnose and treat them. They recognize the level of trust patients have in them as well. It is about time they returned this favor to half the population which has placed its trust in them. It is about time we granted greater credibility to female medical experiences and their systemic exclusion from our medical literature.
‘I will not permit considerations of age, disease or disability, creed, ethnic origin or gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient”
-Hippocratic Oath, World Medical Association (2017)
Let this be more than just an empty promise by our future physicians.
A/N: Guess that concludes the three parts. Though not quite in line with the other two, it has been a nagging issue at the back of my mind because such incidents are unheard of in the Asian context, more likely due to silence than an absence.