Women less likely to get correct treatment in ER because they're viewed as 'hysterical and exaggerating'

Women presenting to the emergency department in pain are less likely to receive medications they need to treat it compared to men, new research shows.

An analysis of discharge notes of more than 21,000 patients from Missouri and Israel showed that female patients were less likely to be prescribed pain meds, and their symptoms were more likely to be dismissed. 

Dr Alex Gileles-Hillel, a co-author and doctor at Hadassah-Hebrew University Medical Center in Jerusalem, said: ‘Women are viewed as exaggerating or hysterical and men are viewed as more stoic when they complain of pain.’

It is the latest evidence of sex bias in medicine, with women also less likely to be treated for a heart attack than men.

Physicians put sex bias in medicine to the test by presenting both male and female nurses with identical fictional vignettes about a male patient and a female patient presenting with severe back pain.

When asked to assign a pain management score to male and female patients with the exact same complaint and health history, nurses perceived female patients’ pain as less intense and less deserving of treatment.

Pain is subjective, and doctors and nurses rely on patients to rate it on a scale from one to 10, with 10 being unbearable.

Medical professionals decide whether to administer pain medication and how strong it should be based on what patients tell them.

The latest research published in the Proceedings of the National Academy of Sciences reported that women, even when rating their pain as high on the scale, were nearly 20 percent less likely to get pain medication than men, even when their self-reported pain ratings were the same.

Using notes describing the patient’s treatment written when they left the hospital, the doctors found that 38 percent received some type of pain relief medication, compared to 47 percent of male patients with similar symptoms.

Women tended to score their pain slightly lower than men did – 6.64 versus 6.81. 

But researchers accounted for this and found a similarly disparate pattern across all pain ratings.

Further analysis revealed that nurses were 10 percent less likely to record women’s pain scores at all, compounding the odds that they wouldn’t receive the care they needed.

Women tend not to be taken seriously when they complain of health issues such as chest pain, raising the odds that they will suffer or die of a condition that could have been prevented

And women tended to spend an average additional 30 minutes waiting for a nurse or doctor to acknowledge them in the emergency department compared to men, who spent less time in the waiting room.

To further put their hypothesis - that a sex bias exists in ER - to the test, the researchers handed short written patient descriptions to 109 nurses at a Missouri hospital to judge the intensity of the patient’s pain.

The written scenarios for a male patient and a female patient were exactly the same. The only difference was the sex of the fictional patient: ‘Ms. [Mr.] Jones presents to the Emergency Department. 

'She [he] is a 44-year-old female [male], previously healthy. She [he] has sharp and throbbing backache that started gradually the day before.

‘She [he] rates her [his] pain as 9 out of 10 and says it interferes with her [his] functioning. Ms. [Mr.] Jones reportedly has not tried anything yet to relieve the pain, is normally healthy, and is not currently taking other medications.'

Each nurse was then asked to rate their perception of this pain on a scale from one to 100 (maximal pain).

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When the nurse was presented with the vignette describing a man, they tended to rate his pain closer to 90, with an average of 80. 

But when presented with one describing a woman, the average pain rating was 72. The disparity persisted regardless of whether the rating nurse was male or female.

Researchers called this gap a symptom of women’s pain being generally ‘overlooked’, which has ‘troubling societal and medical implications.’

Women who seek a doctor’s help for pain simply tend to be taken less seriously than men, a product of centuries of women being painted as more emotional and dramatic than men and more likely to overstate their pain.

A 2009 study in the Journal of Women’s Health reported women were twice as likely as men to be given a mental health diagnosis when they presented to the doctor with signs of heart disease.  

Swedish researchers said in 2018: ‘Women with pain can be perceived as hysterical, emotional, complaining, not wanting to get better, malingerers, and fabricating the pain, as if it is all in her head.

‘Other studies showed that woman with chronic pain rather are assigned psychological than somatic causes for their pain.’

The disparity between the care that women get versus what men get plays out most starkly in instances of women presenting to the emergency department with signs of a heart attack.

A 2022 study found that men were around 22 percent more likely to be seen by a doctor immediately when presenting with chest pain than women were.

Women had to wait 29 percent longer than men to see a doctor, around 11 additional minutes. And when a person is in the midst of a heart attack, that 11 minutes can mean the difference between survival and death.