(The following is part of a series of columns entitled Dx IQ from the Society to Improve Diagnosis in Medicine to help you understand how important your role is in getting properly diagnosed.)
What do these stories have in common? A “funny” pain in a neck is ignored until it’s almost too late. A physician treats a patient for anxiety but misses the signs of a failing heart valve. An issue with blood flow to the brain is misdiagnosed as major depression disorder.
All of these patients have been trapped by medicine’s biggest blind spot: our lack of knowledge about how women’s bodies work. The truth is we don’t fully understand how female bodies differ from males for many common diseases and medicines. That means that over half of the population in the U.S. is experiencing a lower standard of healthcare than the rest. Diagnosis is a complex process involving many steps and people. Missing valuable information makes it that much harder. Mark Graber, MD FACP — and the founder and Chief Medical Officer of the Society to Improve Diagnosis in Medicine (SIDM) — likes to remind us there are only a few hundred symptoms but over 10 thousand diseases.
If you’re a woman, chances are you’re nodding your head. You may have your own story about feeling let down at your last doctor’s visit. If you’re a man, you might be rolling your eyes but the weight of evidence bears it out.
The Knowledge Gap
Maya Dusenbery, author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, calls it the Knowledge Gap. She says women patients have been left out of all kinds of research until recently. While the National Institutes of Health [NIH] has tried to increase the number of women patients in clinical research, they don’t enforce it. They leave key decisions up to the researchers, like whether to analyze the results by gender. They also only review the gender of participants by year, not by disease or condition.
Graber agrees. “The Knowledge Gap is very real,” he says. “It’s definitely true that the vast majority of studies in medicine were done on men and usually pretty healthy men…So, there are built-in biases to the knowledge that we’ve been given.”
When he was in medical school and during his residency, Graber says that his training consisted of “facts” that applied primarily to men. “We were taught that the classic symptoms of heart attack are X Y & Z but those are all studies done in men. You weren’t taught that there are different presentations for women.”
Substandard care of women with heart disease and diabetes, two common conditions, are both so well documented that study after study, including one as recently as 2018, begin by stating it as accepted fact.
Lyn Behnke is a Michigan-based cardiovascular nurse practitioner who knows all about the differences between the way women and men experience heart disease symptoms. "As a clinician, I see women misdiagnosed all the time,” she says... (READ MORE)