Gender bias in the medical profession adding to women’s pain

By Tony Poland, LegalMatters Staff • Gender bias within the medical profession is a long-standing problem that can lead to misdiagnosis and ultimately prevent women from getting the disability insurance benefits they deserve and the treatment they need, says Toronto and Markham-area disability lawyer Rupa Karyampudi.

Karyampudi, a partner at MK Disability Lawyers, says studies have shown that one in five women believe that a health-care provider has ignored their symptoms. 

“Too many times their pain is dismissed or misdiagnosed or attributed to a psychological problem. It is all in their heads. It is not real,” she says. “Many of our clients suffer from chronic pain issues and it is especially daunting when you are not being heard.

“Studies show that if you are young and female or a person of colour or with limited education, your risk of misdiagnosis is much higher,” Karyampudi tells LegalMattersCanada.ca. “Racially marginalized people already have a problem navigating the health-care system. Add in the gender bias and it makes it much more difficult. This issue extends from the medical field to the insurance companies and right to the legal profession to some extent.”

‘Chronic pain is an invisible illness’

She says when someone is in constant pain it is especially frustrating if their concerns are ignored as well.

“Chronic pain is an invisible illness, much like mental illness. Disability insurance claims are therefore dependent on the subjective reports of our client,” Karyampudi says. “There is no objective testing, though objective medical evidence is really what insurance companies are looking for to prove a claim. So, it is a challenge at the end of the day.

“The test for disability is functionality. We have to present evidence that shows our clients are not functional due to the pain.”

In the past, women have been excluded from medical testing so treatment models are based on research conducted on men, she says.

According to the report by the Guardian, a U.S. study on women’s health conducted in 1985 warned that “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive.”

“For much of documented history, women have been excluded from medical and science knowledge production, so essentially we’ve ended up with a health-care system, among other things in society, that has been made by men for men,” Dr Kate Young, an Australian public health researcher told the newspaper.

Women experience more chronic pain than men, according to Medical News Today (MNT) but the medical profession is more likely to regard these patients as “too sensitive, hysterical, or as time-wasters.”

More likely to be diagnosed as a psychological problem

MNT pointed to studies showing doctors are more likely to diagnose women with a psychological cause for the pain, rather than a physical one, compared with men. 

These studies found women received smaller amounts or less-effective pain medication, more antidepressant prescriptions and more referrals to mental health services, according to MNT.

“Historically, when doctors were educated in medical school, all their models for treatment were based on men’s experiences,” says Karyampudi. “Too often when doctors cannot figure out what is wrong, they will attribute it to anxiety or depression without really exploring further. Anxiety has become like a catch-all kind of diagnosis.”

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This presents a problem because not only are these women going untreated but they are also being denied insurance benefits.

“When they try to file their claim for disability, the insurance company says there is no objective evidence to support it. They may determine that the claimant has some anxiety which can be simply treated with medication and that they can work with accommodations from their employer.”  

Karyampudi says the hurdles women face are further exacerbated by the fact that some law firms will refuse to take cases where doctors are not supportive of the claim.

‘We realize that not all doctors understand chronic pain’

“When we first meet with these clients, we do not discount that they are women and their doctors are not supportive. Yes, it can be a challenge but we realize that not all doctors understand chronic pain, particularly in women,” she says. “We encourage clients to advocate for themselves. We encourage them to keep pushing the doctor, maybe bring a family member or someone else to help make their case. Ultimately, they might need to get a second opinion.”

While consulting another doctor sounds like a logical next step, Karyampudi says it can come at a risk.

“Sometimes an insurance company has a claimant who sought a second opinion and will accuse them of doctor shopping,” she says. “We will work on behalf of the client to address this accusation. It is a matter of convincing the insurer that this person felt her symptoms were being ignored. We also have studies showing that there is gender bias to back this claim.”

Karyampudi says there needs to be a broader understanding of the gender bias issue.

More education is required

“I fear that some of these women might be dismissed by the legal field as well. There really should be more education for both doctors and lawyers,” she explains. “I know in law school we tend to take a gender-neutral approach to everything. That does not always work because we end up defaulting to whatever the societal norm is, which is the white male. As lawyers, if we don’t acknowledge there are biases it can be a disservice to our clients.

“It is important clients know I am aware that this problem exists and I am working to bring the issue to the forefront.”

Karyampudi says she believes it is her job to help clients “advocate for themselves within the medical system.”

She says she tells them to go to their doctor ready to ask questions. 

“Be proactive. Write down your symptoms, the frequency and severity. Ask if there could be more than one thing going on based on your symptoms,” Karyampudi says. “You have to feel comfortable with your doctor. If you are feeling your concerns are being ignored, find a doctor who will be supportive, even if there is a risk it will be seen as doctor shopping. In the end, it is better for both your well-being and your case to have a doctor who listens to you. 

“Then I advocate for them in the legal system,” she adds. “Our role as lawyers is to take the evidence and weave a persuasive story that proves their case. We are their voice.”

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