Background: Gender Disparities in Healthcare
When compared to men, women aren’t taken as seriously in healthcare settings, which can lead to their concerns being downplayed or ignored. For instance, a 2023 podcast series from Serial Productions and The New York Times titled “The Retrievals” recounted the stories of numerous women who experienced uncontrolled and immense pain during egg retrieval (as part of fertility treatment) and whose concerns were dismissed; it was discovered later that a nurse was stealing the fentanyl that was supposed to be given to the women, so they weren’t receiving the drug during the procedure. Another example involves cardiovascular health. Women’s cardiovascular issues are often under-screened and undertreated, and this can come about not only due to provider bias but also because women’s health issues are under-researched and/or misunderstood (Kim et al., 2022). As is evident, there are disparities in medicine that impact women’s abilities to receive timely and appropriate care.
A Patient Experience
A woman presented to the emergency room of a major academic medical center with hypersalivation. An urgent endoscopy was performed and a bezoar of bathroom tissue was found in the esophagus and removed. When asked about the bezoar after the procedure, the patient denied consuming the tissue and psychiatry was called for a consult. The woman was ultimately involuntarily committed to the locked inpatient psychiatric unit before being released two days later. Upon being released, it was discovered that she had iron deficiency anemia, which caused her to develop pica and consume the bathroom tissue.1. She was treated with an iron infusion, and her condition improved within one day.2
A retrospective analysis of the complete blood count from the patient’s initial emergency room visit revealed all the tell-tale signs of iron deficiency (i.e., severe microcytic and hypochromic anemia), which was overlooked by her treating physicians.
Additional Context: Women and Iron Deficiency Anemia
According to Dugan et al. (2021), “Iron deficiency anemia is particularly common in women due to increased iron loss from menstrual bleeding or increased demand during pregnancy” (p. 57). However, despite how frequently it occurs, anemia in women is often overlooked. One reason for this is that there is a lower reference range for defining anemia in women, and this can delay diagnosis and treatment (Dugan et al., 2021, p. 57). In addition, as discussed previously, women’s concerns are often not taken as seriously, and their symptoms and/or pain may be downplayed or ignored by providers.
Reflection
- Consider the information provided above. What issues or attitudes are at play? How did they come about? What is the impact on patient experience/outcomes?
- How can you ensure the patients you work with aren’t negatively impacted by these issues or attitudes? What can you do to improve gender disparities in healthcare?
References
- Burton, S. (Host). (2023). The retrievals [Audio podcast]. Serial Productions and The New York
- Times. https://www.nytimes.com/2023/06/22/podcasts/serial-the-retrievals-yale-fertility-clinic.html
- Dugan, C., MacLean, B., Cabolis, K., Abeysiri, S., Khong, A., Sajic, M., & Richards, T. (2021). The misogyny of iron deficiency. Anaesthesia Supplement, 76(S4), 56-62. https://doi.org/10.1111/anae.15432
- Kim, I., Field, T.S., Wan, D., Humphries, K., & Sedlak, T. (2022). Sex and gender bias as a mechanistic determinant of cardiovascular disease outcomes. Canadian Journal of Cardiology, 38(12), 1865-1880. https://doi.org/10.1016/j.cjca.2022.09.009