Women Must #ChooseToChallenge Providers About Health Concerns

The campaign theme of International Women’s Day on March 8 is Choose to Challenge, which urges all people to outwardly challenge gender bias and inequality where they see it to raise awareness and create change. An industry in need of such a challenge and change is healthcare.

Decades of academic studies have documented huge gender disparities in healthcare around the world, with women patients and their concerns being treated far less seriously than those of male patients.

For example, although men and women report cardiovascular-related chest pain at roughly the same rate, men with chest pain were 2.5 times more likely to be referred to a cardiologist than women, according to a 2018 study. Even after adjusting for the patient’s age and cardiovascular disease risk factors, the estimates did not significantly change.

This gender bias in healthcare can have deadly consequences. Analyzing data from the U.K.’s heart attack registry from 2003 to 2013, the University of Leeds concluded that “women in the U.K. were more than twice as likely to die in the 30 days following a heart attack than men.”

You don’t have to be a medical researcher or scientist, however, to suspect that women’s health concerns are not treated as seriously as those of men. In a 2014 survey by the National Pain Report and the non-profit For Grace - of more than 2,400 women in the U.S. with chronic pain conditions, 84% of respondents said they felt they are treated differently by physicians because they are women, 75% said they were told by providers that they would have to learn to live with their pain, and 45% said they were told their pain “is all in your head.”

Research is slowly but surely catching up with what women have been challenging for years, it is not in fact “in our heads.” Such examples showcase that women’s hormones play a role in the effectiveness of some drugs during a menstrual cycle. Antihistamines, antibiotics and antipsychotics have all been found to be impacted by hormones. Antidepressants have also been shown to affect women at different times of their cycle causing fluctuations in symptoms. According to the National Institute of Health, “understanding the interplay between the menstrual cycle and antidepressant medication will ultimately translate into more diverse and improved patient care.”

Even children seem to face gender-related pain bias from adults, according to a 2019 study. In the study, adult participants were shown videos of boys and girls receiving a finger pinprick to test for iron levels in their blood. More adults perceived the boy as experiencing more pain than the girl despite the same clinical circumstances and identical pain behavior across conditions.

Open the Discussion

It should be clear that women simply can’t afford to wait for gender inequities in healthcare to vanish overnight. Rather, they must be proactive and “choose to challenge” their providers if their health concerns are overlooked or goals are misunderstood or unachieved. When speaking with their medical doctors and doctors of chiropractic (DCs) about their health concerns and care, women should be open, honest and comprehensive.

As a practicing DC, I have seen far too many women downplay symptoms of fatigue and chronic pain that turned out to be indicative of a larger condition, such as an autoimmune disease. Some may not even have mentioned a health concern. That is a mistake because while DCs are committed to our patients’ overall health (including their quality of life), patients need to speak up, have their voice heard and respected.

When it comes to pain – particularly the neuro-musculoskeletal pain that DCs encounter every day – if our care is not delivering the improved symptomatic reduction, mobility or quality of life for our patients, I appreciate when they express their concerns in an open, honest and respectful manner. We will immediately adjust our care strategy to attain the results we both seek and which our patients deserve.

A reluctance to challenge a provider’s care plan can be particularly dangerous when it comes to opioids and pain, especially for women. Research by the QuintilesIMS Institute in 2016 and 2017 shows that women ages 40 to 59 “are prescribed more opioids than any other age group and receive twice as many opioid prescriptions as their male counterparts.” Among women, this age group also has the highest death rates from opioid abuse.

Much of this can be avoided if women speak up and ask more about their providers’ decisions regarding pharmacological interventions. Just as importantly, providers need to explore all options and engage women in the decision-making process.

#ChoosetoChallenge Today

Patients need to remember that they are in control. Pharmacological care is not the only answer. Women should challenge the options if all they are given for pain care is an opioid.

However, opioids are not a care strategy that patients will need to challenge with their DC since chiropractic care is, and always has been, drug-free. But DCs want patients to be forthcoming about the effect chiropractic care is having and if it is helping them reach their healthcare providers, whether that is pain reduction, mobility, or (if a student, amateur or professional athlete) improved athletic performance. Fortunately, the Gallup-Palmer College of Chiropractic report shows that 93% of adults said their DC often listens; demonstrates care/compassion (91%); and explains things well (88%).

A doctor-patient relationship works best – and achieves the most favorable outcomes – when it is a genuine collaborative effort. When women are empowered to challenge their providers about their care, the mutual goal of long-term health and well-being can be achieved.