A study from the University of Wisconsin found that over 40% of adolescents with chronic pain report experiencing pain dismissal from a physician.
Pain dismissal is belittling or denying a report of pain.
A related study conducted led by the University of Wisconsin and Medical College of Wisconsin surveyed young adults with chronic or recurrent pain and found that females were significantly more likely than males to report that their pain was dismissed by their physician.
In a research paper written by Diane Hoffmann, a professor of healthcare law at the University of Maryland, Hoffman said that this discrepancy could be due to the implicit belief that men are less expressive about their pain and, therefore, when a man expresses his pain, he is more likely to be taken seriously.
“In [the] ICU, whenever we are working, female patients usually call [nurses] more frequently than male patients,” said Usha Bhandari, a registered nurse at the Pomona Valley Hospital Medical Center, “and when [female patients] do need attention from medical staff they may be less believed than a male [patient].”
A literature review from the University of Gothenburg analyzed 77 articles about gendered norms and gender bias in the treatment of pain. The reviewed studies showed that women reporting pain are perceived as “hysterical, emotional, complaining, not wanting to get better, malingerers and fabricating the pain.”
The study also showed that women with chronic pain are often dismissed as suffering from a psychological illness rather than a somatic one. In the reviewed studies, women with chronic pain frequently reported being mistrusted and psychologized by their healthcare providers. The results showed that doctors may discredit a female patient’s pain and that the neglectful attitude became problematic.
A contrasting article from The Journal of Pain examined the patient cases from over 700 physicians by varying patient gender and race experimentally while holding the symptom presentation constant. The researchers compared the prescribed dose of narcotics to the maximum permitted dose. This study found that there is no significant evidence that physicians treat women less aggressively for pain.
“Females have a lower threshold for pain. We do see that; but as a physician we try to be as objective as we can and do all the imaging studies,” said Dr. Mukti Tripathi, an internal medicine physician at Kaiser Permanente, “For example, if a patient complains of pain, we try to get to the underlying illness by getting an ultrasound and bloodwork.”
In a case study published by the AMA Journal of Ethics, researchers commented that when female patients felt that their pain complaints were dismissed, they may be inclined to amplify symptoms, push for more diagnostic tests and be more insistent of their condition. As a result, physicians may view these women as histrionic and unreliable in the reporting of their symptoms — perpetuating the cycle.
In Hoffmann’s analysis, she writes that medical schools must teach students an approach that does not, consciously or subconsciously, discount any patient’s subjective report of pain. She says that educating doctors about this bias is also important because if healthcare workers are aware of this implicit bias, they can take steps to prevent prejudice.
Although it may be difficult to definitively prove that implicit bias causes an inequality in healthcare on the basis of gender, Hoffmann said that educating both patients and physicians can increase quality healthcare.