Women and Health Care Disparities: Who Dies and Who Profits?

Are women dying of cancer in the same way they die of heart disease, because physicians trivialize their complaints and they are powerless to get second opinions?

How many decades has it taken for cardiologists, practitioners at the apex of medicine, to acknowledge that symptoms of heart disease for women may differ from those for men, and for general practitioners to address that fact?  Older women die of heart disease in droves because they are treated too late or ineffectually, or they cannot get the referral.  How long does it take for the public to catch on, or has it?

What is the percentage of women in lucrative cardiology and radiology practices?  (Have you ever met a female cardiologist?)  Who are the star patients of the new “concierge” cardiologists?

Women’s health-and-spirituality movements tend to bypass the system.  Why play on an uneven field?  This is not the same thing as insisting on quality care, however, or documenting unnecessary deaths due to systemic negligence.  Who would support a study of gender bias in cancer detection?  The American Medical AssociationThe American Academy of Family PhysiciansThe American College of RadiologyThe American Society of Clinical Oncology?  (Try an affirmative action head count on their boards of trustees.  Then compare with The American College of Cardiology.)  How about The National Institutes of Health, or The Centers for Disease Control?  Physicians cannot acknowledge diagnostic error to their patients due to fear of lawsuits, they claim, so who is it who finally reports?

This is the one-two punch from the patient’s perspective (keeping in mind the gold standard in cancer treatment is early detection.)  First, the physician brushes aside complaints and belittles patient concerns.  Second, the insurance industry encourages referral madness, making it nigh impossible to get a qualified second opinion, or, in the case of breast cancer, even to know what that means.

Breast cancer patients are apparently familiar with this scenario, as are mothers of children with cancer.  A chilling thought, indeed.

Who dies and who profits?

The most glaring disparity in health care delivery may be staring us right in the face.  Worse yet, it may have nothing to do with the digital divide.


Posted in: demographics | e-patient stories




6 Responses to “Women and Health Care Disparities: Who Dies and Who Profits?”

  1. Barbara Tunstall says:

    It isn’t just women. My husband’s family was a monetarily and insurance poor family, with a poor education. His father got cancer and died at 53 with little intervention. His mother had cancer at 62 and also died quickly. Part of the problem comes from the doctors treatment of the poor underinsured patient, and the other mismanagement comes from the patients lack of understanding that you have rights, you can question and you need to understand your treatment. They never questioned anything a physician said. Took the little yellow pill or red, etc., without knowing what it was or what it would do. So many issues!!! But the point is that it goes both ways.

  2. Christine Gray says:

    Yes, this is true, but it is not useful to phrase the argument this way. Undoubtedly that was how the medical community first responded when women started noting that women were dying of heart disease — a supposedly “male” disease — in droves through misdiagnosis and undertreatment. The one factor that cross-cuts race and class is gender. Women are not a minority of the population, but a majority.

    My grandfather, who was one of the founders of the hospital where he was treated, received extraordinary care when he was ill, whereas many of my grandmother’s complaints were dismissed as old age. Many of his ills were brought on by his own behavior. Hers, not at all.

    The scary thing is the “trickle down” effect to children w/cancer. The “moms” are overreacting … about that symptom, even though it is out of the ordinary for their child. The kids with proactive parents have a better chance to live.

    More interesting things happen if we disaggregate sex. For instance, a lot of men require the “nagging” of wives to get colonoscopies and visit doctors for prostate issues, which is why married men live longer and healthier lives. Married women, not. They do double duty, for their husbands, then typically leave their own health for last (that was the theme of Breast Cancer Awareness Month, which triggered this whole chain of events. If men can’t see a physician because it’s embarrassing or demeaning in the same way they refuse to ask for directions when they are lost, bad on them. It’s not like they can’t get the service if they demand it. For women, a different story.

    The “trivialization” of symptoms and concerns applies up and down the class ladder, more intensively with women of color. Besides which the majority of the un- or -underinsured, I believe, are women, so there is a double whammy income-sexism.

    A gender debate needs to be conducted as such, ergo the success of the heart disease studies. It cannot be deflected immediately in the interests of other groups. The NIH hc disparities study listed here has gender as a buried factor. “disparities” is a code word for mostly race, some class, little if any gender.

    The scary thing about the women and heart disease issue, physicians have begun their own inquiries into why women hesitate to be aggressive in seeking and following up with good coronary care. They need to look inward, not outward.

    [Barb is laughing; they never met me :) :) ]

  3. MiMi Olsson says:

    Even in today’s society women still consider themselves the nurturers….their main focus is husband and children. After my granddaughter finished treatment for mesenchymal chondrosarcoma we all fell apart…one by one we marched into therapy or anti-depressants….all except the Mom. She dismissed her ailments and still does. And we let her because, Well, someone has to take care of us, don’t they?

  4. Jan Osterndorff says:

    This is an area where we need the help of female physicians, who are already a beleaguered lot. The most productive way to combat this, I suspect, is by educating every woman/girl that gender bias continues in many hidden ways. Health care is just the most life threatening. Women need to actively support one another at every opportunity and support the active study of bias in the sciences.

  5. […] Response to the “Spin” series on the crazy-making quest for a second opinion on an abnormal mammogram was mixed, as was the response to the companion piece on gender disparities in the early detection of cancer. […]

  6. Debra says:

    This is definitely my own experience. I have Celiac disease, hypothyroidism, and pernicious anemia. It took ten years to get a diagnosis. I was prescribed antidepressants and antihypertensives and sedatives and told I had diabetes. Every time I took the long list of my symptoms to a doctor they dismissed it as female hormone trouble or psychosomatic illness, or blamed symptoms entirely on my weight.

    It’s even worse if you’re an overweight or obese woman, as many doctors will take the lazy way out and blame your problems on your weight, even if you know the weight gain was caused by your illness. You are given a prescription for a diet or diet pills or gastric bypass and sent on your way. And you are blamed for the continual failure of weight loss attempts to improve your health.

    Online patient groups saved my health. I was able to get information that’s just not available elsewhere, hidden from patients as if it was a dangerous secret, and got a recommendation for a doctor in my area who is now taking good care of me. A doctor who embraces the collaborative doctor-patient relationship.

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