Does gender play a role in medicine?

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Julie-Anne Mitchell

National Heart Foundation spokesperson on women

This year as we reflect on the International Women’s Day pledge for global parity by 2133 - a long term goal by anyone’s standard - and how everyone, men and women, can pledge to take a concrete step to help achieve gender parity more quickly – in the board room, the workplace and in the take home pay packet. Its worth asking does the same situation exist in a female dominated industry like health? Let’s look at heart disease as an example.

When most people think of heart disease, the image of an older man clutching his chest is often the first thing that comes to mind. When we think of a doctors it is often an image of a male doctor at the bedside, and when we think of researchers more often than not it’s an image of Sheldon Cooper (from the Big Bang theory) or Julius Summer Miller that springs to mind.  

The truth is largely borne out by these unconscious assumptions. Heart disease is the single biggest killer of Australian women and the leading cause of death for most women around the world. But it is also the leading cause of death in men both here and internationally and this is image is locked onto again and again in films, TV series and photo shoots of emergency wards - with subtle yet significant implications for women.

Firstly it means that women don’t perceive themselves at risk of heart disease and so are (a) less likely to have heart healthy checks, (b) slower to act on worrying symptoms, and (c) more likely to delay in calling an ambulance until, in some cases, it is too late.

This male perception of heart disease can also sometimes lead to delays in diagnosis and treatment. Up to 40 percent of women report that they did not experience chest pain during their heart attack, with non-chest pain symptoms such as breathlessness, nausea, arm or jaw pain often more common. This can lead clinicians to attribute their symptoms to other conditions or cause time delays in referral for more specific diagnostic tests. In fact although women with heart disease stay in hospital longer than men, on average 20 percent more is spent on care for men compared with women.

Even on discharge from hospital the implications of poor awareness continue to play out. Women are less likely to be referred to cardiac rehabilitation programs for information on nutrition, physical activity and treatment advice, and even if they are referred they are more likely to drop out citing family responsibilities. They are also less likely than men to continue to take their medication long term and less likely to make the lifestyle changes necessary to live well with heart disease.

The second implication of this bias is that most research into heart disease has been undertaken on men and findings extrapolated to women. It is only in the last ten years that there has been increasing recognition of the subtle but important sex differences that can influence how women experience heart disease and how they might respond differently to treatment. This is a new field of endeavour and there is much more that we still need to learn, but an historical lack of gender analysis in examination of medical findings has been detrimental to women’s health on a scale much broader than just heart disease alone.

This bias also extends to the workforce. In regard to medicine, females are now on parity in entering medical degrees with males, but in 2012 according to the AIHW only 38 percent of women were represented in the medical workforce with even smaller numbers evident in speciality areas like cardiology. This pattern is also evident in research with the Australian Academy of Sciences highlighting that just 17 percent of senior science academics in Australian universities and research institutes are women.

There is much work to be done in balancing the scales. We need to find new ways of communicating to women the importance of their own health and challenge the unconscious bias that permeates our health system. We need to support more investment in gender based research, particularly into the causes, treatment and prevention of heart disease. We also need to be less reductive in how we talk about heart disease and look at heart disease in the context of important milestones in our life; childhood, adolescence, pregnancy, menopause and older age.  We need to create workplaces that are flexible and inclusive and allow time for career interruptions that will not adversely affect career advancement.

International Women’s day was born in 1908 when 15,000 women marched through the streets of New York demanding shorter working hours, better pay and the right to vote. We are still on that pathway with the World Economic Forum estimating that it will take until 2133 to achieve global gender equality.  117 more years is a long time to wait. Surely we can do better.