by Carolyn Thomas ♥ @HeartSisters
My interest in women’s misdiagnosed heart attacks began after my own misdiagnosed heart attack. Despite textbook cardiac symptoms of central chest pain, nausea, profuse sweating and pain down my left arm, I was confidently told: “You’re in the right demographic for acid reflux!” – and sent home from the Emergency Department.
I know that, had I been appropriately diagnosed and treated on that fateful day, I’d have little interest in this topic. But I wasn’t. So I do. . .
It’s why I’ve spent the past 13 years speaking and writing (here, here, here, here and here, just for starters) about diagnostic error in women’s cardiac care.
Yet emerging studies continue to look the same: Different researchers, different dates, different academic institutions – but basically, the study conclusions I write about are the same, best summed up by my irreverent heart sister Laura Haywood-Cory (a survivor of a SCAD heart attack at age 40 and, like me, a graduate of the WomenHeart Science & Leadership training at Mayo Clinic), who bluntly translates them like this:
“Sucks to be female – better luck next life!”
“This research clearly shows that women are at a higher risk of being misdiagnosed following a heart attack than men.”
I want this to stop.
But alas, no sign of stopping any time soon. Here’s the latest evidence, this time from Spain.(2) Lead author Dr. Gemma Martinez-Nadal reported that physicians were significantly more likely to consider heart disease as the cause of chest pain in men, compared to women. This gender bias was maintained “regardless of the number of risk factors or the presence of typical chest pain in women.”
Physicians in this study were asked a simple question (the same question that your physician faces if you report chest pain): was this chest pain due to either “a coronary cause or another cause such as anxiety or a musculo-skeletal complaint?”
The answer to such a simple question could be called the rate-determining step, as explained by my late ex-husband (a chemical oceanographer and researcher).*
In other words, the answer physicians give to this question will determine whether your cardiac symptoms will be taken seriously.
The answer physicians give to this question will determine whether you’ll be referred for further cardiac diagnostic tests in case your initial tests come back “normal” – as so often happens to women even in mid-heart attack – because cardiac diagnostic tools have been, until recently, designed/developed/researched in (white middle-aged) men.
The answer physicians give to this question will determine whether you’ll be referred to a cardiologist.
But once a physician has locked onto anxiety or any other psychological reasons for your symptoms, you can essentially kiss a cardiac diagnosis goodbye. See also: “When Your Doctor Mislabels You As An “Anxious Female”
That’s the rate-determining step. This kind of diagnostic error is often based on what social scientists who teach critical thinking skills call an anchoring bias – “locking on to a diagnosis too early” (and pronouncing, for example: “You’re in the right demographic for acid reflux!”)
This new Spanish research seems alarmingly similar to Dr. Gabrielle Chiaramonte’s 2008 Cornell University study.(3) I described her research like this:
“Some of the patient reports listed a “recent psychological stressor” in the patient’s life.
“When physicians reviewed charts in which heart disease symptoms were presented in the context of a psychological stressor, fewer women received coronary heart disease diagnoses than men did (15% vs 56%), or cardiologist referrals (30% vs 62%), or prescriptions of cardiac medication (13% vs 47%).
“Researchers found that just the mention of recent stress shifted the interpretation of women’s symptoms so that these were thought to have a psychological origin.
“By contrast, men’s comparable symptoms were perceived as cardiac whether or not psychological stressors were present.”
While not all worrisome chest pain symptoms are due to a heart attack, the increasing weight of research on gender bias in cardiology does not lie. See also: “There Is No Gender Bias in Medicine. Because I Said So…”
Meanwhile, here’s how Dr. Martinez-Nadal presented her research results this month to her colleagues attending the European Society of Cardiology’s Acute Cardiovascular Care Congress:(2)
“Heart attack has traditionally been considered a male disease, and has been under-studied, under-diagnosed, and under-treated in women.
“Our findings suggest a gender gap in the first evaluation of chest pain, with the likelihood of heart attack being under-estimated in women. Chest pain was misdiagnosed in women more frequently than in men. This low suspicion of heart attack occurs in both women themselves and in physicians, leading to higher risks of late diagnosis and misdiagnosis.”
One of these studies dates back to 2008, one from three years ago, and another (all with essentially identical conclusions) dates from last week. So you tell me: are men’s cardiac symptoms still taken more seriously than women’s?
And what can women do when they truly believe the diagnosis doesn’t match their symptoms? Dr. Jerome Groopman, in his must-read book “How Doctors Think” , suggests that you ask these three questions of your doctor before you leave:
- “What else could it be?” The cognitive mistakes that account for most misdiagnoses are not recognized by physicians; they largely reside below the level of conscious thinking. When you ask simply: “What else could it be?”, you help bring closer to the surface the reality of uncertainty in medicine.
- “Is there anything that doesn’t fit?” This follow-up should further prompt the physician to pause and let his/her mind roam more broadly.
- “Is it possible I have more than one problem?” Posing this question is another safeguard against one of the most common cognitive traps that all physicians fall into: search satisfaction. It should trigger the doctor to cast a wider net, to begin asking questions that have not yet been posed, to order more tests that might not have seemed necessary based on initial impressions.”
This problem of cardiac misdiagnosis in women must be addressed in medical school training, in physicians’ ongoing professional development, and, most importantly, in mandatory reporting of diagnostic error. The field of medicine, in fact, is alone among all professional workplaces in that, when something goes wrong for the client, the official kneejerk response is to refuse to talk about it. We can’t fix something that physicians refuse to even measure. See also: Mandatory Reporting of Diagnostic Errors: Not the Right Time?
Sadly, I’m thinking that Laura Haywood-Cory’s conclusion is still correct.
♥
PLEASE don’t leave a comment here detailing symptoms you may be experiencing. I’m not a physician so am not qualified to advise you. Please see a physician to ask specific medical questions.
♥
NOTE FROM CAROLYN: My book “A Woman’s Guide to Living with Heart Disease“ reads like the“Best Of” Heart Sisters blog archives. You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (if you use their code HTWN , you can save 30% off the list price).
* Rate-determining step: “In a sequence of elementary steps by which a chemical reaction occurs, the slowest step in a chemical reaction mechanism is known as the rate-determining step. The rate-determining step limits the overall rate and therefore determines the rate law for the overall reaction.”
♥
Heart Sisters 
I have always read about people who are in denial when they are experiencing a heart attack.
The only people in denial are the people around me. Not me!!! I had to shut them out because I am very angry and disgusted with them. It causes me more stress so I had to cut communication with them or in some cases where that is not possible, I give very short sentence answers and never reach out. It’s times like this when you learn who you can count on.
Thank you for sharing the video you are in. I showed that video to my Dad and he is one of the few who believe me. I also shared that video to my Facebook and pinned it to the top. I have not shared my personal journey on Facebook. I don’t document my life on there.
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Hello Tracy – first, thank you for sharing that video with your friends and family. In just 22 short minutes, this documentary film packs a non-stop punch by sharing shocking first-hand experiences of eight heart patients and seven physicians/scientists who are working to improve outcomes for women with heart disease.
Second, it’s unfortunately common that often the very people we count on to believe us or support us during a medical crisis can be the ones who aren’t able to do so – for many reasons. This is especially true if the patient’s diagnostic tests are inconclusive or point to a misdiagnosis. It’s just harder to cope with a person with “normal” test results.
I wrote much more about how pervasive denial can be – among all kinds of people.
Take care, stay safe. . . ♥
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Hello. I am one of the many women struggling. I am admitted in the hospital now and waiting for an angiogram. I have been here almost a week.
My symptoms started March 15 after eating homemade edible for the first time. I am 51 yrs old. I felt heaviness across upper back close to neck. Then edible effects kicked in and I laid down because I was afraid of falling and hurting myself. Then chest heaviness and pain set in. I passed out. Woke up in morning feeling fine.
March 26 felt same symptoms of upper back pressure and chest heaviness. Pain only a 2-3. Received nitro at ER checked for heart attack.
About 10 days later after several ER trips and worsening symptoms (left arm felt funny kind of numb by elbow, throat tightening and heavy sensation in jaw like insane gravity trying to pull it down. Breathless while just walking to bedroom to kitchen. Tried to feed cats but had to lay down to catch breath. Fortunately my dad moved in to help me when this nightmare started so he took care of them. I went to the ER and was finally admitted to hospital.
I had a MIBI test and that test said I was clear. I was told must be fibromyalgia. I did not agree, so he said “Long COVID”.
Meanwhile my symptoms worsen and attacks more painful. Sometimes pain in arm, neck and feels like heart is being crushed to death and pain radiates to the back.
More tests ordered, which I had to advocate for. No angiogram. I know people that had blockages that were only detected by angiogram. One friend was blocked so bad he needed a quadruple bypass. My friend lived in Toronto at the time. He was told he was clear prior to angiogram because all tests showed nothing.
My last attack was intense. Back to the ER in ambulance. Very fortunate to finally have my symptoms acknowledged instead of dismissed as GERD (acid reflux). The ER doctor even mentioned microvascular angina as a possibility!!! Another exam by a second ER doctor. I was admitted, and am now waiting for angiogram. While sitting up to brush my teeth last night, the pressure was so heavy and I felt breathless.
Vertigo started May 4th. I have always felt light headed dizzy along with symptoms however this vertigo is beyond crazy. My ears have been ringing for weeks.
I started using a wheelchair April 11 because I am unable to walk without crushing sensation. The longer I stand or walk the worse it gets. Feels like 20kg is being added to weight each second I stand, until I get breathless and must lie immediately. I was crawling from bedroom to bathroom for weeks. Crawling into tub. Crawling to front door into wheelcair for yet another trip to the ER……wondering why I was not getting help…..would they let a man crawl around in his house for weeks and be told ER docs he has GERD and sent home??
Again and again….with each attack becoming worse than the previous one.
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Hi again Tracy – what a dreadful time you’ve been having! It’s very interesting to me that your complex symptoms began on the day you ate homemade edibles for the first time. Most research on cannabis consumption and heart disease has focused on people who smoke it, but very limited studies have focused on edible cannabis products.
One case study described here, for example, reported a 70-year old man who experienced his myocardial infarction, or heart attack, shortly after consuming a cannabis-infused lollipop. More studies are needed, but in the meantime, you are experiencing a whack of distressing symptoms that may indeed be linked to heart issues of some kind.
But whatever has caused them, the key question for you now is how to address those symptoms? Something is causing your debilitatiing condition of not being able to walk – but right now you simply don’t know if your heart is the culprit. That Emergency Department doctor may be on to something with his mention of microvascular angina.
I hope that somebody soon will be able to provide you with answers so you’ll get some relief.
♥
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Yes, more studies need to be done regarding edibles and heart patients.
You’re right, I’ve had many tests this past year.
Last year in Feb. I had routine bloodwork and EKG prior to fibroid removal and endometrial ablation. The EKG was abnormal. I had vasopasms. I had another EKG in April with same result, so I was referred to a cardiologist and had an echocardiogram, stress echocardiogram and wore a heart monitor. I felt fine the entire time. My migraine medication was taken away while my cardiologist investigated. I only needed one pill every 2 months anyway because I started using migraine excedrin from the USA.
No cause was found for my vasopasms. I was allowed to go back on the lowest dose migraine medication. I decided I didn’t need it anymore and never set it up with my doctor.
In January I was treated for SVT in the ER. The doctor injected me with a drug to stop the heart and reset it to normal heartbeat. I’ve had this since high school. It always resolved itself quickly on its own. When I became an adult it rarely happened. Many years passed between episodes. It was never investigated until January this year.
I hope I can get answers soon. I would like relief from my debilitating symptoms. I have no other health issues other than what I mentioned and sleep apnea. I use a CPAP.
I had mild covid in February this year. My echocardiogram was rescheduled. I was experiencing mild chest pain but mainly pressure across chest and upper back. I told the technician but he was not interested in hearing my complaint; he said we only have half an hour and I noticed he was running behind. During the exam he asked me if I thought I was old. I forget the other questions but it was clear he was ignoring my physical complaint and was questioning me psychologically?? I’m not sure if I am using the correct term for his line of questions.
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Hello again Tracy – asking a patient “Do you think you’re old?” is a new one – and I thought I’d heard every inappropriate medical question by now… Was he making a joke? If not, I cannot imagine the reason for asking such a question in the echo lab.
Coincidentally, one of the most uncomfortable cardiology tests I’ve ever endured was during a stress echocardiogram appointment several years ago. In fact, it was so awful that I wrote about it, and even filed an official complaint to the head of the department. Amazingly, she took my concerns seriously because I was the second patient to complain about her staff in less than a week. Things changed after she investigated the incident – and my Carolyn’s Top 10 Tips on How to Treat Your Patients ended up being posted on staff room bulletin boards throughout the hospital!
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No, he was not joking unfortunately. I thought it was a strange question and I felt belittled.
I’m glad you made a complaint. Your blog is informative. I had no idea these issues existed until I experienced problems. Thank you for all your hard work to inform others. I noticed you wrote a book too.
Unfortunately my angiogram has been rescheduled because a patient was put in my room before they received the result of their PCR test. This happened 2 days before my scheduled angiogram. My angiogram was scheduled about a week after I was admitted. Now I have to wait 2 more weeks. I had another PCR test and fortunately I am negative.
I have symptoms 24/7 and I am completely debilitated. I can’t walk because the heaviness is unbearable and becomes worse the longer I stand. I’m using an office chair to wheel myself from my bedroom to bathroom. I have symptoms sitting up too, but not as bad as standing. I spend most my time lying down. I was released from the hospital.
I was told my angiogram is rescheduled a little over 2 weeks away because I was exposed to COVID and that hospital has strict rules. I am aware that city’s hospitals have very strict rules because I went to the ER there. I am desperate for help which is why have been to my local ER several times and another ER in a bigger city.
I never had any bad attacks in the hospital like I did at home and I think it’s because I exerted myself less in the hospital and pushed myself at home. It is more difficult to keep still at home, but now I am listening to my body and hopefully get through this nightmare without another trip to the local ER.
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I forgot to mention my prescription migraine medication I stopped taking was imitrex.
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About being diagnosed with anxiety — the one time I called 911, when my heart went into Atrial Fibrillation and I knew exactly what was going on because hubby has this and we compared notes, the medic came in, a nice young man, and the first thing he asked was, “Are you having anxiety?”
After reading your blog and book, I actually kind of anticipated this question, and I quickly explained that I was pretty sure it was a-fib, that I had 2 stents, ran a cardiac patient support group, knew a lot about heart disease, etc.
We went to the ER in the ambulance and I was correctly diagnosed and treated (they kept me overnight while waiting for my heart to pop back into rhythm — which interestingly happened when my hubby kissed me!).
That medic came into my ER room before he left and told me it was the right thing to do to call 911 and come in for treatment. Perhaps that was his way of apologizing, I don’t know. He was actually very nice overall but I do hope he developed another way of greeting his patients.
But honestly, if that were to all happen again, I think my response to his initial question might be “Something weird is happening with my heart! Of COURSE I have anxiety!!!” Sheesh!
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Oh Meghan – you have no idea how many times I’ve wanted to scream the same thing to doctors/nurses/paramedics or anybody who accuses heart patients of appearing “anxious” – as if it’s NOT absolutely normal to be EXTREMELY anxious when something’s wrong with our hearts! But when “anxious” is used as a default diagnosis to replace the correct diagnosis, it’s even more damaging – because nobody wants to be sent home and then somehow work up the courage to return to the same people who thought you were “just” being anxious. Arrrrgh!
I loved the part of your story where the medic stopped by to see you before he left (he didn’t have to do that – and it was important for you to hear it!) Still, I too hope he stops greeting patients with that “anxiety” statement!
Take care, stay safe. . . ♥
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My bypass operation was 1983, over 37 years ago. I have 10 stents in two of my bypasses, because they had been blocked.
Six years ago I was baking a cake. The cake was already in the oven. Suddenly I had such stitches in my breast that I had to sit down. I took 3 nitro pills, but they did not help at all.
I told my husband, “I think I’m having a heart attack!” He called immediately the ambulance. The paramedics came and saw me sitting at the table. “I’ve had a heart attack, I have three bypasses and several stents and nitro does not help.”
They laughed me out and said: “We cannot believe you. You are sitting there at the table and it smells so good. Are you getting guests?”
“No, I am not getting guests. I am baking a cake!” My husband shouted at them and forced them to take me to the hospital — I had a stent thrombosis.
Another time I was brought at night into our little home hospital with unstable angina pectoris. The pain awakened me several times. The EKG at night was okay. In the morning a doctor came because I had told the nurse, I have angina pectoris and you have to send me to a heart hospital.
He looked at me and said, “You are an anxious person.” I got so angry that the pain became worse and I told him, “I want you to take an EKG right now!” So I went behind the doctor to the EKG room and had more and more pain. Now he saw it on the EKG. After half an hour, a helicopter took me to my heart hospital. It is 140 km away from us.
I know from my experiences that I have to lie on the floor and keep my hand on my breast and whine. It is the best way to be taken seriously.
Learning by experiencing.
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Lovely to hear from you again, Mirjami. Those experiences you’ve had over your long life as a heart patient are shocking examples of how even a woman with a history of severe heart disease like you sometimes has to fight to be believed (unlike Pauline’s comment, below, in which her dizziness symptom was immediately taken seriously because she was already a heart patient!) Being laughed at by paramedics, or needing your husband to shout at them to take you seriously was horrible! I hope there were consequences for those two paramedics for such unprofessional and downright dangerous behaviour.
I do have to ask: what happened to that CAKE in the oven?!? 😉
Take care, stay safe. . . ♥
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I hope that my brain functions longer than my heart. I am lucky to have a home doctor who always sends me, if I want to, to the heart hospital – even if he does not see any new bad traces in the EKG.
But if something happens in the night or on weekends, I have to call the ambulance. And you never know who comes.
Perhaps I should have offered a bit of the hot cake to the paramedics. Accusing paramedics or doctors is not clever. Our town has only 7,000 inhabitants and the village where I live 550.
Carolyn: I hope you are well and have got a shot against COVID-19.
I have not. We have not enough shots here. Only 9.3% of Germans have got the vaccination, most of them over 80 years old. The English mutation is spreading here and we have lockdown till 18th April. All restaurants are closed etc.
Easter is in the bucket.
I wish you happy Easter. Perhaps you can see your lovely granddaughter. I have not seen my son and grandson over 1 1/2 years because of this horrible virus.
Greetings,
Mirjami
.
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Oh Mirjami – it’s so painful not to see your son or grandson in such a long time! I can understand the strict COVID precautions, of course – but it still hurts. I hope that you will one day this year see them both and be able to give them big long hugs and big smoochy kisses!
I am doing well – here on the west coast of Canada, vaccine appointments are being booked according to age (they started with people in their 90s). My age group might be starting next week to make our appointments. I will feel so relieved to get my first dose – although I understand that we’ll still have to be very careful, wear our masks and follow all the COVID rules until the majority of us are fully vaccinated. Meanwhile, I’m very glad to be spending time here on my blog – and with readers like you during this strange time in our lives.
Happy Easter to you, too Mirjami. . . 🙂
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To Mirjani – It’s very sad that someone with your heart history still struggles for help and experiences medical gaslighting. Very discouraging… to say the least.
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It may not be very practical, but honestly, I think the best way to avoid these biases is to require that each would-be specialist in a given field should be required to have currently, or in the past, a condition treated by that specialty!
I, too, have been told by a (male, Mayo) cardiologist that my chest pain is acid reflux. Seriously? Have you ever HAD acid reflux?!?!
I’d rather have chest pain, thank you very much, however crushing the pain is! I’ve also had a variety of female doctors in various specialties, including cardiology, who, however nice in manner, have been dismissive of my symptoms or reactions to treatment.
As I see it, there are three problems at work:
– the adequacy of the medical training
– the personality/ego of the doctor (illustrated by the willingness to work with the patient as a valued partner), and
– the amount of time allocated to build that working relationship.
I’ve seen dozens of doctors since my health issues were finally acknowledged in 2008 – at least 50, not counting physician’s assistants and nurse practitioners. Of all those doctors, I can count exactly 5 who regard me as a partner in my health care. And I’m very aware how lucky I am!
Building a healthy partnership between doctor and patient needn’t actually take all that long. It starts with both sides feeling mutually respectful, and really believing they each have an equal say in how that relationship will develop.
I had that kind of connection with my retinologist within 5 minutes of meeting him. I’d have named my kids after him if they hadn’t already been named! 🙂
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Hi Holly – my immediate reaction to your comment was: “No more male OB-GYNs out there!?!”
Most doctors insist that it’s not necessary to have a ruptured appendix to know how to surgically remove one. This is clearly true, BUT we can’t deny that every time any doctor anywhere suddenly becomes that appendicitis patient, we know that the mere act of being “the patient” will make that person a better doctor!
And when doctors become patients, many are so gobsmacked by the humbling experience that they feel compelled to write articles – or even books – about their dramatic patient journey, now that they ‘get’ it. I once wrote about these doctors in the British Medical Journal (BMJ).
“They announce to their colleagues, for example, that hospitals are demoralizing, medical procedures frightening, lack of dignity embarrassing, symptoms distressing, dependence humiliating, the simplest of tasks exhausting, anxiety relentless, their past as a healthy person but a dim memory, and a future looming bleak and uncertain. Who knew? Welcome to our world, doctors. . .”
Your three identified problems are 100% correct! And I do know what you mean when you describe those five minutes it took for you to “connect” with your retinologist (I felt that instantly too with my cardiologist).
P.S. Wonder how many babies out there have been named after him?!?! 🙂
Take care, stay safe. . . ♥
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Yes, there are empathetic, competent, caring doctors who haven’t dealt with the conditions they treat. It would be really difficult, perhaps impossible, for a retinologist to treat diabetic macular edema if she’d had it herself, given that it damages central vision, so my recommendation isn’t really that specific.
But… If a doctor doing an appendectomy (or heart transplant, or…) had been an in-patient surgical patient (with extra points if it’s an emergency :-), maybe that would help her understand the trauma of not just recovering from the surgery, not just the emotional and physical fall-out from having emergency surgery, but the trauma from just being hospitalized.
The real problem is we live in a power-based society. Many of us have very little power when sucked into the medical system except to ask questions, however uncomfortable the powerful may be with that.
I’ve asked a lot of uncomfortable questions of health care providers in the last 13 years. I’m getting better at both the way I ask those questions and the way I respond to being brushed off because there’s no easy answer, or no desire to try to answer the questions.
It’s hard, though, to know when to back off because there really ARE no easy answers, or it’s really not worth my limited energy to push, or it’s simply beyond the current state of medical science. The best doctors don’t hesitate to say that, rather than going back to rote answers that don’t answer the question.
As always, a thought-provoking post! Thanks for your blog, Carolyn. It’s not just educated me about heart disease, it make me think over my own experiences and learn from them more thoroughly.
Holly
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Holly, I’m so glad you mentioned asking questions – truly, it’s pretty well the only thing patients can do in the middle of a medical crisis, or even a diagnostic problem-solving conversation.
I love Dr. Groopman’s three questions to ask (mentioned in this post) if a diagnosis doesn’t seem correct to us – but you’re so right: we learn how to get better at asking questions over time.
Yet how crazy is that? I never hesitate to ask questions in any other area of my life – imagine if I had to be careful about asking my mechanic or my lawyer a question!!??!!
But I learned firsthand what can happen if patients ask questions doctors don’t like (e.g. I was scolded by an ER nurse who warned me (her exact words, burned into my brain since then): “Stop asking questions of the doctor. He is a very good doctor and he does NOT like to be questioned!” My question had been:
“But doc, what about this pain down my left arm?” when my heart attack was misdiagnosed.
It’s sad that women still have to dance around to remain “good patients”.
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Carolyn – It’s not just patients who dance around when asking doctors questions.
As an ICU nurse, I often knew exactly what treatment a patient needed before the doctor returned my call for assistance… However, I am not allowed to diagnose or treat medical conditions.
If the doctor I called to address the problem did not give me what I felt was the correct answer for my patient’s condition, I then began the game of questions and suggestions until he/she not only came up with the right answer, but thought that they had come up with the idea themselves.
Some doctors who knew me would partner in discussions about treatment. But they were in the minority.
Was this because I was “female”? Was this because I was “just a nurse?” I don’t know. But it was important to drop pride and ego and keep the patient’s best interest at the center of the discussion. This applies to ourselves as our own advocate as well.
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I know what you’re saying, Jill. I witnessed this standard practice many times myself during years working in palliative care. Easing an in-patient’s intractable pain, for example, might require breakthrough meds, but the RN caring for that patient (often a senior nurse with decades of palliative care/symptom management experience) would have to call the patient’s doctor – the MRP (Most Responsible Physician) – for a doctor’s order to do so. At that time, medication changes required a doctor’s orders – even if the doctor was less knowledgeable than the nurse.
If the MRP listed on the patient’s chart was the patient’s GP (i.e. a person with typically minimal actual knowledge of end-stage symptom management), then this call went something like this:
MD: “So. . . what do you usually recommend in situations like this?”
RN: “Well, most of our doctors would order ABC at this point.”
MD: “In my opinion, I think we should order ABC.”)
RN: “Thank you SO much, Doctor!
This kind of dance was seen by both parties as necessary – as you say, to get the best care for their patient.
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Despite progress in attitudes towards women (it’s been 100 years since we were given the right to vote), I still regularly encounter the idea that women are more emotionally labile than men. Which leads to the erroneous conclusion that they can’t be trusted to give accurate information… that their reports are colored with unrestrained emotions.
Emotions are real, women are better than men at expressing them, but that need not be a deterrent to ascertaining accurate information.
Also the subtlety of some of women’s symptoms are confusing to our own selves, let alone to the doctors we are reporting them to. For example, I get a symptom that feels like all of the sudden there is not enough blood/ oxygen going to my muscles to make them work. My back, arms and legs ache deeply and I have to stop what I’m doing and rest. I know it is cardiac-related but it won’t show up on a test unless I am attached to an echocardiogram while it is happening.
Anyway, I do feel having more women cardiologists and more Women’s specialty heart clinics, like they have at Mayo Clinic in Rochester, will be helpful.
But, yes progress is truly SLOW.
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Hello Jill – I agree with your assessment of this well-known gender bias, as I wrote here in “Brave men and Emotional Women”:
What bugs me is the common defense that this is somehow the way women describe their symptoms that is the problem, rather than the way physicians are unable to correctly interpret those descriptions.
I admire the important work that Harvard researcher Dr. Catherine Kreatsoulas is focusing on re the words women use in the E.R. She describes observing women in mid-heart attack arguing with E.R. docs about the words “chest pain” by saying, “Well, it’s not really PAIN – it’s more like pressure/heaviness/fullness/aching” – which then makes the doc delete what’s in the chart, replacing it with the words “NO CHEST PAIN!”
So we could start training women to LIE by always using the word “pain” (bad pain! severe pain! unbearable pain!) if they want their cardiac symptoms to be taken seriously in the E.R. – or we could start training physicians to learn HOW women describe their heart attack symptoms (as an alternative to dismissing them).
Good example of your own subtle symptoms! I’m guessing you have enough experience by now to discern the fine line between these subtle signs and a severe symptom one day that does require immediate help.
Take care, stay safe. . . ♥
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Carolyn, thank you! The thin line drives me crazy sometimes. Hypertrophic Cardiomyopathy gives me daily symptoms that are sometimes hard to discern from Coronary Artery Disease. I would imagine microvascular disease presents you with the same difficulties!
Blessings 🙏
Jill
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Oh, yes, that THIN LINE! I think that people who live with various symptoms of chronic illness get pretty good at carefully evaluating each bad symptomatic flare”. Is this something? Is it nothing? Should I call 911?
I often say that I live with the kind of debilitating chest pain (it’s what doctors call “refractory angina” – doesn’t respond to standard treatment) that would send most people flying to the E.R.
But if I did that, I’d be bunking out there 4 days a week! This chest pain feels different from the heart attack symptoms I had – in ways that are hard to describe. All I can say is “Nitro is your friend. . .” 😉
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Oh that’s what I have been saying for weeks. More pressure than pain. I will say pain is 2-3 out of 10, sometimes 4. Pressure is 10!!!
During a bad attack it is 8 with a feeling of heart being crushed to death.
I’m in hospital now waiting for angiogram.
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Hello Tracy – I think that when a female patient mentions the word “pressure” to describe chest symptoms, it just doesn’t have the urgency it might if we’d said chest PAIN instead.
We’re socialized to picture a ‘real’ cardiac problem as looking like a (white middle-aged) man writhing in agony because of horrific chest pain, not a woman who describes her symptoms as ‘pressure’ in her chest.
Good luck to you during your hospital stay – hope you solve the mystery.
Take care, stay safe. . . ♥
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I recently found that it may not apply if one has already had a heart attack.
I mistakenly used the word “dizzy” during a phone call to make an appointment with my doctor. While the dizziness was due to a new medicine, I fit the protocol to go to the ER. I relented after pushing back, and went to the ER where I was given a clean bill of health (all my numbers lined up; good EKG, etc.) and told to CALL MY DOCTOR!!!
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I bet you’re right, Pauline! Once you’ve had a heart attack, physicians/staff look at you differently – almost as if they’re on high alert for any potential cardiac issue they don’t want to miss.
We also know that one of the biggest risk factors for having a heart attack is having already had one – so I believe that there’s generally a low bar for declaring an emergency – even when there isn’t one! I had to laugh at those CALL YOUR DOCTOR instructions – which is exactly what you were trying to do in the first place! 🙂
Take care and stay safe. . . ♥
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Do women physicians have the same bias?
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That’s a great question! It’s often hard to generalize (I have a male cardiologist and a female GP, for example, and both are fantastic). A study out of Israel three years ago did find that female patients treated by female physicians were less likely to be admitted to the Intensive Care Unit compared to male patients being treated by a male physician, but conversely, a number of other studies have found better outcomes when patients (either male or female) are treated by female physicians. A 2016 study for example found that hospitalized patients have a better chance for survival and are less likely to need re-admission to the hospital post-discharge if they receive care from female specialists in internal medicine. A number of studies suggest that female doctors in general are also more likely to treat according to current clinical guidelines, to provide more frequent preventive care, and to use more patient-centered communication than their male counterparts.
By the way, I love your blog and especially enjoyed your recent post about listening to your body (and those 2-week old puppies! Oh my!!)
Take care, and stay safe. . . ♥
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Thank you for the information. I know you can’t make any real generalizations, every doctor is different, regardless of their gender. I just wondered if female doctors tended to take their female patients more seriously than male doctors do. Logically, you would think they would.
Thanks for the kudos on my blog. Those puppies really are cute!
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Logically, that view of course does make sense. Many studies suggest that women are better listeners, for example.
But there are enough exceptions to make me hesitate before making any blanket statements. (I’m thinking right off the bat of a dozen male docs whom I know personally – I would feel respected, heard and expertly treated if any of them were one of my docs. I just want women to be treated with that same quality of care that men expect and get.
And the ICU study was so interesting to me (i.e. female docs of female patients less likely to admit their patients to Intensive Care) – that’s a staggering finding, given how seriously ill those patients must be – it’s simply not possible to believe that only the female docs studied have all the ‘healthiest’ patients – who somehow don’t really need intensive care!
Thanks again – Enjoy those puppies!
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I agree with all you have said. Women don’t seem to have the same quality of care and that shouldn’t be the case. I’m lucky because I love my PCP, who is a male. I don’t ever feel like he dismisses anything I tell him.
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