Why we need to teach gender awareness in medicine - Marina Politis

In medicine, our research, trials and teaching still centre on the male body and experience.

Marina Politis

For women, this can be deadly. In the last decade, more than 8,200 women in the UK have died from deaths which would have been preventable had they received the same standard of care as men, equating to two preventable gender gap-related deaths daily.

This is especially prevalent in cardiovascular disease. Whilst women live longer than men, they are more likely to die of heart attacks. Despite this, coronary heart disease is still perceived as a man’s disease. This isn’t about tragic tales of women’s individual symptoms being missed or their pain not being listened to, though, but one of structural failings, in a system which still sees men as the norm, and women as the other.

When people think about heart attacks, the immediate image that comes to mind is often one of an elderly man clutching his chest and describing a crushing pain that radiates to their left arm, gasping for breath.

Women, on the other hand, are more likely to experience jaw, shoulder, or back pain, often accompanied by nausea or general malaise. This image, most likely, did not spring to mind. Despite women being 50 per cent of the population, this presentation is still seen as atypical.

Due to the lack of awareness of female symptoms women may delay seeking medical help in a heart attack and are 50 per cent more likely than men to receive the wrong initial diagnosis. Furthermore, they are less likely to receive timely treatment or be prescribed preventative medications. Even when women do receive the same care as men, this care was often developed predominantly on men due to women’s historic exclusion of trials.

The perception of women as a mere deviation from the normal male, which represents the person, has plagued medicine throughout history. Eve was born from Adam’s rib and from Ancient Greece to the 17th century, female maladies were attributed to the wandering womb - an animal within an animal which supposedly wrought havoc as it bumped into women’s internal organs, giving rise to physical or mental symptoms.

Whilst today, the uterus no longer wanders, women are still all too often reduced to their reproductive systems. Their symptoms often written off as psychological or a result of hormones running amok, women therefore face delayed or inappropriate care, and worse clinical outcomes. “Don’t be so hysterical” is a phrase not unfamiliar to many of us, but with the word hysteria coming from hystera, the Greek for womb, it denigrates women’s bodies and perpetuates stigma surrounding mental illness. Given this, it is more likely that the speaker calling a woman hysterical suffers from a case of sexism.

As a medical student, when I open a textbook, I am still confronted with predominantly male diagrams, learn about drugs and investigations developed primarily on men and practice examination skills on my male peers before my female peers.

Men and women’s bodies are different, so we must stop treating them the same. There is a misconception that equality comes in the form of gender blindness, but this is not the case. We need gender awareness and it is time that our textbooks, teaching and trials serve and represent all of our patients.

Marina Politis is the deputy chair of the BMA’s Student Welfare Committee