Deadly Bias: Gender inequality in healthcare

Christina Pingel and her book: "Diagnosis: Woman"

Christina Pingel is the author of the groundbreaking book “Diagnosis: Woman – How Male-Dominaed Medicine Almost Cost Me My Life”. Her work delves into critical issues such as the ‘Gender Health Gap’, ‘Medical Gaslighting’, and the ‘Gender Pain Gap’. Through a combination of data, personal experiences, and societal critique, Pingel sheds light on the pervasive biases in healthcare systems that disadvantage women and individuals who don’t conform to stereotypical norms, such as those of white men.

Her book is more than a narrative—it’s a call to change. Pingel emphasizes that these disparities are not fleeting trends but systemic issues deeply rooted in the healthcare industry. From discrepancies in heart medicine to the broader neglect of women's symptoms, her book seeks to challenge the status quo and demand meaningful change.

A personal tragedy sparks a lifelong mission

Christina’s journey into addressing gender biases in medicine stems from a deeply personal tragedy. At the age of nine, she lost her mother to an undiagnosed heart defect. Her mother, only 33 years old at the time, required a pacemaker—a need that went unnoticed by doctors. Tragically, her condition escalated to a cardiovascular collapse, leaving her clinically dead before she was briefly revived. This harrowing experience not only shaped Christina's childhood but also inspired her to expose the failings of the medical system.

Years later, Christina herself began experiencing heart problems. By her mid-twenties, she noticed severe arrhythmias, which worsened over time. Despite numerous medical consultations and tests, her symptoms were dismissed as psychological stress or hormonal fluctuations—a textbook example of medical gaslighting. Doctors often questioned whether she might be pregnant or simply overworked, reinforcing stigmas about women’s health and emotional resilience.

The toll of dismissal and misdiagnosis

Christina’s struggle with her health was marked by repeated invalidation. Although a cardiologist identified a minor mitral valve insufficiency when she was 26, this diagnosis was trivialized and not communicated to her primary care physician. Over the years, Christina's symptoms intensified—extreme fatigue, persistent chest pressure, and debilitating arrhythmias. Yet, these symptoms were routinely dismissed, forcing her to doubt her own body.

“And I was repeatedly told that I was imagining it, so to speak, that I was under too much stress as a woman.”

This neglect culminated in a life-threatening situation. At 35, Christina was diagnosed with severe mitral valve insufficiency, requiring urgent surgery. Despite the severity of her condition, she narrowly avoided long-term heart damage—a fortunate outcome, but one that highlighted the systemic failures in her earlier care.

Structural biases in healthcare

Christina’s story reflects broader trends in healthcare, particularly in the treatment of women. Statistics show that women, on average, delay calling an ambulance for heart attacks by approximately 30 minutes—time that could mean the difference between life and death. This delay is often rooted in societal conditioning, which teaches women to downplay their symptoms and internalize the notion that their issues are "in their heads."

Christina also observed how stereotypes influence medical diagnoses. Women are often labeled as overly emotional or stressed, while men’s physical complaints are taken more seriously. This bias has deep roots in traditional gender roles, where women are expected to endure pain quietly while men are perceived as less attuned to their health.

Data, research, and the Gender-Data-Gap

The biases Christina highlights are not just anecdotal but supported by research. For example, medications are often tested primarily on men, excluding women from clinical trials. This lack of inclusivity in research creates a gender-data-gap, where women’s unique physiological and hormonal differences are not adequately studied. 

Additionally, Christina points to studies showing that female patients are interrupted by doctors after just 14 to 16 seconds when describing their symptoms. This dismissal perpetuates a cycle where women's voices go unheard, their symptoms misdiagnosed, and their health outcomes jeopardized.

Unveiling biases in women's health: A systemic challenge

A culture of dismissal in medical diagnostics  

Women often face systemic challenges when seeking medical care, particularly when discussing issues related to their reproductive health. Many women report being interrupted early in consultations with doctors, which prevents them from fully describing their symptoms. This dismissal can lead to incomplete diagnostics and perpetuate a sense of shame or doubt about the severity of their conditions. It often results in women downplaying their own pain or concerns, assuming that their symptoms are either insignificant or overly exaggerated.

Workplace health surveys: A mirror of societal attitudes  

An interesting example comes from a workplace health survey focused on "hidden problems." While the survey captured common issues like diabetes or caregiving responsibilities, it largely ignored women's health issues, such as severe menstrual pain or menopause-related challenges. This omission wasn't due to the absence of these problems but rather because women have been conditioned to minimize or remain silent about them. These ingrained attitudes reflect a broader societal norm where health issues tied to female biology are often dismissed or stigmatized.

Historical lack of support for women’s health  

The conversation also highlighted the lack of support and education around pivotal life stages such as menstruation and menopause. In the past, young women had limited resources, often relying solely on family or friends for guidance. Technological advancements like health-tracking apps are relatively recent developments that have begun to fill this gap. Even scientific research has lagged behind: for instance, it was only recently that the first images of ovulation were captured—a stark contrast to the countless studies focused on sperm and fertilization. This reflects a historical neglect of women’s health in scientific and medical research.

The need for cyclical understanding in healthcare  

A striking example of systemic oversight is the failure to consider a woman’s menstrual cycle when scheduling surgeries. In one case, a woman was sent home hours before a major heart operation due to concerns about menstrual-related bleeding risks. There’s no standardized approach to align medical procedures with women’s hormonal cycles, despite evidence suggesting that this could significantly improve recovery outcomes. This oversight extends to post-operative care, where women often face longer recovery times than men, partly due to physiological differences that aren't accounted for in current medical protocols.

A call for gender-inclusive medical education  

One of the most significant barriers to addressing these issues lies in medical education and practice. For example, gynecologists typically do not receive extensive training on menopause during their formal education, learning instead through personal interest or on-the-job experience. This lack of formal training is compounded by the fact that counseling on such topics is undervalued and underfunded, making it less economically viable for doctors to specialize in these areas. Moreover, the siloed approach to medical training often fails to recognize the interconnected effects of hormones on various bodily systems.

Breaking the cycle: What needs to change  

To address these systemic gaps, two major shifts are necessary. First, there needs to be a cultural shift in public discourse, reframing questions about women's health from "Is this a problem?" to "How can we improve the system?" This would normalize conversations about gender-specific health issues and underscore their importance for all members of society, not just women.  

Second, foundational changes in education and healthcare training are imperative. Introducing gender medicine as a mandatory subject in medical school curricula would ensure future practitioners are equipped to address these disparities. Cross-disciplinary approaches could also help physicians better understand the broad impacts of hormones and other gender-specific health factors.  

The journey toward equitable healthcare requires systemic change, beginning with recognition, education, and a commitment to inclusivity at every level of society and medicine.

The role of data in closing the Gender-Health-Gap

One critical step toward addressing the medical gaslighting faced by women is the collection and analysis of robust data. As highlighted in recent discussions, the advent of new technologies and increased focus on women's health offers unprecedented opportunities to bridge the gaps in understanding and treatment. For example, insights into cardiovascular health risks for postmenopausal women reveal that they are significantly more vulnerable to heart disease—a fact unknown to most women. Enhanced data collection can inform preventative care, providing women with the tools to protect their health.

This progress underscores the power of collective efforts: women advocating for themselves, researchers focusing on female-specific health issues, and organizations pooling resources to illuminate overlooked areas. Over time, these data-driven approaches can revolutionize the understanding and treatment of conditions that predominantly affect women.

Shifting perspectives through public awareness and education

Beyond the medical realm, public discourse and education are paramount in tackling gender biases. Books such as *Invisible Women* shed light on how women are systematically excluded across various domains, including healthcare. Although society often touts gender equality as achieved, closer scrutiny reveals persistent disparities. For instance, traditional gender roles often resurface during pivotal life stages like family planning, forcing women to shoulder disproportionate burdens.

Public awareness campaigns must challenge misconceptions about equality by showcasing real-world inequalities. Efforts to normalize conversations around women's health, from menstrual cycles to menopause, play a crucial role in creating environments where women feel validated and heard.

The need for structural change in healthcare systems

For lasting change, healthcare systems must be restructured to accommodate the unique needs of women. This includes training medical professionals to recognize and respect gender-specific symptoms, as well as integrating courses on gender medicine into medical education. While some progress is being made—such as the upcoming introduction of gender medicine as a medical elective—this remains a nascent effort.

The lack of economic incentives for physicians to specialize in areas like menopause care further underscores systemic shortcomings. This field requires time-intensive consultations and personalized treatment plans, but limited financial rewards discourage practitioners from pursuing specialization. Breaking down these barriers involves rethinking healthcare policies to ensure fair compensation and adequate resources for patient care.

Combating internalized misconceptions

Internalized societal narratives also hinder progress. Women are often socialized to downplay their pain, doubt their own experiences, and accept dismissive medical advice. These tendencies are reinforced by stereotypes suggesting women are "too emotional" or "too sensitive." The cumulative effect leads many women to accept inadequate care without question.

Changing these deeply rooted beliefs requires empowering women to advocate for themselves. Whether in healthcare, workplaces, or personal lives, the confidence to demand fair treatment and second opinions is key to breaking the cycle of neglect.

A call to action for collective change

Ultimately, addressing medical gaslighting and the gender health gap demands a multifaceted approach. From systemic reform in healthcare education to grassroots awareness efforts, all levels of society must work together to create an equitable landscape. Encouragingly, recent years have seen a surge of interest in gender-specific healthcare, driven by women-led initiatives and increasing public awareness. This momentum highlights a growing recognition of the importance of these issues and the possibility of meaningful progress.

By amplifying women's voices, fostering inclusive research, and challenging outdated norms, we can build a future where all individuals receive the care and respect they deserve. Gender equality in healthcare is not just a women's issue—it benefits everyone.

Autorin: Tsion Basazinew