The gender pain gap: have I missed diagnoses?

I worry that I've missed serious diagnoses in women. I consider myself a thoughtful doctor, but we all carry unconscious biases, and one I've reflected on is how I consider women's pain compared with men's. It's a recognised problem, known as the gender pain gap.

What the research shows

Research shows that women's pain is more often put down to psychological causes, leaving women feeling their pain is "in their head". They're more likely to be labelled as exaggerating. The stereotype that women overstate pain can lead doctors, whether they're men or women, to dismiss both what women say and how they show pain, and to underestimate how bad it is.

Why it matters

Feeling dismissed is one of the main reasons women put off seeking care. Conditions that need urgent attention can go untreated, leading to missed and delayed diagnoses.

Something I've noticed in practice is that most of the patients who tell me they had a heart attack that was missed earlier are women. Heart disease is the leading cause of death in women worldwide, yet women have been under-represented in 62% of heart disease trials. Women are more likely to have symptoms such as nausea, jaw pain or shortness of breath, rather than the classic chest pain most doctors are trained to spot.

Being aware of it, and actively working against it, feels like a good starting point.

Bigger than the clinic

This isn't only a medical problem. The idea that pain is more emotional in women runs through schools, workplaces and families, and is passed on through what researchers call a hidden curriculum. I can't claim to be entirely free of this bias. But I can be aware of it, and work against it.