Melanie Sloan, lead author of a study of more than 6,600 people with autoimmune conditions, asks doctors to say “I believe you” to patients whose symptoms they cannot see. We are still having to demand that medicine take a woman’s account of her own suffering seriously!
The researchers, from Cambridge and the University of East Anglia, found that 43 percent of women reported having their condition attributed to a psychiatric cause, against 33 percent of men. For psychosomatic misdiagnoses, the figures were 34 percent and 22 percent. Allowing for age, disease group, continent and household finances, they put women’s increased likelihood of reporting these misdiagnoses at 46 percent and 74 percent respectively. Most participants were women and most were from the UK.
Among men, the most frequently reported wait for a diagnosis was less than three months; among women, one to two years. The women reported more consultations as well. They kept bringing their symptoms to doctors while the condition remained unidentified and treatment was delayed.
Fatigue and pain occur in many illnesses; identifying an autoimmune condition can therefore be difficult. A psychological explanation, however, requires evidence of its own. The researchers suggest that medicine continues to regard women as “less credible and emotional reporters of symptoms than males”. On this basis, a doctor can discount the evidence the woman brings precisely because a woman brings it. The difficulty of the case becomes entangled with a judgement about the patient which no examination has established.
Shaista Tayabali, a patient and co-author of the study, says: “Although labels such as hysteria are outdated, and fortunately rarely used nowadays, as women we still often have a harder time having our symptoms believed and therefore addressed accurately.”
The prejudice has lost a disreputable name without losing its authority. A doctor who discounts a woman’s testimony can also decide whether she receives a referral or further investigation. She must appeal to the profession whose judgement she is disputing, and sustain that appeal while ill. Sloan reports lasting damage to women’s trust in doctors and to their self-esteem. After years of having her account dismissed, the patient may herself begin to doubt it.
For a worker who loses pay to attend an appointment, every return costs money. If she needs someone to accompany her, that person must find the time too. A wealthy patient can purchase further consultations; the worker may have to weigh another attempt against the money she needs to get through the week. Let those who prescribe perseverance undertake it on these terms! The researchers accounted for household finances and still found the disparity between women and men. Poverty adds its own difficulties to a prejudice which reaches beyond the poor.
Nor does a woman cease to be responsible for work at home because the doctor hasn’t identified her condition. Where she provides unpaid care, the household must somehow replace her labour or persuade her to continue. Capitalist society relies on this work while leaving each family to arrange it privately. If the family can’t pay for help, relatives must do more, necessary work goes undone, or the sick woman struggles on. Her labour remains indispensable even when her account of what it costs her is treated as unreliable.
Socialist society would undertake this care collectively, maintaining the sick woman’s livelihood and providing for those who depend on her. She could pursue treatment without first having to find a private substitute for herself. To achieve this requires a struggle over the disposal of society’s resources, against the claims of capital and the expectation that women will supply whatever care goes unpaid.
The same struggle must reach inside the health service. Women’s organisations must be able to expose these practices and demand that medical authorities answer for them. Working women must participate in directing the institutions on which their health depends; they cannot leave their emancipation to officials who still regard them as unreliable witnesses.
