Examining gender bias in medicine
When working in the medical field, JCU Senior Lecturer Dr Lea Merone met many women who felt that their chronic diseases were not taken seriously. For her PhD in Public Health, Lea explored women’s experiences in the medicine, medical research and education fields, and discovered insights into the treatment of female patients.
, who currently also works as Acting Director of Clinical Training at the , says that one particular incident opened her eyes to how some doctors treat male and female patients differently. At the time, Lea was a postgraduate doctor working in the United Kingdom.
“There was a young woman, perhaps 24 or 25 years old. She had a seizure, and she was lying on the floor, shaking. Her jaw, as often happens with a seizure, was clamped shut,” Lea says. “So we ended up putting in a nasopharyngeal airway.
"This is a tube about as wide as your finger that goes up into the nose and holds the airway open.” Lea says that this is extremely uncomfortable, but the woman didn’t flinch. Because of the seizure, she didn’t feel the pain.
“We stabilised her and I asked the senior registrar on the ward what he thought had caused her seizure. He said, ‘Oh, she's a young woman in with abdominal pain. It wasn't a real seizure. It was in her head. There's nothing wrong with her.’”
This experience made Lea aware of how frequently women can struggle to have their medical experiences taken seriously when it comes to medically unexplained symptoms (also known as MUS). Lea experienced herself how pain is often downplayed after she developed a painful chronic disease. This motivated Lea to examine gender bias in medicine for her in Public Health.
A subconscious gender bias?
Lea says that doctors aren’t intentionally unsympathetic to women’s ailments. “This bias is systemic and subconscious. I don't think that anything is being neglected or not done out of malice or sexism,” Lea says.
“It's mainly that the norm, so far, has been to conduct medical research focused on men and then translate it to women. It doesn't really enter people's heads that there might be a difference in women’s physiology.”
This oversight might encourage some doctors to overlook medical issues that only relate to women, Lea says, adding that when she was studying medicine in the United Kingdom, people simply weren’t aware this could be a problem.
“There was little understanding that a man and a woman might present differently with the same disease and that they might have different test results,” Lea says. “It is just how people are taught, and it won’t change until somebody challenges that.”
PhD research
For her PhD research, Lea wrote an academic paper called “”, where she interviewed women with chronic conditions who felt their pain had been underacknowledged by their doctors. “All of the women use the word ‘dismissed,’” Lea says.
Lea says her research participants wanted to share their experiences because they were hoping that telling their stories could help bring about positive change in the medical profession.
One of the consequences of women feeling dismissed by medical doctors, Lea says, was that some would look for treatments in the alternative medicine sector, where they felt that someone was listening to them and offering to help.
Lea does not say that alternative medicines are superior to medical doctors, but she says that the way these practitioners interact with patients is different. “The difference in the culture and how the women will be listened to is the key thing,” she says.
This is also why Lea recommended in her that medical doctors should receive mandatory empathy training, so they are more sensitive to people presenting with symptoms that do not have a medical explanation yet.
Possible solutions
After working as a doctor in the United Kingdom and Australia for many years, there are a number of positive changes that Lea would like to see in the health system in the near future to improve patient experiences and outcomes.
“The obvious one that jumps out is I'd like to see the gap closed. I would like to see equity and see the end of systemic sexism and racism in the health service,” Lea says. “I also support some kind of gendered medicine, where women and their ailments aren't dismissed.
“It should be acknowledged that there's not enough known about women's bodies, and that there may be nuances in test results that need interpretation and critical thinking.”
Lea also says it is important that hospitals become more multidisciplinary in their approach to treatments. “The human body is not like the motor of a car. Nobody is just a heart or lungs in isolation,” Lea says. “Pelvic pain might not simply be a matter for a gynaecologist. It might also be caused by the bowel or the bladder, for instance, and that requires other specialist knowledge.
“We need the medical system to understand health and wellbeing within the whole person. We can join teams together and manage particularly complex patients as a unit rather than as individual systems.”
Tips for future researchers
Given that Lea already has a PhD, a Master in Public Health and Tropical Medicine and a Master of Health Economics, she is happy to share the secret of her success: “Your panel. Your panel is the single most important aspect of your PhD,” she says.
“If you're not with the right people, you won't get through. My three supervisors, , Professor Komla Tsey and Adjunct Professor were absolutely amazing.”
“Cate, for instance, is so responsive. Every email that I sent, she responded to promptly. We also met regularly,” Lea says. “Komla is a very supportive professor, and working with Darren was just a wonderful experience. Darren was my tertiary advisor, but he was always there. All three of them always responded.”
Lea and her team of supervisors also wrote a research paper about together.
Lea says it’s important to make sure that a researcher is paired with a good primary advisor. “Your primary advisor does not have to be an expert in your area. But they need to be somebody who you trust and somebody who is responsive, somebody who knows how to research,” Lea says.
“This is important, as the primary advisor has to sign everything off. You will want somebody who responds to you, somebody who's there for you when you need them.”
Long COVID and chronic diseases
Lea has recently started a second PhD where she is planning to focus on medically unexplained symptoms such as and chronic fatigue syndromes, which are still underexplored chronic diseases.