Women say doctors don't believe them when they're in pain, sick or dying. Is there a way to fix it?

Allison McCabe's own story of medical dismissal began last August with a trip to an emergency room in Vancouver.

"I was shaking violently, was having trouble thinking, speaking, and walking, and felt such a deep sense of my impending death I actually texted my mom I loved her just in case I did die," McCabe wrote in an email to CBC News last week.

"The doctor actually laughed in my face and handed me an Advil saying, 'It's the flu, what do you want me to do?'"

McCabe, 31, says she didn't take no for an answer, fighting "tooth and nail to be taken seriously." She ended up having a life-threatening side effect of iron infusions called hypophosphatemia.

McCabe was one of hundreds of readers and viewers who spoke about their own experiences of being dismissed in a Canadian hospital after hearing about the ordeal of a Newfoundland woman who says her gangrenous appendix was repeatedly passed off as anxiety.

Comments on social media point to a common problem spanning decades and borders. Several dozen emails to CBC News explained those experiences in-depth. Many were women who shared concern that their symptoms were overlooked because of their gender.

Shannon Bell of Victoria said she was told she was too young and healthy to have heart problems, and was sent home from the hospital with opiate painkillers. Her family doctor later diagnosed her with a heart condition, using the same test results seen by physicians in the emergency room that wouldn't admit her.

"Women's health care is shocking at best," Bell wrote. "If you don't advocate relentlessly, which is unnecessary, you are brushed aside."

On social media, the stories continued.

"My 'anxiety' was actually complex partial seizures," wrote one TikTok user on the story posted by CBC News. Another user said their stomach pain was brushed off for three years as anxiety and constipation, but ended up being cancer. 

"My doctor suspects undiagnosed endometriosis based on how I become bedridden during periods and … everything else that comes with it," one Reddit user wrote. "They did [an] ultrasound on me to see how it looked and they said everything looked fine."

Elusive answers

Anecdotes like these don't solely abound online. Several books have been written on the subject, too. The author of one of them — Ask Me About My Uterus: A Quest to Make Doctors Believe in Women's Pain — told CBC News she had hoped the medical community had changed since her book came out in 2018.

Abby Norman, speaking from her home in Boston, said she was initially overwhelmed by the number of women contacting her to share their own experiences.

"The response was so intense and so disheartening," Norman said, adding she was "completely unprepared" for the onslaught of emails from women around the world, and even at one point took an online hiatus to recover.

"[It was] scary, on some levels, to think that this issue was so pervasive and so replicable," she said.

"What I was not prepared for was … the anecdotal evidence that would come streaming in. That all of these women who have written to me from all these different places, from all different walks of life – they're telling me the same thing."

Despite years of immersing herself in the topic, Norman still hasn't reached a satisfying conclusion about why women in pain still feel dismissed.

"I didn't have the answer. I didn't have the data. I didn't have the evidence. I couldn't tell them, 'This will work. This will fix it. This will keep you safe,'" she said.

"And even in the years that have elapsed, I have not found it."

Research may point to a solution

Gender bias training happens in medical school, according to Newfoundland and Labrador Health Services, but isn't formally offered to working doctors and nurses in the province.

It should be, according to one American researcher — but needs to be delivered in a specific way to be effective.

"There's just years and years — I mean like at least 30 years — of study showing gender bias [in health care]," said Michelle van Ryn, a doctor and founder of U.S.-based Diversity Science.

Van Ryn heads the implicit bias training company that she started to try to solve the problem Norman and her readers describe. 

The most important part of that training is actually how it's framed, she says.

"The answer is not to vilify doctors," van Ryn says. "When the articles come out and it vilifies them, it sets us back, because understandably they feel hurt, they feel misunderstood, they feel undervalued, they feel confused — and none of those things are conducive to learning."

Van Ryn explains that humans have implicit biases built into our brains, simply by virtue of the organ's inherent architecture. It comes from an automatic brain system that makes unconscious decisions in less than a second, guiding our behaviours without us realizing it, she says.

"It's great that that system is very automatically, rapidly and effortlessly telling you that information," van Ryn says. "It just backfires at times in the social world."

When it does backfire — like when a professional unconsciously deems a woman overemotional or sensitive — it can have "devastating" consequences, leading to long-lasting pain, trauma and death among female patients.

"You can't underestimate the negative impact of this issue on health care," van Ryan said. 

"So it's a balancing act between recognizing that this is something that is not [happening] in most cases, but also creating an accountability for learning how to interrupt it. And there are ways to interrupt it."

Van Ryn uses one of those strategies herself: a technique in which she purposefully envisions the person she's engaging with as an equal rather than an adversary or threat, eradicating any unconscious associations with their perceived characteristics.

Van Ryn says gender bias training should be offered in a curious, exploratory way, one that doesn't condemn the people receiving it and teaches them strategies to recognize and halt the automatic brain processes that lead to unconscious bias.

"It's very important that this is ubiquitous. It's not just you," van Ryn said.

"[But] if you do not give people concrete, usable tools to interrupt this, the training also backfires."

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