Our Modern Medical System Is Failing Women

The human mind built the automobile. It built televisions and computers and smartphones. When these things break, we understand how to fix them; we have an inventory of all the relevant components, diagrams of all the working parts.
But we didn’t create our bodies. In some sense—whether you believe in evolution, natural selection, or intelligent design—our bodies are mystical. We are not developing them; we are merely trying to reveal how they work. And, in many ways, they are still beyond our ability to fully comprehend.

When we approach our bodies from a scientific perspective, we are therefore limited in our ability to hypothesize, study, test, and evolve our understanding. We have made massive strides in the last several decades, but in a sense, we still enter into every observation from a place of not having the full picture. We begin with a set of assumptions built on our prior research, but—as my work and that of our prior research, but—as my work and that of others is beginning to prove—many of those assumptions may be erroneous.
One of the biggest and most flawed assumptions in medicine is this: if it makes sense in a male body, it must make sense in a female one.

Our Modern Medical System Is Failing Women
Our Modern Medical System Is Mostly Failing Women!

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Does Our Modern Medical System Failing Women?

In every aspect, our current modern medical system is based on, tailored to, and evaluated according to male models and standards. This is not an abstract statement or even an observation. It’s a fact. All our methods for evaluating, diagnosing, and treating disease for both men and women are based on previous research performed on male cells, male animals, and male bodies. There are reasons our system has evolved this way, many of them scientifically reasonable. However, recent research is revealing that female bodies are physiologically different from men’s on every level—from our chromosomes to our hormones to our bodily systems and structures. Therefore, the medicine that works for men doesn’t always work for, or even apply to, women.

In the ED, I am on the front lines of medicine, and this gives me a unique perspective. I see a broad view of all aspects of health care and the conditions that many women live with every day. From infections to heart conditions, sprained ankles to strokes, head trauma to back pain, I see them all at play, in real time, across thousands of patients per year. More, I see how the current male-centric model of medicine is causing women to receive potentially inappropriate, ineffective, or even substandard care, every single day.
Women in cardiac distress don’t receive the diagnostic tests they need because our protocols don’t account for the way heart disease presents in women’s bodies. Women are prescribed inappropriate doses of common medications because the initial drug trials didn’t take into account the differences in female metabolism and hormonal cycles. All these issues, and more, contribute to poorer overall outcomes and higher mortality for women of all ages and backgrounds.

TO ME, Julie’s case was significant because she actually presented with male-pattern heart disease, but in a distinctly female way. Women’s symptoms are simply different from men’s. They don’t always have the classic male symptoms and pain profiles. Their symptoms often mimic other diseases an Their symptoms often mimic other diseases and events that are considered more “female”—such as the panic attacks cited by Julie’s previous doctors. Unfortunately, the difficulty she had in obtaining a diagnosis is all too common for women with cardiac issues, particularly younger women.
If a man comes into the ED with chest pain and shortness of breath, there’s no question that he may be having an MI. If a woman comes in with the same issue, and she has a history of anxiety listed in her chart, the consensus will likely be that she’s just suffering muscular and respiratory spasm related to anxiety. If her EKG comes back normal or close to normal, she’ll be sent home. Although the symptoms she’s exhibiting are strong potential indicators of female cardiac distress, our tests and protocols simply aren’t designed to diagnose female patterns of disease, which tend to be more diffuse and uncharacterized than their male counterparts.

Discrepancies like these are what led me to specialize in sex and gender medicine in the first place. As a fresh-faced attending physician with a passion for women’s issues and a strong calling to distinguish myself as a researcher in my chosen field, I found it fascinating that researchers and specialists alike acknowledged both vast and subtle differences in symptomology, disease progression, and outcomes between men and women across the spectrum of physical and mental health—and yet no one was asking why such differences were present or how they might be affecting the way women were being cared for every day in both inpatient and outpatient settings and across all specialties. Sex and gender differences in medicine weren’t even being explored beyond the traditional scope of “women’s health”—meaning, obstetrics and gynecology (OB/GYN) and breast health—let alone incorporated into the research and dialogue that ultimately shapes our medical procedures and policies in the ED and elsewhere.

Although I know that there are researchers like me working diligently to explore the difference in male and female physiology, the procedural and practical support necessary to put that knowledge into action isn’t available to most emergency physicians when they show up to work. As a system, we simply aren’t set up to give women the specialized care and treatment they need and deserve.
There are many reasons for this, which we will explore together in detail throughout this book. The core issue, however, is that, despite decades of research and accumulated information, we are only just beginning to understand the scope of the differences between men and women and how those differences might impact everything from how drugs are prescribed, to how routine tests are performed, to how pain is assessed and treated, to how systemic disease is diagnosed.
In other words, we need to reinvent modern medicine from the ground up to include the half of the human population it has, until now, marginalized and left behind.

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