Women’s health advocates and others have long recognized the gender gap in healthcare, particularly when it comes to women’s heart disease. Symptoms of heart disease in women are frequently dismissed, or misdiagnosed as signs of another condition. Misdiagnosis, in turn, can have a number of long-term, pernicious effects – not only does it delay appropriate care, but it can mean unnecessary treatment for a condition the patient does not actually have, frequently with troubling side-effects. Systemic bias in both the development of new treatments and the training of medical professionals makes the gender gap in healthcare notoriously difficult to overcome – yet physicians and others who embrace a professional duty of care toward patients have a responsibility to work to correct for their own implicit bias, including with respect to women’s heart disease, in order to deliver treatment to all patients in keeping with the medically accepted standard of care. When healthcare providers fail to meet that standard, they may be held liable for medical malpractice.
At Firecrest Injury Law, we see legal action for medical malpractice as not only a means of ensuring that individuals adversely affected by medical negligence are awarded appropriate compensation for their losses and suffering, but also as a tool for furthering women’s health advocacy. By holding medical negligence to account through malpractice litigation, we strive to draw attention to the gender gap in healthcare and the tangible harms this systemic bias inflicts on patients and their families, in order to create the impetus for meaningful change. To speak with a member of our team regarding your own concerns, call our office in Albuquerque, New Mexico at 505-218-9949 to schedule a consultation.
Historical Background
“A century ago,” according to “The Slowly Evolving Truth About Heart Disease and Women,” a February 2024 story published in American Heart Association News, little was known about heart disease – what caused it, how to treat it. There was even less awareness of the impact of cardiac conditions on women, in large part because heart disease, as the same report puts it, was considered “a man’s disease.”
Public Messaging: A Woman’s Body in a Man’s World
That perception – that heart disease is a problem pertaining to men – has been slow to recede, even as medical and public knowledge of heart disease has grown by leaps and bounds. As late as the 1960s, the American Heart Association (AHA) itself held a conference whose theme was educating women on how to care for their ailing spouses with cardiac conditions; “The Slowly Evolving Truth About Women and Heart Disease” further reveals that, in the same decade as the care-themed conference, the organization also circulated a pamphlet with nutritional information, under the dubiously catchy title, “The Way to a Man’s Heart.”
Even through the end of the 20th century, the AHA now explains, public health messaging for women tends to focus on reproductive organs and the various illnesses to which they could become susceptible. Advice was aimed at recommendations for Pap smears (designed to function as a screening system for early detection of cervical cancer) and mammograms (for breast cancer). This emphasis may unfortunately have not only emerged from, but contributed to, a systemic bias that affects the public perception of women’s health concerns.
Lessons Learned Too Well: The Long Half-Life of Public Messaging in Patient Perception
These recommendations and their associated campaigns have had remarkable staying power – maybe a little too much, from a heart health perspective. A 2017 British study, made available to the American public through the National Library of Medicine (NLM), found that women who participated in the researchers’ survey consistently perceived their personal risk of breast cancer to be greater than that for heart disease – even though statistics reported in a fact sheet jointly produced by the AHA and the American Stroke Association show that roughly ten times more women die from heart disease than from breast cancer.
Moving in the Wrong Direction: Troubling Trends in Women’s Heart Health Awareness
The imbalance in women’s health awareness may actually be getting worse, instead of better. A 2020 American Heart Association Special Report revealed that women’s self-reported awareness of heart disease as the leading cause of death among women had actually dropped over the preceding decade, from 65% of survey respondents in 2009 to a mere 44% in 2019. That steep downward trajectory both marks the importance of women’s heart health advocacy, pioneered by groups like Go Red for Women (founded in the early 2000s) and underscores the reality that women’s heart health awareness still has a long way to go.
The Role of Healthcare Professionals
Unfortunately, female patients (and future patients) are not the only ones whose awareness of heart disease in women is lagging the current standard of care recommendations proposed by organizations like the AHA. Many even among the healthcare community may not fully recognize how common heart disease in women is, despite the fact that the Centers for Disease Control and Prevention (CDC) attributes roughly similar proportions of male vs. female deaths to non-specific heart disease in recent years.
Historical Underpinnings of Contemporary Problems in Women’s Heart Disease Diagnosis and Treatment
Global Research Consulting (GRC), a student-run group out of the University of California at Berkeley, has synthesized the results of several studies into a report provides a useful, yet troubling, composite picture that provides clues to how misdiagnosis (and, just as importantly, missed diagnosis) of heart disease in women keeps being perpetuated, despite the many medical advances that have been made in the past hundred years – or even since the 1960s. According to GRC, only 30% of medical schools have been in the habit of including education on gender-specific health needs and how to address them. Medical texts examined for one of the studies summarized in the GRC report showed even greater gender disparity; out of 11 included in the initial review, only one provided robust information about sex-specific differences aimed at understanding patient symptoms and interpreting diagnostic results.
Consequences of Inadequate Training
Historically, not only the anatomical models and descriptions in medical textbooks, but also the preponderance of subjects in clinical trials, have been male. The gender disparity in medical research has not always been structured with ill intentions; for instance, decades of reluctance to enroll female study participants in clinical trials stemmed from the late discovery that thalidomide, widely used in the mid-20th century to treat morning sickness in pregnant women, caused severe birth defects when administered to exactly the population to whom it was typically prescribed (women in the early stages of pregnancy). The drug now has recognized therapeutic uses in treating leprosy and multiple myeloma, but according to MedlinePlus thalidomide is now administered under tight regulatory controls that were developed in large part because the negative effects of thalidomide served as a “wake-up call” to public health and the medical research community regarding the need to expand risk-assessment criteria for new treatments to include possible effects on fetal development.
No one would wish to erase those “safety rails” on medical research, but excluding women from clinical trials has led to another set of problems: Women are not only smaller than men, on average, but they generally have a lower relative blood volume for their size (blood volume does, however, increase dramatically during pregnancy). These sex-based differences would likely lead female vs. male patients to respond differently to some therapeutic interventions, even if the two sexes did not also show marked divergences in their endocrine (hormone-producing) and immune systems – yet healthcare professionals often leave medical school under-prepared to diagnose, and identify appropriate treatments for, half of their patients.
Gender Gaps in Heart Disease Diagnosis
Healthcare always presents a complicated set of considerations, and numerous factors can affect how any specific medical professional approaches the process of diagnosing any one patient. In general terms, however, there are two persistent themes that work together to delay diagnosis of heart disease in women.
Failure To Recognize Symptoms
Doctors often fail to recognize symptoms of heart disease in women, with multiple studies emphasizing that the greater prevalence, among female patients, of symptoms such as jaw, neck, or back pain and general malaise – not always instead of, but frequently alongside – chest pain often led medical professionals to suspect a condition other than heart disease. This tendency can lead not only to a missed diagnosis (failure to promptly detect heart disease) but to a misdiagnosis (attributing symptoms of heart disease to some other condition). A 2010 study available through the National Library of Medicine found that doctors misdiagnosed over 30% of middle-aged women presenting with cardiac symptoms as having a mental health disorder, compared with just 15.6% of men – a percentage that does not account for a host of other possible misdiagnoses.
That considerably more than one in 10 men would also have been misdiagnosed at their initial visit underscores that medicine is in many cases not an exact science, symptoms can vary widely even between patients who have otherwise similar characteristics, and no one, physician or not, can completely avoid making mistakes. On the other hand, healthcare providers have a duty to stay informed about the standard of care in their fields – which, ideally, should include a recognition of under-diagnosis of cardiac disease in female patients, and some attempt to correct for it.
Failure To Test
An aggressive approach to diagnostic testing might be one way to close the gender gap in heart disease diagnosis and therefore reduce the delay in treatment many women with heart conditions experience. Unfortunately, even when healthcare providers do recognize that a female patient’s symptoms are consistent with the presentation of a heart condition, they may not order a robust suite of diagnostic tests. A 2017 study published in the Journal of the American Heart Association found that a doctor’s implicit bias with respect to gendered perceptions of risk tolerance was associated with the type of diagnostic test the physician selected for a patient, irrespective of the test’s estimated diagnostic accuracy.
Taken together, these two broad tendencies in women’s healthcare help to explain why women – especially younger women, who may be at risk for pregnancy-related cardiac complications – are less likely than men to be seen by heart specialists when admitted to a hospital with cardiac symptoms, and more likely to be sent home from an emergency department without diagnosis or treatment after an acute cardiac event,
Gender Gaps in Heart Disease Treatment
Even when a woman is accurately diagnosed with a heart condition, her treatment may not meet the standard of care – and her health is likely to suffer as a result. Numerous studies have found that doctors treat CVD less aggressively in women than in men, while the joint fact sheet from the American Stroke Association and the AHA shows that women are more likely than their male peers to require readmission to a hospital after being discharged in the wake of a heart-related incident. They are at the same time less likely to be referred to a cardiac rehabilitation program, and – perhaps not surprisingly – more likely to die within one to five years of an initial cardiac event.
This last point means that legal support for women’s heart health advocacy cannot stop with addressing medical malpractice in its longterm effects on female heart patients. Tragically, many of the medical malpractice cases arising from heart conditions in women are also wrongful death cases, in which families must show in court that medical negligence led to their loved one’s otherwise preventable death. If this sad situation has affected your family, know that the women’s health advocates at Firecrest Injury Law are prepared to listen to you and take your concerns seriously.
Legal Support for Women’s Heart Health Advocacy: Closing the Gender Gap
A long history of systemic bias in heart disease diagnosis and treatment has led to a wide gender gap in healthcare that disadvantages women’s heart health. Misdiagnosis of heart disease symptoms in women is particularly common and often leads to extended delays in much-needed treatment. Even worse, once diagnosed women’s heart disease is treated less aggressively – and less effectively – on average than are the same conditions in men. Medical malpractice law is not a complete solution, but the women’s medicine attorneys at Firecrest Injury Law view legal advocacy as one tool in a larger fight against systemic bias and its often devastating effects on women and their families. To learn more, or to schedule a consultation with a member of our experienced and knowledgeable team, call 505-218-9949 today.
