A terrible tragedy occurred in recent days. Reut Cohen, who was pregnant with twins, collapsed and died. Her family says she suffered from severe pain throughout her pregnancy, complained about it to her doctors and even went to emergency rooms because of the intense pain. According to the family, although she was hospitalized, the cause of the pain was not identified, she was told there was no treatment and she was sent home. As of this writing, the cause of Cohen’s death is unknown.
But even apart from the specific circumstances of this difficult case, women repeatedly say their complaints of pain do not receive enough medical attention. Are women discriminated against in pain treatment compared with men?
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Women’s pain is sometimes perceived as less severe than men’s
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Based on specific cases and personal stories, it is difficult to determine whether women are treated differently for pain than men. For every woman who says doctors ignored her pain, there may be a man with a similar story. However, in recent years, studies in psychology and medicine have begun making systematic comparisons to examine the issue. Their conclusion is that gender bias in the perception of pain does exist.
Does pain ‘hurt less’ for women?
Studies show that women’s pain is perceived as less intense than men’s. In one study, participants were shown videos of women and men describing real pain they had experienced. The participants, ordinary people without medical training, were asked to rate the intensity of the pain described. On average, they rated the pain described by women as lower than the pain described by men. In other words, they generally believed women hurt less.
Prof. Shoham Choshen-Hillel Photo: Michal RevivoIn another study, participants estimated that men and women experience the same level of pain from similar physical injuries. For example, they believed a woman or a man who broke a leg would experience pain of similar intensity.
However, the same participants estimated that women would report a higher level of pain than they actually felt. For example, they believed that a woman experiencing pain at a level of 7 out of 10 would report it as an 8. By contrast, they believed men would report their true pain level. These findings point to a general tendency among the public to perceive women as exaggerating their pain reports, echoing a long history of labeling women as “hysterical,” emotional, dramatic and overly reactive.
Between real pain and social perception
Are medical decisions by professionals, such as doctors and nurses, influenced by stereotypical perceptions of women’s pain? In a series of studies I conducted in recent years with colleagues from the Hebrew University of Jerusalem, Hadassah Medical Center, and hospitals and universities in the United States, we found the answer is unequivocal: yes. Medical decisions in emergency rooms show bias against women in pain treatment.
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Inadequate pain treatment can harm diagnosis and recovery
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Our findings are based on data from millions of male and female patients who visited emergency rooms around the world, as well as data from specific emergency rooms in hospitals in Israel and the United States. We found that women with pain complaints received fewer prescriptions for painkillers than men, even when they reported the same pain intensity and had the same condition.
For example, a male patient who arrived at an emergency room with back pain he rated as 9 out of 10 had a higher chance of receiving painkillers than a female patient who arrived with the exact same complaint. Women received fewer painkillers overall, both “mild” painkillers such as acetaminophen and “strong” painkillers such as opioids. We also found that women’s pain was documented less often in the medical system and that women waited longer before receiving pain treatment in the emergency room. The biases were found to a similar extent among male and female doctors, as well as among nurses.
Fewer painkillers for women
Proper pain treatment is of critical medical importance. Inadequate treatment can not only cause unnecessary suffering but also harm a patient’s recovery, lead to missed diagnoses of conditions for which pain is a warning sign and even contribute to the development of chronic pain disorders. Still, it is important to note that even for skilled and dedicated medical teams, pain treatment is complex, and it is often difficult to know what the “right treatment” is.
The reason for the difficulty is that pain treatment relies on subjective factors. There is no thermometer or blood test that can show a patient’s “true” pain level, and it is impossible to compare one person’s experience of pain with another’s. Our findings indicate that medical teams are not aware they tend to offer less pain treatment to women. I have no doubt they are trying to do their best in an overloaded system and under conditions of uncertainty. They do not always succeed.
The challenge: pain is subjective
What can be done? The first recommendation is at the level of health policy. More meaningful enforcement of pain treatment guidelines is needed in emergency rooms and other hospital departments, along with greater awareness among medical teams of bias against women. Pain treatment protocols exist in emergency rooms and call for equal treatment of patients according to their reported pain level, regardless of religion, race or sex. But studies in Israel and around the world show that in many cases, the guidelines are not enforced.
Pain intensity is not always systematically documented, although it is required. Too little pain treatment is provided to both men and women compared with recommendations, especially at high pain levels. A systemic response to the problem is needed. Until then, my recommendation to female patients and their families is to report pain to medical staff, even if they are not asked, and to request — and even demand — pain treatment if they need it. Wishing full health to all.
Prof. Shoham Choshen-Hillel is vice dean at the School of Business Administration and a member of the Federmann Center for the Study of Rationality at the Hebrew University of Jerusalem.