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‘Precious, princess’: Health minister warns GPs to brace for women’s pain inquiry findings
By Wendy Tuohy
November 3, 2024 — 5.00am
Victorian Health Minister Mary-Anne Thomas is warning doctors to brace themselves for the results of Australia’s first inquiry into women’s pain, saying it revealed “a misogynist view that pain is part of women’s burden”.
Thomas said she was shocked to learn what more than 13,000 women and girls who shared stories with the inquiry experienced, and that many had serious pain dismissed or were “gaslit” by being told they had mental health issues.
Women testified saying things such as, “I just want to get off the merry-go-round of antidepressants and iron infusions” prescribed for pain.
It’s prompted Thomas to warn that the findings will make difficult reading for the medical profession.
“Brace yourself for what the report is going to say about women’s experience with their primary healthcare practitioners,” Thomas said she had told the Royal Australian College of General Practitioners.
“I don’t want to blame them, but it goes to the Medicare rebates, it goes to what they’re taught and what they know and both conscious and unconscious bias that exists within the health profession.”
Thomas said some women felt they were treated as drug addicts when they asked for relief. She was challenged by researchers for suggesting misogyny may be a factor the gender-pain gap.
“‘It’s natural. Therefore, we shouldn’t do anything about it’ – that was presented back to me. I thought, ‘That’s really something’ – because cancer is also ‘natural’.”
In its submission to the 11-month inquiry, the Australian Nursing and Midwifery Federation included incidents of health workers having their own pain treated dismissively and witnessing women receiving gender-biased treatment.
It received more than 800 responses in four days to a member survey on women’s pain.
Of 89 per cent of nurses and midwives who had experienced acute pain, two-thirds felt “dismissed by health professionals”, and 53 per cent said the response was negative.
A nurse on a mixed specialty surgical ward said gynaecology patients who describe “10/10 pain” were given paracetamol as a first-line treatment to “wait and see if it helps”, while other surgical patients “are given two to three lines of analgesia charted immediately at any instance of pain”.
Another told of “multiple colleagues judging young female patients’ subjective pain scores, calling them ‘precious’, ‘princess’ or ‘overreacting’.”
Men were believed and treated sooner and often given more options. One nurse “watched a man with a carpal tunnel be written up for 20 mg of IV [intravenous] morphine, but a woman with a full reproductive system removal gets written up for only a max of 10 mg of IV morphine.
“Women are seen as if they can’t tolerate pain, or they’re weak or as, ‘You bear children, you can deal with great amounts of pain’.”
Sue Matthews, chief executive Royal Women’s Hospital and National Women’s Health Advisory Commitee
“We are treated differently and are often labelled as emotive or anxious,” she said.
The federation’s Madeline Harradence, a member of the Victorian Women’s Health Advisory Council, said nurses and midwives reported a delay in women getting care for chronic pain and getting appropriate care or treatment for very acute conditions.
“A woman who turns up in the emergency department is not believed, they’re having trouble getting in the door,” she said. “[Nurses] are constantly having to advocate for women against those gendered structures.”
Professor Sue Matthews, the Royal Women’s Hospital chief executive and inquiry co-chair, said it was heart-wrenching to hear from women at community forums, focus groups and online.
“The number one issue for women has been they felt dismissed,” said Matthews, also a member of the National Women’s Health Advisory Committee.
“One of the biggest things we’re hearing is that their pain is attributed to mental health issues or lifestyle factors, when it isn’t [due to those].
“Women are seen as if they can’t tolerate pain, or they’re weak or as, ‘You bear children, you can deal with great amounts of pain’ … It’s the invisibility of those women that’s the problem.”
Australian is behind other nations in stratifying research data by gender and including women in trials, she said. More eduction was needed to increase understanding that women’s pain is not “normal”.
That medical knowledge “doubles every 73 days” means it is very difficult for healthcare practitioners to keep up, Matthews said, and the inquiry would make recommendations about how to support them to do this.
RACGP Victorian Council chair Anita Munoz acknowledged that in parts of the medical system, “there are women who have had bad experiences of not being believed about their pain”, but said inquiries often captured historical as well as contemporary experiences.
Poor understanding of women’s pain was not just a general practice issue, but GPs faced particular challenges because patients often have multiple co-existing problems to be addressed in standard 15-minute appointments.
“GPs and patients bear the brunt of this: we have a more than 40-year-old funding system that financially punishes good GPs for spending in-depth time with patients. The patho-physiology of gynaecological issues and chronic pain is very difficult to do … in the that amount of time,” Munoz said.
‘If it achieves parity with MBS funding that would be good ... the rebate for scanning a scrotum is more than for scanning a female pelvis.’
Marilla Druitt, Royal Australian and New Zealand College of Obstetricians and Gynaecologists
“The Medicare funding system sets up GPs to fail.”
Dr Marilla Druitt, a councillor of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and president of Pelvic Pain Victoria, said she was not at all surprised by what women told the inquiry.
The college’s submission noted “research shows that chronic pain affects a higher proportion of women and girls than men, yet women are far less likely to receive treatment”.
Druitt said it was hard to judge if the use of the term “medical misogyny” by some regarding responses to women’s pain was justified, but if it helped change longstanding women’s health funding problems it might be.
“If it achieves parity with Medicare Benefit Schedule funding that would be good. [For example] the rebate for scanning a scrotum is more than for scanning a female pelvis,” she said.
“I desperately hope that some of what we recommended is accepted.”
The inquiry is due to hand its recommendations to the Victorian Women’s Health Advisory Council by December and will be released in early 2025.
Here is the link:
What is your theory as to why women’s pain is often minimised?
I have a feeling it is a historical carry-over from the days when men dominated the profession. Hopefully things are correcting over time (quickly).!
All suggestions contemplated!
David.
David asks:
ReplyDelete"What is your theory as to why women’s pain is often minimised?"
This book was published in 2019
Invisible Women
Data Bias in in a world designed for Men
Caroline Criado Perez.
In the Preface it says:
"One of the most important things to say about the gender data
gap is that it is not generally malicious, or even deliberate. Quite the
opposite. It is simply the product of a way of thinking that has been
around for millennia and is therefore a kind of not thinking. A double
not thinking, even: men go without saying, and women don’t get said
at all. Because when we say human, on the whole, we mean man.
This is not a new observation. Simone de Beauvoir made it most
famously when in 1949 she wrote, ‘humanity is male and man
defines woman not in herself, but as relative to him; she is not
regarded as an autonomous being. [. . .] He is the Subject, he is the
Absolute – she is the Other.’ "
The end of the Introduction has this:
"Invisible Women is the story of what happens when we forget to
account for half of humanity. It is an exposè of how the gender data
gap harms women when life proceeds, more or less as normal. In
urban planning, politics, the workplace. It is also about what happens
to women living in a world built on male data when things go wrong.
When they get sick. When they lose their home in a flood. When
they have to flee that home because of war.
But there is hope in this story too, because it’s when women are
able to step out from the shadows with their voices and their bodies
that things start to shift. The gaps close. And so, at heart, Invisible
Women is also a call for change. For too long we have positioned
women as a deviation from standard humanity and this is why they
have been allowed to become invisible. It’s time for a change in
perspective. It’s time for women to be seen."
David finishes with
"I have a feeling it is a historical carry-over from the days when men dominated the profession. Hopefully things are correcting over time (quickly).!"
The problem is more than the profession. I wouldn't recommend you hold your breath waiting for change. Little has changed in the gender gap of medicine since 1949