When I Experienced a Clear-Cut Case of Gender Bias in the ER

A couple of weeks ago, I had to take my husband to the ER. He had been coughing for about a week, but he woke up that day with a high fever, chest pain and low oxygen levels, so I persuaded him to get checked out. I followed the triage nurses to the ER room my husband would be examined in, and my eyes drifted to the small whiteboard on the wall that lists the names of the attending doctor and nurses. I sighed and locked eyes with my husband, who knew exactly why I seemed troubled without me needing to speak a single word. I had encountered the attending doctor previously, and it was easily one of the worst experiences I’ve had with healthcare professionals.

• What is Ehlers-Danlos Syndrome?
• What Are Common Ehlers-Danlos Syndrome Symptoms?

I have been outspoken for years about biases in the healthcare industry, but never have I seen it laid out so clearly. Let me preface this by saying  I understand that we are all humans with the potential to have our judgment clouded by biases. It’s natural for us to quickly assess and analyze people to form conclusions based on what we observe.

For example, let’s say you come across one or more people with tattoos that proved to be unpleasant people. Your brain then associates tattoos or other physical characteristics with those unpleasant traits. In the future, when you meet someone with tattoos, your mind then makes snap judgments regarding what kind of person they are. This can often happen on such a subconscious and automatic level that we don’t even realize we’ve made a judgment or assumption. This applies to how we perceive people of different genders, races or overall appearance. Needless to say, this leaves us really open for making errors and treating people differently than others based on our automatic judgments.

The problem here is that, although forming biases is part of being human, these biases have absolutely no place in healthcare and how patients are treated. Those biases will be there no matter what, but it’s an important (yet incredibly overlooked) skill to practice mindfulness and objectivity while treating a patient. When those biased thoughts form, it’s a choice to stay mindful enough to examine them and ask, “Why do I feel that way about this person? How is this impacting the way I’m treating them? How would I treat a patient if this bias was completely removed from the equation?”

You see, in 2019, when I encountered the same attending doctor, I had been diagnosed with a bladder prolapse by my primary care physician days beforehand, which was making it difficult for me to empty my bladder. I have a genetic connective tissue disorder called Ehlers-Danlos syndrome (EDS) that, combined with prior vaginal surgery, which weakened the pelvic tissue that’s supposed to support my bladder. Since I have an HMO health insurance policy, I was stuck waiting for a specialist referral to be approved to address and treat the prolapse.

Over time, my bladder became so full that I looked at least six months pregnant. Trust me, that’s no exaggeration. The more my bladder swelled, the more it kinked-up my urethra, much like the way you would fold over and squeeze part of a water hose to kink it and stop the flow. I was in pain and uncomfortable, as well as at risk for a serious bladder infection, so I called my primary care physician. He advised me to go to the ER, tell them my diagnosis and request that they drain my bladder with a catheter. Sounds simple enough, right? Well, it wasn’t.

I’m a chronic illness veteran by this point, so I wrote out a list of my conditions, my surgeries and my medications. I gave it to the nurses, and then recited them when the doctor entered the room. I explained that my primary care doctor had sent me here to get my bladder drained due to my bladder prolapse. Rather than doing what I was there for, he asked if I could provide a urine sample. I told him I would give it a shot, but the whole reason I was there was because I couldn’t use the restroom.

While I was in the restroom attempting to provide the requested sample, the doctor pulled my husband aside to ask him about my mental health and ask if I abuse any medications. My husband got the feeling that the doctor believed me to be mentally unstable or drug-seeking. When I came back with an empty sample cup, they just focused on getting blood drawn. He ordered basic blood testing as well as a drug test. I had no worries, as I had nothing in my system.

By this time, the discomfort was causing tears to form and I tried to stifle my pained whimpering. My ability to tolerate pain is extremely high, so it’s rare to see me crying due to pain. But I was faced with an inner battle. If I asked for pain relief, they would label me a drug seeker and use that to fuel their pre-conceived notions of me. Yet, I wasn’t sure how much longer I could handle the intense pain and pressure, and I was yearning for relief.

I already knew that tears wouldn’t sway them either. I once cried in pain in a different ER for two hours straight. I wasn’t even asking for pain medicine, but they treated me as though I had. When they entered my ER room, they would give me an annoyed scoff and tell me I needed to calm down and control myself. Even the most adamant of drug-seekers likely wouldn’t have the energy to cry for hours when it’s clear that the doctor isn’t going to cave, but biases override logical thinking by design. I certainly didn’t want a repeat of that situation this time, so I refrained from asking for any pain relief, despite silent tears sneaking down my cheeks.

After an initial assessment, the doctor informed me he would be doing a pelvic exam because it didn’t make sense for such a young woman to have a prolapse. He insinuated that he thought I was either lying or coming up with a false self-diagnosis. I was frustrated, but I had no choice if I had any hope of relief or treatment.

I changed into the hospital gown and waited. And waited. And waited some more. By the time the doctor came back into the room, my mother had arrived to sit with me as well. She and my husband stood to the back of the room so the doctor could do a pelvic exam. When it was done, he confidently asserted that there’s no bladder prolapse, and he could feel that my uterus was very hard and swollen, likely to prepare for the arrival of my menstrual cycle.

Here’s the kicker: I had already informed them (twice, actually) that I’ve had a hysterectomy. My husband, my mother and I exchanged glances before I finally blurted out, “I don’t have a uterus.”

His stunned silence was almost comical, and I’ll never forget the shock on his face. Before quickly leaving the room, he mumbled, almost inaudibly, that he had definitely felt something. Again, I was left waiting without any explanation for around two hours. I wish I could excuse it by saying that maybe the ER was busy, but it was almost entirely empty the whole time I was there, and even the nurses didn’t seem to know where he kept disappearing to.

Still unable to admit that my diagnosis was valid, the doctor sent someone to perform an ultrasound and estimate how full my bladder was. Afterward, he finally ordered another nurse to drain it with a catheter. A couple weeks later, my diagnosis was confirmed by a gynecologist that specializes in urology, and it had to be surgically repaired. Part of the pain involved and the swelling felt during the pelvic exam was due to multiple abdominal adhesions formed around my bladder and tugged on it.

By the time all was said and done, I had spent approximately five and a half hours in the ER for what should have been a cut-and-dry situation, especially since the hospital shared the same charting system as my physician’s office at the time. They could have easily verified my diagnosis instead of assuming I was lying or had no clue what I was talking about. Considering the fact that all I asked for was relief by way of draining my bladder with a catheter without asking for pain medication, there was no reason to question whether I was on drugs or seeking drugs. I mean… who even shows up to the ER asking for a catheter or uses a full bladder as an excuse to get a drug fix?

Needless to say, when I saw the doctor’s name on the whiteboard in my husband’s ER room, I had very little hope for him to receive proper testing and treatment. Much to my surprise, my husband was very quickly and thoroughly cared for. Make no mistake, I’m beyond grateful for that, because my husband’s health is infinitely more important to me than proving a point.

Still, the contrast between the treatment we received was so loud and blatant that it couldn’t be ignored. In fact, my husband brought it up to me before I even had the chance to point it out. Since I look very different now than I did in 2019 and I had a mask covering most of my face, I didn’t see even the slightest flicker of recognition when the doctor looked my way — therefore ruling out the idea that maybe he was more thorough because he didn’t want to risk getting reported for poorly treating the spouse of a patient he had totally fumbled in the past.

To sum it up, we arrived at the ER around 1:30 p.m. The doctor didn’t question a word he said, and he listened attentively when my husband spoke. No drug test, no questioning or unbelieving stares, no drug-seeking labels applied. They ran every test they could remotely justify running, and by 2:30 p.m., he had already been diagnosed with pneumonia and given a pain relief shot to soothe the pain from coughing. During the final two and a half hours of the ER visit, they ran two courses of IV antibiotics with fluids and gave him oral hydrocodone that he didn’t even request since his pain relief shot was still effective.

Until the day I took my husband to the ER, I always assumed my personal appearance (like having half-shaved hair at the time, tattoos on my arms, two small nose piercings, etc.) were more to blame than my gender. Now, although those may have been contributing factors, I believe my gender played the biggest role.

Since the dawn of medical care and research, care has been tailored to men. It was assumed that male and female biology have no differences, and females at a reproductive age were even excluded from clinical trials and research as recently as 25 years ago.

There’s a multitude of conditions that present differently in women than in men, yet healthcare professionals are mostly only taught to look for the symptoms men would have. For that reason, women with those conditions are misdiagnosed or brushed off, sometimes with tragic results. Research studies have also tried to call attention to the fact that women are still widely regarded as “hysterical” whenever they exhibit strong emotions, similar to the way I was brushed off and told to calm down as I was crying.

Women also make up the vast majority of chronic pain diagnoses, and some research indicates that women often feel pain more intensely than men — yet, they’re less likely to receive pain medication. Women are subjected to longer ER wait times than men, and they are more likely to be told that their symptoms are psychosomatic.

It’s clear that this is a problem, but what do we do about it?

If you’re a healthcare professional, it’s important to first let go of any denial you have about the fact that these biases exist. As with any other problem, the first step is to identify and acknowledge it. From there, it’s important to become educated, spread that education to others and encourage inclusivity in medical research to ensure the results aren’t skewed. Care should be individualized to account for unique factors, while also removing harmful biases and judgments.

We do understand there are bad apples out there that make you suspicious of people, but each patient should be a fresh slate. Each patient should be considered innocent until proven guilty. Nobody deserves to be automatically labeled as hysterical, drug-seeking and/or malingering.

If you’re a patient, even if you’re being impacted by a bias that’s unrelated to your gender, it’s critical to advocate for yourself. If you’re being dismissed, seek a second opinion, or however many opinions it takes to find someone who recognizes and validates your situation. If you have a chronic condition, don’t be afraid to raise awareness and educate others that may not understand it. Speak out and voice your opinion, no matter how much they dismiss you. Stay respectful, of course, but don’t allow yourself to be silenced by someone who doesn’t want to acknowledge their faults. And, most importantly, never allow them to make you doubt yourself or feel guilty and ashamed.

If you’re a caregiver, friend or family member, don’t be afraid to advocate for someone you care about. Help them spread awareness to people you know that don’t understand the health issues at hand and the biases that impact treatment.

No matter who you are, what you look like or what you’re going through, you are valid. You deserve thorough and individualized care, and you’re not “crazy” for pursuing that care. This issue won’t be resolved overnight, but it will never be resolved at all if we don’t advocate and spread awareness.