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Twitter Calls Out Practice Exam Question for 'Medical Misogyny'

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In July, Karina Wagenpfeil, a writer and scientist with ME/CFS, MCAS, POTS, and EDS, tweeted photos of a problematic practice question for a medical licensing exam from Medscape. In the multiple choice question, people choose a diagnosis for a woman who goes to the ER for physical pain not detected by various lab tests. The “correct” answer to the question is Munchausen syndrome, a mental disorder characterized by deliberate acts to seem ill to receive attention. Other options are somatization disorder, conversion disorder, hypochondriasis, and malingering — none of which, Wagenpfeil points out, are physical disorders.

In a follow-up tweet, Wagenpfeil said Munchausen syndrome, an outdated term for “factitious disorder imposed on self,” is considered rare. A woman with undiagnosed pain, however, is not rare. There are many conditions that cause pain but are difficult to diagnose, she continued.

Medscape is used by medical professionals for “medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education,” according to its site. This means mostly medical professionals and medical students would see this question.

Question on Medscape

Factitious disorder imposed on self affects 1 percent of patients in hospitals across the U.S., according to the Cleveland Clinic. Meanwhile, women with chronic pain are more likely to receive inadequate treatment for their pain, according to a study in SSRN. Healthcare providers were more likely to discount reports of pain from women. Women with chronic pain were also more likely to be diagnosed with histrionic disorder, or excessive emotions and attention-seeking behavior.

In the practice question, the prompt says the patient is “quick to suggest treatment options and listens intently whenever any medical professionals are in the room.” Wagenpfeil pointed out that it is rational to educate yourself and suggest treatment options to get better when you’ve been suffering for a while.

Medscape tweeted Wagenpfeil that it has contacted the publisher of the quiz, Osmosis, an online platform for studying medicine and healthcare.

Osmosis then tweeted out an apology and removed the question because it “perpetuates medical misogyny, a huge problem women face when seeking treatment from medical professionals.” The company also said it is performing a review of its content.

In a joint statement to The Mighty, Shiv Gaglani, co-founder of Osmosis, and Rishi Desai, chief medical officer, said a contracted writer wrote the question. They are looking into how the question made it through the company’s reviewing process.

“The patient experience is something we strive to highlight in all of our content and we will continue to work with patients and their families to ensure that their voices are elevated in everything we produce,” they said.

Other Twitter users responded to Wagenpfeil’s tweet with frustration and experiences of their own.

Originally published: July 26, 2018
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