Aranka Ballering (29) did not expect such big differences between what men get done in the doctor’s office and what women get. Men, the biomedical researcher discovered, are more likely to receive a physical examination, an X-ray, an ultrasound or a referral to a specialist than women who come to the doctor with exactly the same complaints. “Women undergo laboratory tests more often. Partly because of this, they have a 6 percent lower chance than men of being diagnosed with a disease.”
On April 3, Ballering will receive his PhD from the University Medical Center Groningen. She looked for differences between men and women in large databases with patient data from general practitioners and from the Groningen biobank Lifelines. She looked at common physical complaints, such as headache, back pain, muscle pain, shortness of breath, nausea, dizziness or fatigue. “Complaints that everyone has sometimes. These generally pass again, but in some people they persist for unclear reasons.”
The subject of stigma has interested her immensely since she worked with leprosy patients in India for her master’s degree in international public health, she says at home at the kitchen table in Alphen aan den Rijn. “There are prejudices and stigma surrounding male-female differences. And also around persistent physical complaints.”
Women, she discovered, experience these physical complaints more often than men. “They also often last longer for them. They go to a doctor more often. And once you go to the doctor, there are huge differences in diagnostics.”
That sounds seriously wrong.
“Yet it is difficult to conclude. We also discovered that women who do receive this diagnosis or a referral are less likely to be diagnosed with a disease than men. It more often remains a symptom diagnosis. Then no physical abnormality is found, the symptom of headache remains the diagnosis of headache. Then it is logical that women receive this diagnosis less often. If a GP already knows based on experience that nothing will come of it, why would he offer it?”
There’s nothing atypical about it. It’s just how it manifests itself in a woman
With the danger that a doctor is more likely to miss a disease in a woman. Women sometimes suffer from abdominal pain for years before they are diagnosed with endometriosis.
“Yes, fortunately more is now becoming known about endometriosis. But how often a disease diagnosis is missed is difficult to investigate, because how do you know if something has been missed? You cannot simply conclude that this is worse care for women. Such a symptom diagnosis is not necessarily incorrect. Sometimes there is simply nothing to be found. Then the diagnostic criteria are not met.”
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Are those diagnostic criteria correct?
“These should indeed be examined and possibly adapted for women. Until 2000, medical research was mainly conducted on men. In medical science, there has long been the idea that a woman is a copy of a man, but with breasts and a uterus. Canada was the first to see a change, but only in the last fifteen years has Western Europe seen greater attention to the differences between men and women in health care.
“Cardiology is leading the way in this. When a heart attack occurs, women sometimes have different symptoms than men. These are called ‘atypical complaints’, but I don’t think that is correct. There’s nothing atypical about it. It’s just how it manifests itself in a woman.”
We see that there are very different outcomes in care for men and women
Don’t men simply pound their fists on the table more often at the doctor’s office to demand an X-ray?
“That is often assumed, but there appears to be little difference between men and women, my colleague Ilona Plug discovered. Subjects read transcripts of consultation room conversations and had to say what gender they thought the GP and the patient were. A lot of people misjudged that, their assumptions about how a man or a woman would say something, or what they said, were wrong.”
Why is it that women more often experience physical complaints that cannot be explained?
“Experiencing physical complaints is an interplay between biology, psychology and social factors. We know that women are biologically more predisposed to register physical sensations. It is thought that this has to do with pregnancy, menstruation, breastfeeding, where women need to be more aware of what is happening in their bodies. There are also genetic differences. We discovered that the contribution of genetics to the experience of complaints is about 20 percent in men and 12 percent in women. It seems that psychosocial factors play a greater role in women, such as gender, the role that society attributes to men or women. The stereotypical idea is that men should be stoic and tough. It is more socially acceptable for women to express their pain.”
Women are whiners?
“The last thing I want is for my research to reinforce that stereotype. We see that there are very different outcomes in care for men and women. Then we should not place the blame on the woman, but on a higher level.”
I am walking through a minefield, these are two controversial topics
At the doctor?
“No. If during medical training little was said about differences between men and women, you cannot blame the GP for this. So it is at an even higher level. Current knowledge may not be adequate for women. That insight is starting to sink in. Scientific journals and grant applications now ask how you take sex and gender differences into account in your research.”
What do you hope to achieve with your research?
“I hope to change the stereotype. My research shows that there are actual differences between men and women in the experience of physical complaints. This is based on biology, psychology and social factors. And that’s not whining or stoicism. It is simply: the man and the woman, there should no longer be any value judgment attached to it.”
Is that why you formulate so cautiously?
“Yes, I am walking through a minefield, these are two controversial topics. People quickly conclude: the care for women is not good. And a symptom diagnosis is very unsatisfactory for some people. But sometimes it fits best.”
And then as a woman you have to stoically bear your fate?
“Not everything can be solved by medical science.”
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