Each May, Women’s Health Month serves as a powerful reminder of the importance of prioritizing women’s well-being. Centering women’s health is as urgent as ever: self-advocacy in healthcare isn’t just helpful—it can be lifesaving.
All too often, women visit a healthcare provider with pain in one arm and shortness of breath and are told it’s likely stress or anxiety only to suffer a heart attack soon after.
“Unfortunately, there are a lot of implicit biases that we see happening in healthcare,” said Catherine R. McManus, assistant professor and vice chair for education in the Department of Nutrition at Case Western Reserve University. “These unconscious biases have heightened activation when individuals are multitasking and working under pressure—two very common occurrences in the healthcare setting.”
McManus noted that women are regularly assessed, diagnosed, referred and treated not only differently than men with comparable health problems—but often at a lower level of quality and with less adherence to established standards of care. This inequality has the potential to lead to worse outcomes for women across numerous conditions, including higher complication rates, increased morbidity and greater mortality.
To discover more about the impact of gender bias in healthcare and how women can advocate for their health, The Daily spoke to McManus about practical steps women can take to ensure they receive the care they deserve.
The reality of being dismissed
Gender bias in medicine is well documented, as shown in this video regularly used by McManus in her classes.
Women often wait longer for pain relief in emergency rooms, are more likely to have symptoms dismissed as psychological or emotional and tend to receive less aggressive treatments than their male counterparts.
“Conditions that uniquely or disproportionately affect women—such as endometriosis, Polycycstic Ovarian Syndrome and chronic pelvic pain—are frequently underdiagnosed or misdiagnosed,” said McManus. “Such disparities in care may stem from two common but harmful assumptions in various scenarios—that men and women are the same when important anatomical or physiological differences exist, or that men and women are different when they actually are not.”
Both lead to stereotypical thinking and clinical misjudgments which are errors that affect how healthcare providers interact with, evaluate and ultimately treat their patients—even how they refer patients to specialty physicians.
A notable example is in the realm of cardiac care.
A meta-analysis published in PubMed examined 19 observational studies encompassing over 240,000 participants. The results revealed that only 39.6% of women were referred to outpatient cardiac rehabilitation programs, compared to 49.4% of men. This disparity persisted across various study designs and healthcare systems, suggesting a systemic bias in referral practices.
Why self-advocacy matters
In McManus’s view, self-advocacy means more than asking questions—it means refusing to be sidelined. For women especially, that means speaking directly, requesting second opinions when necessary and pushing back when answers don’t feel right.
“Women tend to describe symptoms in a more narrative or subjective way, which unfortunately often leads to dismissal,” McManus noted. “Try to present symptoms objectively, speaking factually rather than with feelings.”
McManus also offered another approach for women to self-advocate: write down symptoms and include a pain rating for each using an objective scale.
“For example, explain to the clinician that your pain scale is 1 to 10 with 1 being a stubbed toe and 10 being child birth,” she explained. “This way when you say your pain is a 7, they can conceptualize your discomfort better and it’s less likely it will be minimized.”
Questions could save lives
To empower women to take charge of their health, McManus outlined six essential questions that can guide conversations with healthcare providers, ensuring that critical concerns are addressed and the best care is pursued.
These key questions can help ensure women receive comprehensive and respectful care, and they promote shared decision-making, broaden diagnostic consideration and help make sure critical possibilities aren’t overlooked:
- What are all of the treatment options available?
- Why are you recommending this particular plan of care?
- Why am I not being offered this treatment option?
- What else could this be, beyond mental health or anxiety?
- Are there any tests or screenings we should consider based on my symptoms or family history?
- What are the risks and benefits of this decision? When should I follow up if things don’t improve?
When to question care
It’s not always easy to tell when bias is at play, but there are warning signs, according to McManus. If a patient feels their provider is disengaged or interrupts frequently, symptoms are not being documented, the treatment plan doesn’t match what the patient described or a patient leaves the appointment feeling minimized or brushed off, McManus said the patient may want to ask if the recommended treatment plan would also be offered to a male patient.
“For a woman going into an appointment, it is important to be aware of the fact that we do see more dismissal of symptoms when they are female specific health conditions,” McManus pointed out. “Because the pain that is being experienced can often be culturally dramatised, it’s important to know that what you are experiencing does have diagnostic criteria and should be addressed.”