Hysteria was an ancient term used to describe uncontrollable emotions, resulting in the admission of many women to asylums for symptoms such as a “tendency to cause trouble”. The source of the alleged insanity was said to come from the uterus, thus the treatment in some cases was a hysterectomy. While no longer a recognised medical condition, it has a legacy in modern medicine.



As is often the case, I was in a multi-disciplinary meeting of heart doctors as the only woman. It’s a situation that I have become uncomfortably comfortable with. The meeting began and our first patient was a woman in her 40s. She had been seen by doctors in the community and at the local emergency department with pain in her arm and shortness of breath. Each time, the diagnosis was anxiety.

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Finally, someone did a blood test called a troponin, a marker of heart injury. “Just in case,” was the reason given. The test showed that the cause of the symptoms was indeed a heart attack. More tests showed the culprit, a tight blockage of the coronary arteries starving her heart intermittently of oxygen. As the men in the room discussed the possible treatments for the woman, they kept coming back to the fact that “she had no symptoms”.

I found my voice. “But she does have symptoms, they’re just not male-type symptoms. Look at her, she has had he symptoms attributed to anxiety on at least three occasions. It’s very typical of how we manage women’s health”.

Some stared blankly at me. Others rolled their eyes. One educated me on the science behind symptoms and how that correlated with treatment, as if I didn’t know. All of a sudden I felt like I had been lumped in the same basket as this patient: melodramatic, pushy and anxious.

The fact is, when it comes to women’s health, and in my field specifically – women’s heart disease – women are dismissed. Women are also conditioned to dismiss their own symptoms for fear of appearing “silly”, and health care professionals such as doctors and nurses do the same. Over and over again, this dismissal of a woman’s symptoms leads to delays in diagnosis, treatment and could cost lives.

Women are less likely to recognise the symptoms of a heart attack because they are different than a man’s

We are often so shocked to learn that health care is biased. Whether it by gender, race or your economic means, we all feel that in a hospital, those who minister to the sick and the systems they work in should see past any of these differences to provide appropriate care. And while the reasons that care varies based on gender are more complex and nuanced than overt sexism, the end result is dire for women.

Even in the most extreme illnesses, a cardiac arrest where the heart has stopped, bystanders are much less likely to provide life-saving CPR. In research done by the American Heart Association, only 39% of women whose heart stops get CPR in a public place. Men on the other hand get CPR 45% of the time and are a whopping 23% more likely to survive. It may be due to the fact that bystanders are nervous about removing her clothing or touching her breasts. Even in death (or near death), we’re placing modesty above survival.

Heart disease is the leading cause of death worldwide for men and women. In contrast to popular opinion, women are two to three times more likely to die of heart disease than breast cancer. Research has shown that women are more likely to die after a heart attack than men, especially when they are young women. The reasons for this difference are astounding. In Australia, if you are Aboriginal, you are 64 times more likely to have rheumatic heart disease, and higher if you are female – an illness largely eradicated from developed populations. The combination of gender and race is even more lethal.

Women are less likely to recognise the symptoms of a heart attack because they are different than a man’s. Women don’t necessarily feel that classic description of chest pain; they get shortness of breath, arm pain or tiredness. From there, women are less likely to undergo tests to check their heart such as coronary angiography (a special x-ray test of the coronary arteries), receive treatment like stents or heart surgery or state-of-the-art medications. In fact, according to a British study, women who had a heart attack were 59% more likely to get the wrong diagnosis in the first place.

Until recently, research into women’s heart disease has been minimal. In many conditions that are subject to research, female patients make up only a small portion of study participants. It means that the “best treatments” are best treatments for men. Drugs that have changed the way we treat heart disease and saved many lives may not work as well in women and they may also have side effects that are unique to women.

It’s not just in hearts either. Women get misdiagnosis or under-treatment in conditions like endometriosis, aortic aneurysms or dementia. In the UK, National Institute for Health and Care Excellence (Nice) guidelines were developed in order to reduce the delay in diagnosis of endometriosis which can be as long as seven years. When they are in pain, women don’t receive the painkillers that men do; in fact they’re more likely to be given a sedative medication – for the anxiety that is diagnosed by a healthcare worker, not the pain that the woman actually feels.

As a woman and as a doctor, I find this constant and wide-reaching battle to achieve equity in such a basic human right as healthcare so frustrating. Although I am female, I am not being the least bit melodramatic when I say that this bias means that women will die. And if they don’t, they will keep enduring a health system that leaves them unwell and with a poorer quality of life than if they had been a man with pain in his chest.

As frustrating as it is and as much as I want to lay blame, the reality is that the biases in healthcare exist largely because of centuries of bad science, social norms or a lack of women in medicine and research. They persist today, aided by unconscious biases that we all have and that our healthcare system has. Unless we challenge these biases and demand research and treatment that is designed for women, we are going to be living this cycle of being second best in healthcare for many, many years to come.

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Where to from here? With growing numbers of female doctors and women in medical research, we hope that these women will take up the challenge to solve the problems that plague women’s health by battling on the front line.

But as disheartening as this all sounds, I urge you to not stop pushing for the healthcare you deserve. As patients, you too have the tools to change the way women receive their healthcare. There are people who will listen to you and understand your body and treat you in the way you need.

For those of us in the healthcare system, our role is surprisingly simple: to understand that women die because they are women. It’s our job to listen and treat everyone with the assumption that they are not hysterical.

• Dr Nikki Stamp is a cardiothoracic surgeon