Listen up women, it isn't all in your head

Today I spoke with a woman who is worried about her ‘episodes.’  Chest pain radiating to her neck, a funny heartbeat, shortness of breath…I am worried too.  But here is the weird thing: she has seen several doctors and they offer similar advice.  “Don’t worry – your heart is fine.  It’s just anxiety.  Take some Ativan.”

Could those doctors all be right?  Could she be suffering from anxiety?  Sure. But do her doctors know this for certain, without checking her for arrhythmias, heart blockages and other cardiovascular or lung conditions?  No, they don't.  No matter how smart or experienced they are, they just can't know that for sure.

Now don’t get me wrong, I realize that anxiety can cause physical symptoms and I am a great believer in the mind-body connection.  But I also know that medicine is not gender-blind.  Men with palpitations get prescriptions for heart monitors, women with palpitations get prescriptions for therapists and happy pills.  I am exaggerating, of course.  Many women do get cardiac tests, and the difference in how men and women are treated is subtle.   It is subtle, but it is also real.

If you wandered into a hospital doctors' lounge and said "you have a 45 year old woman with palpitations - what does she have?" you'd get a bunch of smirks and a few rolled eyes.  While the more intellectual docs might rattle off a differential diagnosis of possible cardiac conditions, I'll bet that a sizable number of doctors would jump to the same conclusion -- anxiety.  And don’t be fooled by female doctors – they may attribute your symptoms to anxiety as readily as male doctors do

It is up to you, the patient, to advocate for yourself.  Be open to the idea that anxiety may be causing your symptoms, but don't let your doctors jump to that conclusion too quickly.  Ask your doctor to list all the possible diagnoses that could be causing your symptoms, then ask why he has chosen one diagnosis over the others.  You might ask "are there some tests that we should do to be sure?"  Or even "I know that many women with palpitations have anxiety, but I want to make sure that my symptoms aren't from something more serious."

Sexism in medicine is real and the first step in combating subtle discrimination is to notice it. 

Women, consider yourselves informed.
Topics: women and medicine