Male/female differences at the GP
Ballering’s gender scale
Frits, a sixty-year-old construction worker, visits his GP with shortness of breath. The GP refers him to a specialist, where it unfortunately turns out that Frits has pneumonia. A few days later, Carla visits the same practice. She’s fifty-five, a housewife, and she, too, suffers from shortness of breath. The GP draws some blood for a workup. The results show nothing, and Carla is sent home.
Sound unfair? Unfortunately, this happens every day.
‘My initial response was that there was no way this was okay’, says Aranka Ballering, a PhD candidate at the Interdisciplinary Centre for Psychopathology and Emotion Regulation at the UMCG. However, she quickly found out that the truth is a little more complicated.
Ballering’s research focuses on everyday physical symptoms that people often go see their GP for, such as headaches, muscle aches, fatigue, (lower) back pain, and shortness of breath.
Women experience these symptoms more often than men do, yet they don’t get diagnosed as often. That means the cause of their symptoms often remains unclear. Ballering wants to know why this happens.
She found out that while men are more often receive physical examinations, x-rays, or a referral to a specialist, women tend to only have lab work done. And lab work leads to fewer diagnoses.
Should women be referred to specialists more often? According to Ballering, it’s not that simple. For one, women suffer from bladder infections more often, in which case they actually benefit from lab work.
But there’s something else going on. When a woman does undergo a physical examination, the chances of a doctor finding something are smaller than when a man is examined. That’s ‘really weird’, says Ballering; you’d expect that people suffering the same symptoms and undergoing the same examination would all be diagnosed.
Take, for example, x-rays taken of people complaining of shortness of breath. Men are more often diagnosed on the basis of x-rays than women are. This could mean that fewer women receiving x-rays is justified. Perhaps women’s symptoms aren’t indicative of the same underlying disease, such as pneumonia.
‘But you never know if doctors are overlooking diseases in women’, says Ballering. ‘Many methods are based on male patients, which could mean they’re less sensitive and less aimed at women.’ Ballering would love to study this, but it’s difficult. ‘How can you figure out whether a method works the same for men and women when the measuring method itself is the problem?’
And who do women suffer from these symptoms more often, exactly? Perhaps, the researcher wonders, they literally occur more often among women. ‘But it’s also possible that they feel these symptoms more acutely, or that they’re more likely to visit the GP when they have them.’ No wonder women are diagnosed less often, then.
Men might have a higher tolerance for pain
It’s also possible that men visit their GP less, for instance because they have a higher tolerance for pain. Or perhaps they’re more directly in contact with their GP than women who serve as caretakers, for instance. Ballering suspects that social patterns and expectations might play a role, and this is what she’s currently investigating for the Gender and Health programme at the Netherlands Organisation for Health Research and Development (ZonMw).
She looks at both sex and gender. Sex deals with biological characteristics such as genes, hormones, and anatomy, while gender has to do with the social and societal expectations of men and women.
One traditional gender role, for example, is that women are expected to take care of the children and men are supposed to work forty hours a week.
How much someone actually conforms to those expectations and gender roles varies from person to person. Ballering has created a scale incorporating these gender roles.
She used data from Lifelines, a study in which more than 150,000 people from the north of the Netherlands participate. The participants were asked about their hobbies, their work, family patterns and dietary preferences; all things that men and women generally give different answers on.
The key word being ‘generally’. The more someone shows characteristics that are associated with the female sex, the more ‘gender points’ they get on Ballering’s scale.
‘We actually had quite a few men who had a female gender score, but that doesn’t necessarily mean they were transgender men. They’re just men with more female psycho-social characteristics than male ones. Gender roles are very fluid. Almost no one is one hundred percent male or one hundred percent female. Nearly everyone has characteristics of both.’
The more female characteristics, the higher the gender points on Ballering’s scale
Ballering discovered that common physical ailments were associated more with gender, regardless of people’s sex. That means that it’s not just about women who experience more symptoms, but about people who fulfil female gender roles. This was most obvious in men.
‘It’s possible that men in a typically male gender role aren’t as vocal about their symptoms’, Ballering extrapolates. ‘For people in a female gender role, it’s more acceptable to talk about physical complaints. But we expect people in a male gender role to have more of a stiff upper lip, to be more stoic.’
‘Because women are more open about their symptoms, doctors might think that for a man to come to them, their issues must be serious.’ And vice versa: ‘That women’s symptoms aren’t as bad.’ This theory is bolstered by the fact that men are diagnosed more often.
Ballering doesn’t know whether men are rightly referred more often. But she’s certain that gender plays a role. That’s something that GPs can use to make better decisions. ‘The most important thing is to find a solution for people who don’t get diagnosed but who are still suffering from their symptoms. Regardless of whether they’re male or female.’