I think it is the notion that women are more easily effect by stress and more likely to be swayed by emotion than men. Silly concepts that still pervade the medical community.

I don't know...maybe it's a nod to the fact that many women have to balance so many things in our lives rather than a slam on our emotional states.

When my mother had heart palpitations, her first doctor tried to prescribe her anti-depressants. She had to go to another doctor to finally get a proper diagnosis.

There are a LOT of doctors out there who still have the rather victorian attitude of women = hysteric.

I personally find that most of the doctors I have been to in my life have not regarded anything I have said to them. I told my doctor I had a headache, next thing I am a migraine sufferer! I tell my doctor my pupil is contracted, what does he do? He shines a light in my eye and says its normal!!! WTF!!!! Of course it looks normal YOU ARE SHINING A FRIKKEN LIGHT IN MY EYE ASSHOLE.

Dont think this was a sexist thing but man, I had to vent.

Well, I'll tell ya...every time I have been to a doctor in the past 5 years my symptoms or illness has been attributed to pregnancy or stress (even though I have never been pregnant). So...

I really believe that it is still the attitude that women don't get heart disease, even though that in the last couple years that has been proven false.

And the fact that doctors don't believe women, and think that we are hysterical and illogical.

I recently went to a new doctor for a refill on my long term antidepresant. I had been off of it for almost a year because I didn't have health insurance and couldn't afford it. Before that I've been on and off this antidepressant for 8 years (since I was 14.) During the year I could not get the medicine I did not do well, and often considered checking myself into a mental health facility or doing worse. I told this to the doctor and he actually told me that he didn't think I needed the medication, because 95% of people only need it short term, so I couldn't be part of the 5% that have a permanent chemical imbalance. I told him about my family history, and that my previous physician did believe it to be permanent. He gave me a paper to take home, and wrote out my prescription. When I got home I read the paper, it was about reducing stress in my life and finding god to battle my mental illness. Yeah thanks, like I haven't tried everything else. I'll go exercize until my brain chemicals fix themselves.

(just so we don't get into this convo again. I have tried to go off the meds. I have gone through years of therapy, of various kinds. I have changed my diet, increased exercize. I've changed my life, I've done alot, and none of it has fixed my brain chemistry. Antidepressants are not for everyone, and I don't advocate that anyone take them that don't need them. But if you do need them, short or long term there is no shame in it.)

My gyno laughed when I asked him if there could be a relationship between my lack of sex drive and the fact I hadn't had a period in months.

I mean, if there's no connection, okay, but explain it to me as if I were an adult (I know, crazy).

/rant.

Sadly, not surprising. Ever since Freud came up with the notion of "hysteria" women's mental and physical health problems have always been taken less seriously than men. I wonder how many women's lives could have been saved if their doctors had treated their hearts "like a man's".

Maybe it's a silly reference, but does anyone remember that episode of Golden Girls?- when Dorothy felt like she had the flu for 6 months and every doctor said it was nothing and one doctor specifically said she must have been depressed and should go to the salon and change her hair to make herself feel better. But then she went to a specialist who said she had Chronic Fatigue Syndrome, which at the time was a newly acknowledged condition. I think it made a very valid point about female patients.

When I was in college, my boyfriend and I both had seriously sore throats, and it felt like strep throat, which I had had many times. We went to a neighborhood clinic to get checked out. The doc looked at him first and immediately diagnosed it as strep. Then I went in and told him my symptoms, and he told me I was just having sympathetic pains. He wouldn't even look in my mouth. I actually said, "You realize he is my boyfriend and I have kissed him, right? Look just in case." He barely looked and told me it was nothing. I actually had to go to another clinic to get diagnosed with strep. It was appalling. This was about 10 years ago, which is still recent.

This happened to me! I was having some scary symptoms, and finally, after several months of them (and a family history of heart disease) went to a cardiologist. He didn't even ask me what was wrong -- he just assumed, sight unseen, that I was having emotional problems. Gee, thanks! I insisted on getting tested.
Luckily for me, they didn't find anything. But I deeply resented being diagnosed as a hysteric/hypochondriac without so much as an interview. No other doctor has ever treated me this way. It was really upsetting, and I really wanted to report him to someone.

I suspect something like this pretty much describes most of my experiences with the medical establishment for the majority of my life- I've been misdiagnosed on Lyme Disease, Appendicitis and chronic fatigue syndome, all attributed to psycho-somatic, stress related illness. This is by male and female doctors, across the board. Now even the thought of going to the doctor when I'm sick does set in hysteria, because I know I'll have to do battle to get anything really serious acknowledged. It's one part sexism, one part a sad commentary on our broken healthcare system.

The symptoms aren't the only thing that matter. Not everyone with chest pain should be evaluated for cardiac disease. Is heart disease in women under-diagnosed? Yes. Are too many men (and women, in my community) referred for testing? Yes.

I need to track down this study to see what they actually measured, since of course the reporting has been oversimplified, but I have seen any number of people in my practice with "chest pain, breathlessness or an irregular heartbeat" without referring them to a cardiologist or ordering significant cardiac testing on them. Men and women. Depends on the age, pattern of symptoms, other risk factors and whole bunch of other things. Care has to be individualized.

I do agree that women's symptoms - all sorts of symptoms - are too often dismissed, and that the significance of heart disease in women is not adequate addressed. The solution to that isn't more cardiac testing for everyone.

Jesus, I'm having this exact problem. I went to the doctor because of daily heart palpitations for the past few weeks and the first thing he did was ask if I was stressed. When I said, "No more than usual," he kept asking me stress-related questions. I assured him that I've been a hundred times more stressed in the past and never had heart palpitations, and at the end of the exam he did refer me to a cardiologist but said, "I wouldn't worry, it's most likely just stress-related."

I hate the idea that I apparently don't know how stressed I am. Dude, if it were stress-related, I'd know, because I'd be stressed. The only thing stressing me out now is you.

If we had free and fair healthcare, women would be able to get their own cardiology exams without a doctor's referral. I think part of the reason doctors don't refer women to those exams is because it's expensive (and because they don't take women's health issues seriously enough).

I'm pretty sure this study is based on a survey given to doctors, where they were asked what they would recommend for the next treatment step based on case histories. Identical case histories were more likely to be referred to a cardiologist or for further testing if the patient was identified as a male. The NYT health section had a thing on this about a week ago, or maybe a bit more, and there was a big discussion on it on their Well-blog.

This is such a great example of preconceived notions about gender shaping medical knowledge and practice. On the other hand, maybe we should just be happy that they're not offering smelling salts anymore.

(Disclaimer: this comment may contain trace amounts of sarcasm or have been processed in a facility where sarcasm is handled.)

"If we had free and fair healthcare, women would be able to get their own cardiology exams without a doctor's referral. I think part of the reason doctors don't refer women to those exams is because it's expensive (and because they don't take women's health issues seriously enough)."

Going directly to a specialist is not a solution. I can track down the specific study later, but essentially general practitioners and specialists were compared head to head in terms of cost and outcomes when presented with general symptoms. The result? GPs were cheaper and more likely to get the right diagnosis.
GPs are trained to think about diseases throughout the body where the specialist is more likely to think about whatever they specialized in. And if they only think about the organ they specialized in, guess where they're going to decide the problem is? And they'll do enough of the specialized, expensive tests to confirm this diagnosis.
Part of the issue here is that men and women have different signs and symptoms for heart attacks, which may or may not (not, according to the following study) be well known. To make things worse, many of the symptoms in women look like a lot of other diseases, or may even resemble entirely benign processes. In a world with unlimited resources, every woman (or man for that matter) could be examined for every possible disease that matched a particular symptom, but that would not necessarily be ideal--some of these tests and subsequent therapies carry their own risks and complications.
I don't say all this to be an apologist for health care providers. The bottom line is that this is a serious issue and needs to be/is being addressed. Better education for physicians, better ways to identify and treat heart disease in women, better ways to train physicians to communicate are all important for this issue. I just wanted to try to fill in a perceived gap in the discussion on this topic. Everybody is on the same side here :-)

From Critical Care Nursing Clinics of North America, 20 (2008) 251-263

"The complexity and vagueness of symptoms in
women make it di?cult for a woman to recognize
that she is having an AMI and for health care
providers to diagnose and treat the AMI rapidly.
Women may not experience the typical male AMI
symptoms of ‘‘crushing chest pain radiating down
the arms and to the jaw’’ but may have atypical
chest pain consisting of chest discomfort, heavi-
ness, tightness, or indigestion not related to
something they ate, or they may not report any
chest pain [26]. McSweeney and colleagues [27]
found that only 29.7% of women who had an
AMI reported having chest discomfort. Shortness
of breath, extreme fatigue, and weakness are typ-
ical symptoms that many women report with
AMI. McSweeney and colleagues [27] also found
that 90% of women experienced prodromal
symptoms, including unusual fatigue, sleep distur-
bances, shortness of breath, indigestion, and anx-
iety, before the development of AMI. African
Americans women did not report chest pain but
experienced shortness of breath, weakness, and
dizziness with AMI [28]."

I'm tired of doctors blaiming everything on "stress."
Guess what... being sick or injured is stressful. If you're having crushing chest pain and are perfectly calm I'd wonder what kind of drugs you've been doing.

This is an important issue. Health care providers and society should take people's concerns seriously.

Speaking of people bypassing doctor's referrals, I will repeat the story of my wife's experience with heart palpitations. She has demonstrated to me how her pulse can spontaneously begin to race, say even beyond 160 beats per minute, with no obvious stressors. She simply came up to me in the living room, put my hand on her chest and said, "feel this." (I am a nurse, btw.) I asked her how long this has happened for her. Since she was a teenager, was the reply. I suggested she see a doctor.

Well, the doctor did take her seriously, and put her on a portable cardiac monitor for 24 hours. For a full day, she carried a device strapped around her waist, with leads taped to her chest. The result, and diagnosis? Nothing. Or I should say, the symptoms did not present themselves while she was being monitored, and were unable to be evaluated.

That is understandably frustrating. Fortunately for my wife, no cardiac conditions have been found in this or any other routine examinations, nor do her symptoms of sudden, unexplained palpitations represent a significant burden. She denies being in pain during those periods, nor does she, e.g., become faint.

More significant to me is the fact that the hospital charged $1,500. For nothing, basically.

Yes, that is an excessive amount, but the point is, modern health care (people's time and hospital resources) is not free. Even with universal health care, someone would be picking up the tab (Medicare/Medicaid in the US represents 21% of all federal fiscal spending, and there is a projected $85.6 TRILLION shortfall in funding), and some reason should be exercised with use of health care services. Abuses with the free health care available to those over age 75 in Japan led the government to require a fee per visit of about $5, to prevent the elderly from literally using hospitals as a social outlet, sitting chatting or reading magazines in air conditioned offices, asking nurses to let them use massage chairs or exercise equipment meant for rehabilitation, or to have nurses give them vitamin shots, perform dips on samples of their urine, or take their blood pressure. That is an inefficient use of resources. I don't blame those elderly people. They only did it because they could.

Should people with sincere concerns go to their health care professional? Of course. But there are practical concerns, such as the fact a specialist like a cardiologist with a one month waiting list (as for dentists, we were fortunate to find one who accepted new patients in my community at all, their services are in such demand, despite their numbers), does not have the time to simply answer people's health questions, without good reason. Nurses aren't really being paid to check people's daily blood pressure on a walk in basis, either, as some people in Japan apparently thought.

If you have issues with your doctor taking your concerns seriously, I hope you have the option of seeking a doctor more to your liking. As long as time and resources are limited*, I would prefer people find a satisfactory doctor who can give them referrals, to people seeking help from specialists directly.

* Perhaps your local doctor or doctor friend doesn't mind people approaching them for exams or advice on demand. On the other hand, I have seen how my mom paid $200 (or was it $100?) for my dad's oncologist to explain to the gathered family for 15 minutes "why" my dad died from cancer, because he doesn't normally have time to do that.

What makes me irritated about this study is how obvious it is that the medical establishment has very little concept of how emotions are related to the body's physical state. Okay, so the doctors focus in on stress -- these women probably are really stressed out, but why don't the doctors take it one step further to see what the stress is doing to the heart? There is a well documented connection between the two. See the link to an article from Women to Women dot com in my sig (a very respected clinic in Maine cofounded by Dr. Christiane Northrup).

I'd like to hear from any woman who has been given a diagnosis of hysteria or psychosomatic conversion disorder because of physical symptoms.
I have periodic paralysis which has cardiac features and was misdiagnosed many years ago. I'm writing about this experience and am curious about how often this still happens.
Thanks to all for sharing stories.
mamstudio@embarqmail.com