In Canada’s Healthcare System, Being Female Can Have Deadly Consequences

Photo via Flickr user neovain.
Canada’s wait times across twelve major medical specialties have doubled in the past twenty years, and may be associated with as many as 44,273 untimely female deaths, a recent study from the Fraser Institute has found.

In 1993, the typical wait time from a doctor’s referral to treatment was 9.3 weeks. Last year it was 18.2 weeks. And for every extra week that patients wait, we see an increase in the mortality rate of three female deaths per 100,000 people. In total, wait times may have contributed to 2.5 percent of all female deaths in the country.

“That’s not to say that it doesn’t exist for male mortality as well,” said Bacchus Barua, one of the authors of the study and an economist with the Fraser Institute, a right-leaning think-tank advocating for increased privatization in health care. “But given the present data, it seems clear that it does indeed exist for women.”

The increase in mortality associated with wait times was “likely unnecessary” and “these widespread, systemic delays have important consequences for patients, their friends and families, and the economy,” the study said. The ultimate consequence of these delays—death—most often falls on women.

Barua didn’t want to speculate on why exactly long wait times kill more women than men, but he said that “there have been some hypothesis that it’s possible there might be some gender bias in how doctors receive complaints.”

The evidence of that is strong and even Statistics Canada has acknowledged it. In a study that came out in 2010, the government agency said that “women were significantly less likely than men to see a specialist within a month. This could result from systemic gender biases in access to health care services, evidence of which has previously been demonstrated.” StatsCan put it to doctors’ “diagnostic and management practices.”

What does that mean? It means that doctors, a majority of whom are male, white, and come from families with an annual income over $100,000, take women’s complaints less seriously and choose less aggressive treatment options for them, according to Women and Wait Times, a paper by the research group Women and Health Care Reform.

In general, women and men communicate with their doctors differently and don’t have the same experiences of treatment, the research says. The effects of these differences is apparent—for example, even though women have a higher need for hip and knee replacements than men do, when they need them, they are three times less likely to get them.

Colleen Fuller, a health and pharmaceutical researcher who’s worked with Canadian Doctors for Medicare and the Canadian Centre for Policy Alternatives, questions the Fraser Institute’s methodology but has no doubt the health care system treats women differently than men. She said the wider issue is access, not wait times.

“The medical system is very patriarchal,” she said. “And not all females are at a disadvantage equally. If you’re older, if you’re racialized, if you’re an immigrant, and now if you’re a refugee, you’ll have more problems.”

In the last fifteen years, doctors have been making more money but working fewer hours, which puts even more barriers in place, Fuller said. “Doctors are the ones responsible for wait times,” she said. “Even though there’s a lot of rhetoric about government wait lists, they aren’t government wait lists. They are physicians’ individual wait lists.”

It is up to doctors to prioritize patient needs and offer as many options as possible. This means their own attitudes constantly come into play. “There is not a queuing system that is fair and equitable,” Fuller said. “And anything that isn’t fair and equitable has more dramatic impact on people who are systemically at a disadvantage.”

The research by Women and Health Care Reform found specific examples of doctors’ attitudes that may cause them to care for women differently. It found that myths about women and their bodies are still pervasive—even for men who’ve graduated medical school.

“Some doctors may believe that women are better able to handle pain, because women can endure the pain of childbirth,” the study said. “Some doctors believe women’s pain is caused by being overanxious and believe that women are ‘overly emotional’ when they report pain symptoms.” The paper also noted that there “is much evidence to suggest that doctors make more errors in diagnosis and choose less aggressive treatment options with women than with men.”

Fuller sees the entire medical system to be based in myths like these. “The philosophical framework around medicine has been driven by a sexist perspective on female sexuality,” she said.

Evidently, doctors’ attitudes toward women are important. In fact, they probably couldn’t be more important, considering doctors are the only strange men we allow to shove various instruments up our vaginas on a yearly basis (unless you’re into that).

It’s for exactly that reason that this issue is intensely personal for many women. Fuller told me she stopped seeing male doctors at the age of 20, when she read in Cosmopolitan magazine that she shouldn’t be taking birth control pills because she has type 1 diabetes. When she asked her doctor about it, he laughed at her.

“For him it was a funny issue, but for me it was about figuring out how to stay healthy and not get pregnant,” she said. “That was the last time I saw a male doctor.”

He probably thought it was a joke that she was getting medical advice from Cosmo a magazine who just published a story about how Paris Hilton now has a pet Unicorn. But Cosmo was right, and in this case provided her with legitimate information about her condition while her physician failed to do so. (If you’re a woman with type 1 diabetes, long-term use of birth control pills may increase your risk of complications because they raise your glucose levels, according to the New York Times. Perhaps Fuller’s physician could have mentioned that before prescribing them to her.)

For many women, it only takes one male doctor being flippant or creepy or insensitive for them to swear off male doctors forever. And when half the population feels uncomfortable seeing two-thirds of the doctors, it’s no wonder they have worse health outcomes. Male doctors may not be able to fully understand the different health concerns of women, but they should strive to empathize, at the very least. Having a uterus shouldn’t be a necessary requisite to feeling compassion. Maybe feeling compassion should be a necessary requisite to being a doctor.

@waitwhichemma