Fun and Fitness for the 40-Something

Here’s some important medical news you may have missed: When patients show up with symptoms of coronary heart disease (CHD), doctors are more likely to attribute the symptoms to mere stress if the patient is a woman. That could lead to delayed diagnosis and, in turn, treatment. As a woman with a family history of heart issues, I find this pretty scary, especially as heart disease is widely recognized as the leading cause of death for women.

A study presented at a recent symposium sponsored by the Cardiovascular Research Foundation looked at the effects of patients’ gender and the context of how heart disease symptoms are presented—i.e., with/without mention of life stressors and anxiety—on primary care physicians’ patient evaluations. Such physicians are usually the first medical professionals a patient consults about symptoms.

Eighty-seven internists and 143 family physicians read a vignette of a 47-year-old male or a 56-year-old female (the ages put them at equal risk for CHD) presenting a multitude of CHD symptoms and risk factors. Half the vignettes indicated the patient had recently experienced a life stressor and appeared anxious. Each doctor read one version of the vignette and then specified a diagnosis, made treatment recommendations and indicated the etiology of symptoms.

The results showed a gender bias when CHD symptoms were presented in the context of stress. Compared with the male patient, the woman received fewer CHD diagnoses (15% vs. 56%), cardiologist referrals (30% vs. 62%), and prescriptions of cardiac medication (13% vs. 47%). You don’t need to be a scientist to see that those differences are very significant—alarmingly so.

It gets worse for women who recently experienced a stressor or who “appear anxious” when consulting their doctors about potential CHD disease symptoms (and what woman would not be anxious in that scenario?). The presence of stress shifted the doctors’ interpretation of women’s chest pain, shortness of breath and irregular heart rate so that the symptoms were attributed to a psychological origin. Men’s symptoms, on the other hand, were perceived as organic regardless of whether stressors were present. One reason for the difference? The greater likelihood that women will discuss stressors with their physicians—as we’re always advised to do!

The lead researcher concludes that results “suggest the need for the development of educational initiatives aimed at improving health care providers’ understanding of gender differences in symptom presentation.” In particular, she says, “they need to be especially careful to rule out coronary heart disease before considering an anxiety diagnosis.” That’s putting it mildly, I’d say.

This entry was posted on Tuesday, October 21st, 2008 at 7:29 am and is filed under Health and Wellness, News. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.