Medically invisible women part two: a practice manager’s guide to encouraging equality

In the second instalment of our review of Caroline Criado-Perez’s talk on medical gender data bias at Digital Health Rewired, Practice Business explores what practice managers might do to ensure that the women in their surgeries are better engaged, empowered, diagnosed and treated

Caroline Criado-Perez’s talk about her thesis of the existence of a medical gender data gap at Digital Health Rewired 2020 event focused on clinical trials and hospital care – how women, in her view, are often missing from the former and sent home, perplexed without a clear diagnosis, from the latter. She argued that medical data is disproportionately skewed towards male bodies and that a thought system, originating in ancient Greece – where female bodies were seen as ‘mutilated’ male bodies and, in the Renaissance, as male bodies ‘turned inside out’. Nowadays, the disparity is more subtle – hidden, even – in the ways in which women are excluded from medical research, with the menstrual cycle said to over-complicate the outcomes of clinical trials. Women are more likely to be misdiagnosed and not taken seriously by medical professionals, and they are more likely to die from heart disease than their male counterparts. 

Could such a gender data bias trickle down into primary care – where women are often first evaluated by the NHS? 

Those working in primary care may feel that conducting clinical research is outside the remit of their practice but they can certainly change their operational models and it is in general practice, the gateway to the NHS, where taking women seriously could have the greatest impact. 

Fortunately, GP demographics paint a much more progressive picture. In March 2014, the number of female GPs outstripped the number of males for the first time in history. Data published by the Health and Social Care Information Centre shows that, in 2015, 54.4% of GPs were female, meaning that women are more equally represented in general practice than ever before. This is a huge step towards reducing misdiagnosis of women – but more needs to be done. 

What can practice managers do to ensure their practice actively works to reduce the impact of a system which uses data that has excluded them for so long? It is not an insurmountable task, and small changes to practices can make a big impact on how female patients feel towards the healthcare they’re receiving. Here are some ways that practice managers can ensure that things are more diverse, inclusive and equal for both men and women:

1. Raise awareness. It is commonly believed that inequality no longer really exists – but this is not really true. Make sure the GPs in your practice are armed with the facts: that women are often misdiagnosed and are more likely to be diagnosed with ‘medically unexplained symptoms’, and that men are more likely to be referred to secondary care exploration when presenting with pain than women are with the same type of pain. 
2. You can actively challenge these statistics in your practice. Encourage your GPs to ask; ‘Am I treating this patient differently because she’s female? Is the pool of medical evidence, and data I am basing my diagnosis on, skewed towards male expectations? Is there a GP in the practice who might be better-equipped to treat this patient or make them feel more comfortable during consultation or examination? 
3. You could encourage your doctors, and other clinical and non-clinical practice staff, to read and discuss Perez’s book ..
4. Train your practice staff in equality and diversity. This training should include statistics about how women are often underrepresented in clinical trials, and how they are less likely to be taken seriously than men with the same health concerns. Encourage your GPs and other clinical staff to keep their eyes out for new, sex-aggregated medical data and to adapt their clinical practice accordingly. Training should be about encouraging practitioners to explore their own blind-spots, to ask whether common practice is the right practice, and to spot when they accidentally make unfair assumptions about patients based on their sex.
5. Make sure the makeup of your team is diverse. You need women on the team to represent and advocate for 50% of the people on the planet. Of course, diversity goes far beyond sex, and it is important that many different demographics are represented in your practice. For more information on becoming a diverse practice, visit … 
6. Allocate a GP in your practice to be the lead on women’s health; if you manage a larger practice, you might want appoint two or three women’s health leads. This is not only important because female GPs are more likely to understand women’s health problems, but also because female patients may feel more comfortable being treated and examined by a female doctor. 

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