The Discrimination in Your Doctor's Office

Women ache more often than men, but guys get better pain relief from doctors. What’s going on? And what can you do about it?

By Alice Lesch Kelly
dr doctor pain discrimination hand prescription Rx
Photograph: Oleg Prikhodko
  • Pick the right doctor.Even the most conscientious doctors can find it challenging to treat you effectively, because they may lack instruction and experience in managing pain. (Medical schools tend not to emphasize this subject.) So if your current physician isn’t giving you the relief you need, consider seeing one who is well trained in treating pain or visit a multidisciplinary pain-treatment team. Go to pain.com to search for pain clinics near you.
  • Talk to another woman. There are exceptions, of course, but many women feel that their concerns are better heard by female physicians. That suspicion was backed up in a 2008 Pain Medicine study in which researchers discovered that female doctors were 16 percent more likely than male doctors to administer pain medications to emergency room patients who experienced moderate to severe discomfort, according to study author Basmah Safdar, MD, co-chair of the Chest Pain Center at Yale–New Haven Hospital.
  • Keep a log. Provide useful diagnostic information by tracking the intensity and frequency of your pain in a journal that you show your doctor. Jot down what the pain feels like; how long it lasts; what makes it better or worse; when it strikes; whether menstrual or menopausal symptoms trigger, aggravate or improve it; and what medications you take and how well they work. Rate your pain on a 0-to-10 scale, 10 being the most severe. “You can tell your doctor, ‘This past week I had two days when my pain was a 6 out of 10,” recommends Marni Jackson, the author of Pain: The Science and Culture of Why We Hurt.
  • Know your goals. And share them “Explain to the doctor that you have pain, you expect treatment, you want to know the risks and benefits of various treatments, and you want to leave with a treatment in hand and a plan about what to do if the treatment doesn’t work,” Fishman says.
  • Communicate specifics. “Doctors only know what you tell them,” Jackson says. During your appointment, explain exactly how the pain interferes with your life. For example, rather than simply say you have migraines, report that twice a month you’re in bed with a migraine for eight hours and you’re so debilitated that you have to call a relative to take care of your children, Jackson suggests.
  • Be realistic. Trial and error is a normal part of pain treatment. When a doctor at the Stanford University pain clinic prescribes a pain medication, there’s only about a 40 to 60 percent chance that it will prove to be the right drug. “And we’re pretty good at this,” says Stanford’s Mackey. “There’s a huge individual variability in the way patients experience pain and how they respond to these medications.”
     
  • Don’t rule out antidepressants. Although many women feel that a prescription for an antidepressant is an insult, the fact is that some of these drugs may help reduce certain kinds of pain, even when depression is not present. For example, tricyclic anti-depressants such as amitriptyline (Elavil) and imipramine (Tofranil) can lessen pain caused by lower-back troubles, tension headaches, arthritis, fibromyalgia and nerve damage resulting from diabetes. They appear to work by blocking pain-communication pathways in and near the brain.
  • Stay focused. If your doctor implies that your pain is all in your head, make sure you speak up. Say, “What do you mean by that, exactly? Are you suggesting that I’m imagining this pain or that I’m overreacting? Why would you say that?” If that is indeed what he is suggesting, don’t let it shake you. “You know what you know, and you know what you feel,” says Anita J. Tarzian, PhD, a health care ethics consultant and former hospice nurse. “You have a right to the best quality of life you can get.” And that may well mean searching out another doctor, one who will take your problems seriously.
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Speak Your Doctor's Language

First Published March 21, 2011

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