What is the Yentl Syndrome?
The phrase “Yentl Syndrome” was coined in 1991 by Dr. Bernadine Healy, who remarked:
“Yentl, the 19th-century heroine of Isaac Bashevis Singer’s short story, had to disguise herself as a man to attend school and study the Talmud. Being ‘just like a man’ has historically been a price women have had to pay for equality. Being different from men has meant being second-class and less than equal for most of recorded time and throughout most of the world. It may therefore be sad, but not surprising, that women have all too often been treated less than equally in social relations, political endeavors, business, education, research, and in health care.”
This reality is certainly true in health care, especially cardiology– Diane E. Hoffman, Associate Dean & Professor at the University of Maryland’s study The Girl Who Cried Pain found that women experience and report more frequent and greater pain, but less likely to be well-treated than men for their painful symptoms. Dr. Jennifer Wider, spokeswoman for the Society for Women’s Health Research, remarked, “Studies show that doctors, regardless of gender, tend to undertreat female patients and take longer to administer medication to women.” View the infographic below for quantitative measures of this phenomena:
Why Does This Issue Persist?
For the purposes of this presentation, we will focus on the Yentl Syndrome mainly as it relates to the prevention and treatment of heart disease – the disparity between men and women in medicine is often most apparent in cardiology. The following reasons explain why the Yentl Syndrome continues to be an issue within our society.
Women Are Often Ignored From Research
Cardiovascular disease is the leading cause of death for both men and women, but the latter are often ignored in clinical trials. The genders vary in signs, symptoms, and outcomes, making it important that both genders are appropriately observed. Unfortunately, this is not the case: On average, only 33% cardiovascular clinical trial subjects are female, and only 31% of cardiovascular clinical trials with both genders report results by sex, despite how essential it is to diagnosis and treatment. Furthermore, a 2010 Cardiovascular Quality and Outcomes study found that guidelines around preventing cardiovascular disease in women came from trials where only 34% of participants were women.
Doctors Are Often Unaware Of This Disparity
In 1996, a national survey revealed that 66% of doctors were completely unaware that symptoms of heart attacks vary by gender. In 2014, the Women’s Heart Alliance found that on approximately 50% of physicians polled believe there are differences between male and female hearts. Finally, a 2005 study revealed that less than 20% of doctors know that more women die from heart issues each year than men. For this reason, a Harvard Medical School article notes that “many women say their physicians never talk to them about coronary risk and sometimes don’t even recognize the symptoms, mistaking them instead for signs of panic disorder, stress, and even hypochondria.”
Stereotypes and Misconceptions About Women
Preconceived notions about women’s reproductive systems and emotional health contribute to the Yentl Syndrome. A 2001 study published in the Journal of Law, Medicine & Ethics found that many doctors mistakenly believe that women have a “natural capacity to endure pain” due to the stresses and pain of childbirth. Furthermore, the assumption that women are more emotional than men is harmful: The same study found that women’s pain is more likely to be perceived as “emotional” or “psychogenic” rather than being considered biological and “real”. This perception is damaging: A 2006 study found that medical students and residents are more likely to misdiagnose women displaying symptoms of coronary heart disease, attributing it to stress, if the patient expresses feelings of anxiety, but the same is not true for men.
Women In Their Own Words
I asked women, both within my community and on the internet, to share their experiences with the Yentl Syndrome. Here is what they had to say:
“My aunt was really concerned about a growing lump in her breast area, so she went to her doctor in hopes of finding a treatment. Her doctor told her that “it’s just swelling” and prescribed her with medication that would supposedly make it go away. My aunt was skeptical because they did not think that it was necessary to get tests done, but she trusted that her doctor would take her seriously. Maybe she shouldn’t have: a few month later, the lump was still there, so she went to another doctor. It turns out that she had breast cancer, and it had progressed rapidly in the last few months. She is in remission now, but what would have happened if she didn’t see another doctor?” – Aima M. from USA
“My PCP is a woman, been seeing her for 10ish years. She’s younger and the absolute best. She takes time to listen and never discounts any of my thoughts, feelings, or complaints. I totally trust her opinion. When I had a health scare in 2015, I had seen a handful of physicians, all male. They all brushed my complaints off as ‘mental’ since they couldn’t see anything. I basically felt like brushed off as a ‘silly girl.’ Now when I’m looking for a specialist, I always try to find a female provider first.”- Aimiee L. from USA
“A few years ago, I had been experiencing excruciating back pain. It had been three months, so I decided to go to the doctor. He told me that it was “probably just cramps” even though I told him that I never get cramps, even when I am menstruating. Even so, he told me to take panadol. My mom and I were not able to convince him to run tests or that I could be experiencing something else, so we found a doctor that took me seriously. It turns out that my kidney was clotting due to undiagnosed Hashimoto’s disease.” – Natalie K. from Australia
“It depends on the doctor I think … but I have been treated by specific ones in a manner that they felt I had no idea what I was talking about and refused to listen to me. My mom went with me to an appointment and even said to the doctor, ‘I don’t feel like you are taking her very seriously.’ He said, ‘Look at her, she is smiling and bubbly, how could she be in so much pain?’… I am always smiling and bubbly, even when I’m pain, that’s just me.” – Lauren K. from USA
Stories In The Media
- How ‘Bad Medicine’ Dismisses And Misdiagnoses Women’s Symptoms (Audio): https://www.npr.org/sections/health-shots/2018/03/27/597159133/how-bad-medicine-dismisses-and-misdiagnoses-womens-symptoms
- The Gender Gap in Pain: https://www.nytimes.com/2013/03/17/opinion/sunday/women-and-the-treatment-of-pain.html
- How Doctors Take Women’s Pain Less Seriously: https://www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/
- Period pain can be “almost as bad as a heart attack.” Why aren’t we researching how to treat it?: https://qz.com/611774/period-pain-can-be-as-bad-as-a-heart-attack-so-why-arent-we-researching-how-to-treat-it/
What You Can Do?
Society for Women’s Health Research spokeswoman Dr. Jennifer Wider says, “Women need to advocate strongly for themselves and trust their instincts…Especially if they are in a lot of pain, they need to speak up immediately.” An anonymous medical expert that I interviewed echoed this sentiment: “I did not realize that I had been ignoring my own female patients’ pain until one of them told me that I was. It was an eye opener for me. I think more doctors– especially male doctors like myself– need to be told this.”
I have also experienced effects of the Yentl Syndrome in my life, and what has helped me advocate for myself is being educated on possible causes of my pain beforehand. When I was experiencing pain and my doctor dismissed it, I offered her research on what my symptoms (especially my pain) could mean. I requested that she run specific tests that could help me reach the correct diagnosis. Indeed, my test results proved that I was experiencing the symptoms of a serious condition that my doctor had initially neglected to check for. Doing research on websites such as WebMD and Healthline before an appointment can empower the patient to make suggestions and request tests that could aid in diagnosis.
Many women that had experienced the Yentl Syndrome noted that they were treated better by female doctors. While women are also capable of contributing to and perpetuating the Yentl Syndrome, a study by the National Pain Report found that 49% of female respondents feel that female doctors understand their pain better than male doctors. The aforementioned suggestions better address the root of the issue, but switching to a female doctor may function as an effective short-term solution.
For Anyone (Especially Doctors):
Studies presented on this page prove that the Yentl Syndrome is a serious issue. Unfortunately, misconceptions surrounding this phenomena and female pain in general have allowed the problem to worsen. Many doctors I interviewed both in-person and online were somewhat aware of sexism in healthcare, but most were unaware of the extent to which it is true; being educated on the issue is the first step in making progress, and I encourage you to do so by using the resources on this page. I also encourage doctors and healthcare professionals to consider their own professional interactions and ask themselves:
- Do I treat my male and female patients with the same level of empathy and understanding?
- Am I equally likely to prescribe pain medications or request lab tests for my male and female patients?
The ultimate goal is for all doctors to be able to answer “yes” to the questions above.
I hope that you find my presentation informative and impactful! Please answer the three-question survey underneath.