I have always, in forty-plus years of life (so, say, for at least thirty years) read that men were the stubborn ones, just wanting to “soldier on”, pooh-poohing others’ concerns that they should get something checked out. I had been made to understand that this was partly to blame for their shorter life expectancy. I had, on the other side of the coin, read that some of the financial impacts of the Obamacare rule, that one gender cannot be charged more than the other, stemmed from the fact that women use more medical services than men on average.
But then Marianne Legato, a cardiologist interviewed in this NPR story states exactly the opposite, at least when it comes to heart attacks, which are the #1 killer of women:
So obviously this really surprised me. Is this actually correct? If so, was all the information to the contrary I read all those years incorrect? Or does this reflect a recent and dramatic change, a 180 degree flipping, of how men and women respectively react to symptoms of serious illness?
I don’t think there’s actually any inconsistency there. As alluded in the interview:
So the symptoms are not the same, and there may be less warning for women. Note that heart attacks are already a disease that is often misidentified, so if you take out a symptom like chest pain it’s not surprising many just think it’s indigestion and continue with their lives. And the main point of the interview seems to be the (incorrect) perception that heart attacks are not common in women.
And it’s important to not confuse misidentification with “soldiering on”. No-one is saying “Oh geez I’m having a heart attack, but I really need to get that Powerpoint done, dammit!”
I have no comment or opinion on whether men or women “soldier on” more often.
My mother-in-law suffered a heart attack about 15 years ago; she had none of the classic symptoms. She just generally felt crummy, and, after a day or so of that, she went to the doctor, and found herself in the E/R, then the cardiac ward, in short order.
Maybe not in the data about the four hour delay–it’s a good point.* But you must then at least think this cardiologist erred in making the broader claim “women deny their illnesses and soldier on”.
*Although the story says it’s only fifteen percent of women with heart attacks who don’t get chest pain. Could that really explain an average four hour delay? And they still get “shortness of breath…sweat profusely and are nauseated”, which isn’t nothing.
Men are, in total, certainly more “stubborn” than women about going to the doctor. Men also make a bigger deal about swabs and internal examinations. Many people with heart problems have “anginal equivalents” instead of exertional chest pain, but particularly women. Which is not say women can’t be “stubborn”, or dislike going to the doctor.
I mean, a lot of women do like to call men babies about cold/flu, so I guess they pride themselves on being more willing and able to “soldier on” in that case.
This picture periodically pops up on Facebook, etc. It is not a meme, nor is it Photoshopped. It was at the bottom of the hill on State Street in Quincy, Illinois, where I lived for a number of years. I drove by it many, many times.
I read somewhere (sorry!) that one reason married men live longer than single men is that their wives make them go to the doctor and nag them to take better care of themselves. Married women do not live longer than single women.
I think that a cardiologist would likely say that because his area of specialty - cardiology - is the one in which women do tend to be most misdiagnosed and undertreated - and uneducated in the signs and symptoms of cardiac distress that they should be aware of.
Menopausal women very often experience shortness of breath, profuse sweating, and even nausea, as symptoms of menopause.
It’s not that they’re ignoring their symptoms, it’s that they’re misattributing them, because people think of heart attack symptoms as pain and pressure in the chest and pain, numbness, or tingling radiating down your left arm. They think that if you can walk around, you clearly aren’t having a heart attack, because heart attacks make you gasp, clutch your chest, and fall over. We’ve all seen it in movies and tv a thousand times.
What we’re looking for isn’t (always) what it actually looks/feels like.
My mother, a retired RN of all people, didn’t go into the ER when she was having a mild attack. It turns out that her pain came in a different area than what she was expecting.
As for the question if women or men soldier on more, I really don’t expect a GQ type of answer because this mostly seems to be confirmation bias and stereotypes.
My friend’s (now) wife was at a dinner party (she a doctor) with us a few years back. One of the guests felt “a little under the weather”, the whole evening. We jokingly mentioned to her that she should check him (yes it was a man) out, and she did so and the moment she saw him her smile vanished, she turned to me and said in no uncertain terms “call an ambulance, NOW”. Guy needed an emergency angioplasty and stenting IIRC.
So its i) not just women and ii) what seems to be symptoms/signs of heart attacks to doctors are not to even knowledgeable laymen. Seriously, he just looked a bit tired to me and she just glanced at him and called for an ambulance.
Heart disease also tends to strike women at much older ages than it does with men, which also means that vague symptoms might be attributed to something else.
And it’s quite possible even she wouldn’t be able to tell you what she saw. Sometimes, it’s nearly unconscious knowledge
I’ve probably made about two dozen 911 calls in the last 6 years. 2 were for textbook cases. (One nonresponsive, the other a blood pressure of OMG/WTF with chest pain.) All the others have just been a gut feeling. Often perfectly normal vitals, various amounts of distress, but something told me to make that call. Sepsis, strokes, heart attacks, UTIs about to go septic, acute kidney failure, organ rejection… I’ve almost never erred sending someone in. (One time I did. I coulda sworn it was a stroke, but she was just blotto drunk.) But if you ask me why I sent that guy and reassured the other and got it right both times…I dunno. Just knew something wasn’t right.
And no, it’s not just men who ignore other stuff, nor is it just women who ignore heart attacks. But in my experience, there’s much more than a grain of truth to the stereotypes.
I think you’re taking your quotes largely out of context. IMO, in that sentence of that paragraph of that article by that particular cardiologist, “illnesses” means “cardiac events”.
Which, as the experts upthread have said, women tend to misdiagnose in themselves. Heck, I remember the genderist flail back in the mid-80s when the medical industry discovered that women weren’t just funny-shaped men with some extra troublesome plumbing.
Gosh, who knew it’d be informative to study and catalog diseases, signs, and symptoms separately in the two sexes. It was an absolute revelation that all the AHA standard heart attack symptoms were really “heart attack symptoms specific to males” and there was a whole different (and more subtle) list of “heart attack symptoms specific to females”. “Who knew??” indeed.
Plus …
Most ordinary folks go through their life with much of their medical knowledge being folk medicine absorbed by osmosis as children and young adults. Many women who’re 50+ today (IOW the “heart” of the heart disease envelope) absorbed their limited knowledge of heart attacks from PSAs shown in the 70s. They *still *don’t know what they should be on the lookout for.
Most people only become lay “experts” on their medical problems after the condition becomes acute.
And drug trials would generally leave women out as well (for well-meaning reasons). Frekonomics Radio has an interesting trio of podcasts with the second one discussing the drug trials.
Studies (pdf) have shown that overall, women consume about 60 percent of the health care in the US, and it rises to 70 percent at Medicare ages, because men die earlier. Presumably that varies by field, and cardiology may have a different ratio.
Expectations play a role. As a menopausal (alright, perimenopausal) woman I find anything I complain about is attributed to menopause. Cold? It’s menopause. Hot? It’s menopause. Itching? It’s menopause. Can’t sleep? Menopause. Sleep all the time? Menopause. My left foot fell off during the night? Menopause.
So… “Doctor, I feel nauseous and have indigestion, and I can’t seem to catch my breath”
Doctor to a woman: “It’s menopause.”
Doctor to a man: “Let’s check your heart out.”
Then there was the time when my mom, in her mid-40’s, went to a doc with chest pain, shortness of breath, and pain in her left arm and jaw. The doc looked at her, said she was under 50 and female and thus she couldn’t possibly be having a heart attack. This despite a 15 year history of seeing a cardiologist, angina, and other symptoms.
Mom insisted on going to an ER anyway. Good thing she did. The doc was right in that she was not actually having a heart attack at that moment, but she had 100% blockages on three coronary arteries and the rest where gunked up, so she was certainly about to have one. No stents in those days, and a shortage of people qualified to do bypasses (this was the 1970’s) so she got put on a waiting list and spent most of the next four months in the ICU. Would have been six months, but a bunch of people on the waiting list ahead of her died before their turn came up.
Another time, around age 60, she was complaining of various symptoms to a new doc who was dismissing her concerns until she showed him her “double-zipper” down her sternum (two heart surgeries) and that’s when he finally started listening and said oh, yeah, we need to check that out.
So, while men tend to resist going to the doc more than women do, once they do go there I think there is still a tendency to listen to their concerns more closely. Even though women are more willing to go to the doc, I think there is still a tendency to diminish their complaints and/or attribute them to “women’s problems” rather than really listen and think about what’s going on.
Not a universal, and not as bad as it used to be, but still a problem.
