“Hysteria”

We’re featuring this great piece from 2022 again today in honor of International Women’s Day 2024.

“Did you know that the word ‘hysteria’ comes from the Greek word for uterus, which is hystera?” My eyes opened wide when my attending shared this fact during our morning medicine rounds. We were rounding on a lovely women in her early 50s who was admitted for recurrent chest pain. Her symptoms had lasted for months and were previously thought to be due to anxiety. This time, further evaluation revealed microvascular angina. She was both relieved that she had a diagnosis, but also understandably frustrated that it had taken so long.  

Historically, “hysteria” was a diagnosis specific to women. They were often diagnosed with it whenever they presented with symptoms that weren’t easily explained and it was believed that the uterus was the culprit of the symptoms. The diagnosis of hysteria wasn’t removed from DSM-III until 1980. But the words “hysteria” and “hysterical,” referring to uncontrollable emotion, continue to be widely used in America.

Unfortunately, this historical context has led to persistent sex and gender bias and discrepancies in care that are still pervasive in medicine today, and adversely affects women. Women are less likely to be referred for additional diagnostic tests compared to men. Women wait longer in the emergency room compared to men who presented with the same symptoms. Mortality from cardiovascular disease is higher in women compared to men.  

Recently, there have been many articles published in the New York Times, Washington Post, and Insider further discussing the sex and gender bias and discrepancies in care that women face. The phrase “medical gaslighting,” a colloquial term used to describe the experience patients feel when their concerns are dismissed or labeled as mostly psychological, has been used in these articles to further portray the experiences that women go through.  

As clinicians, we must be aware of these sex and gender differences, discrepancies in care, and biases that could adversely affect women. Here are some strategies to help combat this:  

1. Be aware of sex and gender bias.

The first step is to be aware of your bias. It’s often implicit or unconscious.  

2. Broaden your differential.

Keep in mind that women can present in different ways, as male and female physiology are distinct.

3. Practice shared decision making.

This ensures better patient-centered care and helps women feel like they are being heard by clinicians. Discuss potential diagnoses and treatment options with your patient, incorporate their values and preferences in the decision-making process, and create a care plan together.  

4. Engage in lifelong learning on women’s health topics.

Women’s health has been underrepresented in medical education and especially internal medicine training. Internists often feel unprepared to give comprehensive care to women. There are wonderful resources available to gain more knowledge including this excellent textbook.  

5. Remember that one size does not fit all.

The conventional approach to medicine is a one-size-fits-all approach and tailored to men, as women were previously excluded from early phases of clinical trials until the 1990s. However, there’s been a lot of progress in research over the past few years to further elucidate how sex and gender differences play a role in diagnosis and treatment. Now, we must apply this knowledge to our clinical practice to give better care for women. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.