Sex Bias in Pain Management at Emergency Departments

What is it about?

Our studies revealed that female patients are prescribed fewer pain relief medications than male patients, even after considering the levels of pain reported and other variables such as age, medical history, and the type of complaint. This suggests a systemic issue where women's pain may not be taken as seriously or treated as aggressively as men's pain. By analyzing electronic health records from American and Israeli healthcare systems, we present evidence that a female patient discharged from the emergency department is less likely to receive treatment for a pain complaint compared to a male patient. Specifically, datasets from emergency departments in the US and Israel, with a total sample size of 21,851 discharge notes, revealed that female patients are less likely to receive a prescription for any type of analgesic medication, both opioids and non-opioids, compared to male patients. Female patients with pain complaints are less likely to receive analgesics for every pain score and at every age group and receive less analgesics from both male and female physicians. In addition, female patients stay an additional 30 minutes at the emergency department, and their pain score is 10% less likely to be recorded by triage nurses. In a controlled experiment involving 109 nurses, pain was rated as less intense if the patient was said to be female rather than male, suggesting that the bias is driven by gender stereotypes. According to the authors, the under-treatment of females’ pain bears immediate implications for the healthcare system and broad implications for society’s attitude toward female pain. Interestingly, we find that this disparity in prescribing pain medication exists regardless of whether the treating physician is male or female. Both male and female doctors are less likely to prescribe pain medication to female patients, indicating that the bias is pervasive and not limited to one sex of healthcare providers. The research also highlights that nurses are 10% less likely to record pain scores for female patients compared to male patients. This lack of documentation can contribute to underestimating the severity of women's pain and result in inadequate treatment. Additionally, the study found that female patients spend an average of 30 minutes longer in the emergency department than male patients. This delay could be due to a variety of factors, including potentially being taken less seriously when they report pain or symptoms. In a controlled experiment, nurses judged female patients' pain as less intense than male patients' pain when presented with identical clinical scenarios. This suggests that there may be an implicit subconscious bias in how healthcare professionals perceive and assess pain based on the patient's sex

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Photo by engin akyurt on Unsplash

Photo by engin akyurt on Unsplash

Why is it important?

Our research reveals a troubling bias in how females' pain is perceived and treated in emergency care settings. This under-treatment of female patients' pain could have serious implications for women's health outcomes, potentially leading to longer recovery times, complications, or chronic pain conditions.

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