The Importance of Gender-Sensitive Health Care in the Context of Pain, Emergency and Vaccination: A Narrative Review

As a consequence, it seems to be probable that the observed gender differences in access to care in trauma centers are multifactorial. Conscious or unconscious gender bias on the part of treating physicians was also identified as a possible cause for the observed gender differences. Borkhoff et al. investigated whether the decision to refer patients for or to perform total knee arthroplasty was influenced by their gender [50]. After analyzing data from standardized patients with identical clinical scenarios who differed only in terms of gender, both general practitioners and orthopedic surgeons were more likely to recommend total knee arthroplasty to men than to women. However, it remained unclear whether the decision was based on conscious discrimination, on an unconscious assumption of the potential benefit or as result of the communication process (for example, because male patients emphasized more strongly that they were dependent on the full functionality of the knee due to occupational activity or sport [50]). Gender stereotypes, i.e., the attribution of characteristics to a gender category, have an influence on the non-individualized treatment of women and men. These stereotypes are learned in the course of socialization and are often unconsciously reproduced daily in social discourses [51]. Male gender stereotypes include the assumption that men are often in a health-wise worse condition than they admit and therefore are supposed to require higher priority trauma care in the event of an accident [52]. In fact, it is known from studies that the male gender is associated with a higher risk of accidents and consequently also with a higher risk of trauma [52]. However, the care in the case of an accident is only one part of the care repertoire of emergency medicine. A retrospective study from the University Hospital of Düsseldorf showed that of 43,821 patient contacts in the central emergency department of the university hospital, the proportion of female patients was 48%; so, women and men do not differ in terms of the probability of needing emergency medical care [53]. One of the stereotypes concerning the female gender is the assumption that women exaggerate their symptoms and are therefore less ill than they communicate. As a result, women’s complaints (with the same symptoms) are more often diagnosed as psycho-vegetative disorders and treated by prescribing psychoactive substances, and women with the same symptoms more often receive a psychological diagnosis, while men receive a somatic diagnosis [54]. For emergency care, this means that women with, e.g., suspected myocardial infarction have a significantly lower priority for the emergency service than men, which is associated with a significantly longer total ischemia time and correspondingly less favorable outcomes (related, e.g., to mortality), as was found in a study from Norway [55]. Gender stereotypes lead to gender-specific categorization, which as an adaptive strategy aims to release cognitive resources by simplifying complex situations to enable rapid decision-making. In the context of outpatient care, in situations of high stress and time pressure for ambulance personnel, patients need to be quickly categorized into treatment pathways that determine what type of care they will receive. Gender stereotypes and the resulting bias can lead to women being placed in less urgent or even non-trauma-specific care pathways [49,56]—i.e., with a mis- and under-supply of care and less advantageous treatment options.