Over Fifty And A Woman And It is all In Your Head

dR. Nisha Chellam
6 min readSep 3, 2019


Your failures won’t hurt you until you start blaming them on others. Zig Ziglar

Four years , four doctors later a woman gets a diagnosis.

The wait time for a woman to get intervention for her abdominal pain is 65 minutes and it is 49 minutes for men.

Middle aged women having a heart attack get sent home more than a young man having a heart attack.

Women healers used to be burnt as witches in the previous centuries.

These are the stats and information brought out by Maya Dusenbery in her book Doing Harm.

Invisible patient , invisible symptoms, invisible diseases

Being a woman is a terribly difficult task, since it consists principally in dealing with men. Joseph Conrad

Have you heard of the Yentl Syndrome?

This is what it is : women are more likely to be treated less aggressively in their initial encounters with the health-care system until they “prove that they are as sick as male patients.” Once they are perceived to be as ill as similarly situated males, they are likely to be treated similarly.* Written in the article “The girl who cried pain” by Diane E. Hoffmann and Anita J. Tarzian.

Why is this so?

It can be summarized with the Genesis 3:16

“To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”

Today this may widen our eyes. However it is important to understand the implications of all this data coming out.

Under-treating or ignoring women because of the bias that the symptoms are more psychological or they are not in as much pain or they are hypochondriac has far reaching effects.

It is not only the workforce but a whole generation is affected. Ask the kids of mother who has chronically suffered from an autoimmune disease or pain or anxiety, to know the true impact.

It is also important and urgent we realize there are several gaps in the care:

Here are a few gaps that have been identified:

  1. The ability to distinguish reality from judgement: The Trust Gap (Maya Dusenbery)
  2. The ability to conclude what is shown is universally applicable: The Knowledge Gap (Maya Dusenbery)
  3. The ability to empathize even though you may not want to judge or not understand: The Gender Gap

The Trust Gap:

A woman is like a tea bag — you never know how strong she is until she gets in hot water.Eleanor Roosevelt

When woman has pain, she has to prove she has pain by , looking like it , by speaking like it and walking like it.

Men just have to be stoic and say they have pain and they get the care. This is what has been proven in studies.

Studies are difficult to do as pain is a subjective feeling. People’s report of pain is influenced not by the intensity of the pain but by their up bringing, cultural and belief system and coping mechanisms.

There maybe real biological differences between men and women.

Women may react and respond to pain in a more constructive way like reporting to the doctor, or praying, or discussing this with friends etc.

Men on the other hand will wait long enough and sometimes use self destructive behavior like drugs and alcohol as they have been trained to tolerate pain or have a pressure to tolerate pain longer.

So when women complain about the pain they so do early and tend to be more sensitive to it. Unfortunately this leads to a delay in diagnosis as they are first brushed aside as it is not really an issue, second it is assumed that women have more tolerance to pain and that they really are not in as much pain as they say they are in.

The history of medicine states when a women keep complaining of pain they are labelled as hysterical or psychogenic. Men when they report pain early or emphatically they can be labelled aggressive.

This gap in trusting a woman for her words or her own judgement is long standing and needs a strategic approach.

The Knowledge Gap:

A woman has to live her life, or live to repent not having lived it. D.H. Lawrence

Unbeknownst to most of the medical profession , the docs on the front lines are given to believe there are certain “mans’ diseases “, and some women’s diseases.

Most studies till more recently were conducted on predominately white male population, 50 to 60 years of age.

There were glaring exclusions of women in general and even more when it comes to women of color.

So a lot of the guidelines are geared toward care and management of diseases studied in men.

What are the implications?

Women who have the same risk as men at the same age: Smoker’s , high cholesterol, diabetes tend to go undiagnosed for conditions like heart disease which is considered predominately a man’s disease. 16,000 women die each year from heart attacks. It is the single most killer of women even more than breast cancer.

There are special risk factors for women that never get addressed like diabetes during pregnancy or hypertension and a condition called pre-eclampsia. All of these will place them at higher risk but they are never asked these questions.

Even their symptoms are not the typical studies.

Women tend to have more nausea and dizziness and weakness and fatigue over the classic angina described in men.

Similarly women struggle to have COPD diagnosed on them to receive the right treatment.

This is called the knowledge gap. A gap in the knowledge of the frontline of Medicine: the doctors.

The Gender Gap:

Prejudice is a burden that confuses the past, threatens the future and renders the present inaccessible. Maya Angelou

The last bias that we have is the gender bias.

Pain and autoimmune symptoms are even more non-specific and sometimes not consistent.

The longer the symptoms and complaints the less women are believed. In fact when men develop symptoms they are referred to the specialty clinic 45 days sooner than women who have similar symptoms.

Men tend to have autoimmune disease less frequently than women. Yet they get diagnosed sometimes faster and get treatment earlier.

Women who are well dressed and are stoic tend to have lesser treatment of their pain and have more time to treatment.

The reason for this seems to be the communication issues related to gender bias.The way women communicate is out of sync with how doctors like to communicate: an interrogative interview.

Women‘s symptoms cannot be completely elicited by simple question answer sessions with the doctor. So a lot of what they say is viewed with suspicion.

This is not something new. Looking through history many of women’s symptoms were associated with emotional overtones. In modern medicine emotions and physical pain are separated and therefore when emotions are brought in they are described as hysteria, psychosis, neurosis and now they are called anxious.

Solutions to Close Gaps:

The question is not who is going to let me but who is going to stop me-Ayn Rand

So how do we bridge this gap of Knowledge,Trust and Gender?

We need to change the encounter between patient and the doctor.

Women need to be prepared for their appointments.

Until they are comfortable with the provider , make sure you as a woman have a male accompany you for the appointment- Brother, husband or boyfriend who supports you and can confirm you do have the symptoms. It is unfortunate but studies have shown when women go in with their male relative to appointments they get to be heard better.

Be prepared with the right questions when you go in for the appointment. Have your timeline of all your symptoms well written and questions well prepared.

Today medicine is a business and in business time is money. It is unfortunate, but the truth.

However addressing and getting tested for an accurate diagnosis has to be planned by the individual patient.

Doctors also need to realize that medicine is advancing in leaps and bounds. There are more environmentally induced diseases than ever more. Patients, particularly women struggle to discuss their issues accurately.

They need help to be heard and the information organized. Time is of essence for both sides.

To help people organize the visit we have formulated a checklist of what needs to be addressed in a visit.

Connect with us to schedule a free consult.



dR. Nisha Chellam

A traditional physician who practices functional medicine disrupting the disease and wellness space. She is a mother and has great passion for teaching.