August 7, 2024 — An analysis of electronic medical records (EMR) in the U.S. and Israel further details medical bias against female patients, by both male and female physicians, in pain management decisions.

The research, published in the journal PNAS, analyzed over 21,000 patient records and found that female patients across every age group were consistently less likely to receive pain medication prescriptions compared to male patients with similar complaints. This bias persists across different ages, pain levels, and physician gender. The study showed nurses score female patients’ pain less frequently, and that females spend more time in the emergency room than male patients.

“Our research reveals a troubling bias in how women’s pain is perceived and treated in emergency care settings,” said Prof. Choshen-Hillel, who heads the MBA program in the School of Business Administration and is a member of the Federmann Center for the Study of Rationality at the Hebrew University of Jerusalem. “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.”

In a controlled experiment involving 109 nurses, pain was rated as less intense if the patient was female, suggesting that the bias is driven by gender stereotypes. Interestingly, the study found that this disparity in prescribing pain medication exists regardless of whether the treating physician is male or female.

The research also highlighted 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.

The researchers call for urgent policy interventions to address this bias and ensure equal pain treatment regardless of sex. They recommend training programs for healthcare professionals to recognize and counteract sex biases and suggest that pain management protocols should be revisited and standardized to ensure fair and adequate treatment for all patients.

The full study titled “Sex Bias in Pain Management Decisions” can be accessed here.

Researchers

  • Mika GuzikevitsMA 1,2*, Tom Gordon- HeckerPhD 3*, David RekhtmanMD 4, Shaden SalamehMD 4, Salomon IsraelPhD 5, Moses ShayoPhD 2,6, David GozalMD 7,8, Anat Perry PhD 5, Alex Gileles-HillelMD 9,10**, Shoham Choshen-HillelPhD 1,2**

Affiliations:

  • 1Hebrew University Business School, Hebrew University of Jerusalem; Jerusalem, Israel.
  • 2Federmann Center for the Study of Rationality, Hebrew University of Jerusalem; Jerusalem, Israel.
  • 3Department of Business Administration, Ben-Gurion University of the Negev; Be’er-Sheva, Israel.
  • 4The Department of Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel.
  • 5Psychology department, Hebrew University of Jerusalem; Jerusalem, Israel.
  • 6Economics department, Hebrew University of Jerusalem; Jerusalem, Israel.
  • 7The University of Missouri School of Medicine, Columbia, MO, USA
  • 8 Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
  • 9 Pediatric Pulmonology Unit, Department of Pediatrics, Hadassah, Medical Center
  • 10The Faculty of Medicine, Hebrew University of Jerusalem; Jerusalem, Israel.

*Equal first authorship

**Co-senior authorship

Funding

  • Israel Science Foundation grant 2824/22 (AGH)
  • Israel Science Foundation grant 354/21 (AP, SCH)
  • Recanati Fund at the Hebrew University Business School at the Hebrew University (SCH)
  • Azrieli Fellowship of the Azrieli Foundation (AP)
  • National Institutes of Health grant AG061824 (DG)