How Gender Bias in Healthcare Hurts Women, Both Patients & Doctors: Q&A

It’s no secret that heart disease is different for women. The symptoms are different, and women are more likely to have their symptoms ignored. This means women are more likely to die of a heart attack than men are. Women's heart issues are a critical care gap, and one many doctors are keen to correct.

We asked Patricia Rodriguez-Lozano, MD about her experience as a cardiologist and the director of the Women’s Heart Health Program.

Gender Bias in Healthcare

What are the biggest challenges facing women and women of color when seeking care?

We know women, in general, experience bias and discrimination based on their gender. They are underdiagnosed and undertreated and, in consequence, have the worst outcomes.

Unfortunately, women of certain ethnicities experience disproportionately higher rates of certain conditions, including heart disease. Also, it is important to recognize that other aspects like socioeconomic status, access to education, employment, and other social determinants of health greatly impact health outcomes.

Women of color have a higher probability of suffering from un- or underemployment, living below the poverty limit, and experiencing inequality in healthcare. A clear example of this inequality is the disproportionate pregnancy-related complications and maternal mortality rate between white women and women of color.

What are the biggest health concerns you see in patient interactions?

Many women I see in my clinic say their doctors never talk to them about their heart issues.  Even when they have a strong family history of heart disease or traditional or sex-specific risk factors for heart disease.

Also, you can see gender bias in that many say their symptoms were not recognized as heart disease-related but mistaken instead for signs of panic attacks, emotional stress, and even hypochondria.

What do you wish all your patients would know or do for their health?

Heart disease is the leading cause of death for women worldwide. Women with heart disease sometimes present differently. The most common symptom in men is chest pain.

But women's heart symptoms might include:

• Fatigue
• Shortness of breath
• Emotional distress

Women may experience these symptoms for several weeks before the index event. Women also have sex-specific risk factors for heart disease like polycystic ovarian syndrome, pregnancy-related complications, early menopause, and autoimmune diseases.

What needs to improve for women to overcome gender bias in healthcare?

Education to increase awareness of how heart disease is different is critical to improving outcomes. All providers that care for women during their life need education. Not only cardiologists but pediatricians, gynecologists, and primary care physicians.

We need a specific curriculum to educate medical students, cardiology fellows, nurses, and other providers about sex differences in cardiovascular diseases. We also need to educate the community and find innovative ways to reach specifically younger women and women of color.

Education will empower women to become advocates for themselves. If you suspect something is wrong with your health, do not let a healthcare provider turn you away until you have all your answers.

What inspired you to go into your field?

I wanted to be a cardiologist since medical school. I fell in love with the anatomy, physiology, and pathophysiology. My passion for research and cardiac imaging led me to seek more training after my cardiology fellowship. I joined the T-32 Advanced Cardiovascular Imaging Fellowship at UVA, where I found the perfect balance of clinical imaging training and research opportunities.

During training, I learned that women are underrepresented in research on cardiovascular disease. Women also have a different heart disease presentation with:

• More non-obstructive coronary artery disease
• Less calcified plaques
• More microvascular disease
• Different risk profiles
• Different symptoms

Because of women's underrepresentation in clinical trials, the traditional algorithm to diagnose and the therapies to treat heart disease in men might only work on some women.

All of these grew my passion for understanding heart disease in women and, this way, trying to improve outcomes in women. My research is now focused on sex differences in cardiovascular disease, and I am also the Women’s Heart Health Program director at UVA Health.

What does it take to be a successful cardiologist?

Cardiology remains a male-dominated specialty. Despite this under-representation, women cardiologists are progressively seen in leadership roles. Including roles in professional societies, clinical practices, health administration roles, and research.

To achieve success in any field, it is essential that one puts in the necessary time and effort. It is important to have clear goals for your professional and personal life. Both are equally important. Here mentorship is essential.

We all should have a team of mentors to help us navigate the challenges and maximize our potential to achieve success. Men are great mentors and sponsors, but ideally, you should have at least one woman to be your mentor or role model. Women can have it all, but probably not all at the same time. We need to learn how to be gentle with ourselves, and again, mentors can help you to navigate specific challenges that come with a career in medicine, especially in cardiology as a woman.

Do you think of yourself as a role model for other women who want to become a cardiologist?

I was born in Peru and dreamt of becoming a cardiologist and researcher since medical school. I am grateful to my mentors and sponsors for believing in me and for the opportunities I have received. My journey has been long and sometimes challenging, and I hope I can provide mentorship and guidance to women, especially those from underrepresented minorities like myself. I hope other women in training or early career can find a positive influence and support in me, especially during challenging moments.

Have you felt gender bias in healthcare was a barrier to your success? If so, how did you overcome it?

Cardiology is a male-dominated field. Women make up only:

• 18% of cardiology fellows
• 10-15% of practicing cardiologists
• 4% of interventional cardiologists

I had my two daughters while in training and experienced a lack of institutional support during my pregnancy and nursing period. Part of the problem was the lack of women cardiologists as faculty at the time that would advocate for other women.

I was lucky to have an extremely supportive husband; with his support, I followed my dreams, never gave up, and continued to work hard. Women, we are brilliant, natural multi-taskers, detail-oriented, and we bring diversity and innovation. I am very grateful to have been fortunate to find mentors who inspired and encouraged me at UVA Health.