New research suggests that whether women feel heard in healthcare may depend not only on how doctors communicate, but also on the setting in which they receive care.
Women living with thyroid disease report higher levels of feeling involved in decisions about their care, empowered to contribute and heard when their diagnosis is made by a hospital consultant rather than a GP, according to research from the University of Aberdeen and Kela, the Social Insurance Institution of Finland.
Published in Social Science & Medicine, the study examined women with thyroid disease across the UK. The findings come amid growing public concern about women’s health, diagnostic delays and experiences sometimes described as ‘medical gaslighting’.
The study found substantially higher levels of patient voice - feeling heard, involved and empowered in decisions about care - among women diagnosed by consultants than among those diagnosed by GPs.
Importantly, there was no significant difference between male and female GPs. This suggests that the difference between primary and specialist care is not simply about individual doctors’ gender or communication style. Instead, the clinical setting itself appears to play an important role.
In primary care, women often present with complex symptoms before there is a clear diagnosis. Thyroid symptoms such as fatigue, weight changes and cognitive difficulties can overlap with menopause, anxiety, depression and other conditions. Time constraints and the challenges of identifying less obvious thyroid problems can make these presentations particularly difficult to interpret.
Among consultants, female consultants were associated with higher levels of patient voice than male consultants. This suggests that doctor gender may become more important in specialist care, where clinicians have more condition-specific knowledge and the difficulties of interpreting symptoms may be reduced.
Professor Alexandros Zangelidis, University of Aberdeen, said: “Our findings should not be interpreted as saying that GPs are failing women. The absence of a gender difference among GPs is actually one of the most interesting findings.
“It suggests that the challenges women face in primary care may be driven largely by the clinical setting itself. Improving patient voice requires us to think about the knowledge, time and referral pathways available to support these consultations.”
Professor Catia Montagna, University of Aberdeen, said: “There is an important distinction between saying that women are not being listened to and saying that doctors are deliberately ignoring them. Our research points towards a much more complex problem.
“When symptoms overlap between conditions, patients can struggle to have their experiences recognised. Improving women’s healthcare requires us to think about medical knowledge and communication, as well as the structures in which care is delivered.”
Thyroid disease affects around one in 20 people in the UK and disproportionately affects women. Symptoms can overlap with menopause, anxiety and depression. Previous research has found that UK thyroid patients report waiting an average of around four and a half years from the onset of symptoms to diagnosis.
The researchers argue that improving women’s healthcare should involve more than asking individual doctors to communicate better. Potential measures include better training on thyroid disease, clearer referral pathways for persistent or complex symptoms, and sufficient time for complicated consultations.
The findings are particularly relevant to the wider debate about women’s health and ‘medical gaslighting’. Rather than suggesting that healthcare professionals deliberately dismiss women, the study points towards a more systemic explanation: healthcare structures can influence whether patients’ experiences are heard and understood.
Dr Tapio Räsänen, Kela, Finland, co-author of the study, said: “The important message is that patient voice is shaped by the clinical environment as well as by the individual interaction between doctor and patient. Understanding these structural factors can help improve women’s experiences of healthcare.”