Women can be failed by healthcare even when clinicians listen carefully, because bias in research design, participation and data analysis can distort the evidence that guides diagnosis and treatment.
A woman describes pain persisting for months. Her doctor listens, asks questions, examines her and consults the evidence. Nothing obvious appears. The symptoms do not fit the familiar pattern, so she is reassured, offered pain relief or told to return if the problem worsens. The consultation may have been conscientious. Yet the woman may still have been failed, not because the doctor lacked compassion but because the evidence available to the doctor had already made her less visible.
A Victorian inquiry involving more than 13,000 women and girls found that 71 per cent felt their pain had been dismissed or downplayed by health professionals. This raises questions about whether clinicians listen to women and take their experiences seriously.
Dismissal may begin long before a woman enters the consulting room, when researchers decide what to study, whose body represents the norm and which outcomes count as evidence. Trials may have included too few women, combined women’s and men’s results or failed to measure symptoms women commonly report.
For much of medical history, the male body was treated as the human standard. Studies recruited men, while laboratory research relied heavily on male animals and cells. Findings were then generalised to women, as though biological differences were an inconvenient complication rather than part of the science.
Representation has improved but inclusion is not enough. A study can recruit women and still fail them if it combines their results with men’s, overlooks different adverse effects, confuses sex-related biology with gendered social conditions, or neglects pregnancy, menopause and ageing. It can also measure outcomes chosen by researchers without asking women which changes matter in their lives.
In a review with Lea Merone, Darren Russell and Cate Nagle, we found that women remained underrepresented in medical literature and that sex and gender were inadequately reported and analysed. Across the studies examining this question, only six to 38 per cent of results were analysed by sex or gender. Women may therefore be present among participants while remaining absent from the knowledge a study produces.
Medical evidence reaches the consulting room through a pipeline. Funders and researchers decide which conditions deserve priority. Researchers frame the questions, recruit participants and choose what to measure. Results are analysed, published and translated into clinical guidelines. Only then does a doctor apply that knowledge.
Bias introduced anywhere along this path travels forward. If heart disease is imagined principally as a male illness, research may concentrate on symptoms more commonly recognised in men. Trials may recruit too few women to detect important differences. Combined results may conceal variations in symptoms, drug responses or adverse effects. Guidelines based on that evidence may then teach clinicians that the male pattern is the normal pattern.
The doctor encounters the patient at the end of this institutional process. Better communication and professional education remain essential, but they cannot fully correct knowledge that was incomplete when they received it. The consultation is the last link in the evidence chain, not the first.
Every publicly funded health study should therefore answer four questions.
First, who shaped the question? Women should be involved early enough to influence what is investigated and which outcomes matter. That involvement must extend beyond the easiest voices to reach and include Indigenous, migrant, rural, disabled and older women.
Second, who was studied? Participation should reflect the people affected by the condition. Researchers should explain exclusions scientifically rather than rely on convenience or inherited assumptions that hormonal cycles, pregnancy or caring responsibilities make women too difficult to study.
Third, whose outcomes were analysed? Benefits, harms and adverse effects should be examined by sex and relevant gendered circumstances whenever scientifically appropriate. Combining everyone into a single average may produce a tidy result but one that describes nobody well. Where separate analysis is impossible because numbers are too small, that limitation should be stated plainly.
Fourth, what changed in practice? Research should not end with publication. Funders and institutions should ask whether findings altered clinical guidelines, professional education, diagnostic tools or treatment, and whether women’s outcomes improved.
Satisfactory answers to these questions should become conditions of public funding, ethics approval, publication and research-impact assessment. This need not impose identical categories on every project. Sex, gender, age, culture and social circumstances matter differently across diseases and research methods. Requirements should be proportionate to the question and population.
But flexibility must not become an excuse for silence. Every study should explain who helped shape it, who it represents, how it examined differences, and how its findings might lead to better care. Publicly funded research carries a public obligation to produce knowledge that is both scientifically credible and useful to the people whose health it promises to improve.
Sex and gender are not interchangeable; neither is always simple or binary. Hormonal variation, pregnancy, menopause, sexuality, age, culture, disability, work and disadvantage may influence risk, symptoms, access to care and responses to treatment. That complexity does not justify defaulting to male bodies or indiscriminately merging data. It calls for better research design, adequate sample sizes and honest statements about what a study can and cannot conclude. Scientific habits deserve the same scrutiny as clinical ones.
The National Health and Medical Research Council’s new direction (The Targeted Call for Research (TCR): Reframing Women’s Health 2026) should be welcomed. But a dedicated women’s health funding round cannot repair the evidence base if mainstream research continues treating sex and gender as optional additions.
Listening to women in the consulting room matters. By then, however, consequential decisions have already been made: what was studied, whose body counted, which outcomes were measured and what entered the textbook. Women’s health will improve when accountability travels along the whole evidence chain, from setting priorities to changing clinical practice, not only when a woman finally reaches the doctor’s door.
Komla Tsey
Komla Tsey is a Ghanaian–Australian writer, retired Professor of Education for Social Sustainability, and part-time Professorial Research Fellow at the Jawun Research Institute, Central Queensland University. His writing explores education, democratic culture, identity, Indigenous empowerment, colonial legacies and the moral certainties that shape public life. His forthcoming memoir, Botoku Child, traces a journey from a small village in Ghana to universities and communities across the world, examining how inherited beliefs, curiosity and lived experience shape both personal lives and democratic societies.