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# Women Aren't Complicated. Healthcare Often Isn't Listening.
- URL: https://www.melaninblissmedia.com/womens-pain-emergency-room-what-research-shows/
- Published: 2026-10-23T21:03:04.000Z
- Updated: 2026-10-23T21:03:04.000Z
- Description: “Complicated” is what people say when they didn’t ask. In the emergency room, the research shows what not asking can cost.
- Author: Amber McClendon
- Tags: Health, Health Equity

Melanin Bliss Media · Health Equity

“Complicated” is what people say when they didn’t ask. In the emergency room, the research shows what not asking can cost.

Somewhere between a homecoming debate and a phrase I had never heard before, someone offered one of the oldest explanations going: women are complicated.

It is a convenient line. It explains why a product missed, why a campaign felt tone-deaf, or why someone never bothered to ask a woman what she wanted. But “complicated” often describes the people doing the asking, not the women answering. It is a shortcut around curiosity.

In healthcare, that shortcut can be measured.

## The shortcut has a cost

When we say a group is hard to understand, we put the burden on the group. Women are expected to explain themselves better, rank their symptoms more precisely, and advocate harder, and then they are described as “difficult” when the explanation does not land.

There is another way to read the same situation. A system that works well for a narrow set of patients, and poorly for everyone else, is not being confused by the patients. It is failing to design for them.

## What the research found

In 2024, researchers at the Hebrew University of Jerusalem and collaborators published a study in the *Proceedings of the National Academy of Sciences* titled “Sex bias in pain management decisions.” They analyzed records for 21,851 patients who arrived with pain complaints at two emergency departments, one in the United States and one in Israel.

The findings were consistent in direction:

- Women were less likely than men to be prescribed pain relief. The gap remained after the researchers adjusted for the pain scores patients reported, along with many patient, physician, and emergency department variables.
- Male and female physicians both prescribed less pain relief to women, so the pattern was not simply about male doctors.
- Nurses were about 10% less likely to record a pain score for women, even though guidelines call for recording one for every patient.
- Women spent about 30 more minutes in the emergency department.

The researchers also ran an experiment. They gave 109 nurses the same clinical scenario, a patient with back pain rated 9 out of 10, and changed only whether the patient was described as a woman or a man. The nurses rated the pain as less intense when the patient was a woman.

## What this does not prove

Good reporting names the limits, and this study has some.

It looked at two emergency departments. It cannot tell us how every hospital, clinic, or primary care office operates. It was a retrospective analysis of records, and it measured patient sex, not gender identity. The authors interpret the pattern as undertreatment of women’s pain, and they call for policy changes, but a records study cannot show exactly why each decision was made. Those are cautions, not reasons to dismiss the finding.

What the study does show is a measurable difference in how pain was recorded, treated, and timed, even when the patient reported the same level of pain.

## Pain bias is not one story

Women are not one group, and the bias they meet is not one bias.

A widely cited 2016 PNAS study by Kelly Hoffman and colleagues examined a different pattern. It found that Black Americans are systematically undertreated for pain compared with white Americans, and tested whether false beliefs about biological differences between Black and white people play a part. About half of the white medical students and residents in the sample endorsed at least some of those false beliefs. Those who did rated a Black patient’s pain as lower and made less accurate treatment recommendations. Participants who did not endorse the beliefs showed no such treatment gap.

For Black women, these patterns do not take turns. They can overlap.

## The stakes can be life and death

The national maternal mortality data shows how high the stakes can be. According to the CDC’s National Center for Health Statistics, the U.S. maternal mortality rate for 2024 was 17.9 deaths per 100,000 live births, with 649 maternal deaths. The rate for Black women was 44.8, compared with 14.2 for White women, about three times as high.

Be precise about what that figure means. It is a different measure from emergency room pain prescribing, and the report does not explain the reasons for the racial gap. The CDC also notes that yearly rates fluctuate because the number of events is small. What the figure does establish is that for Black women, being heard by the health system is not a matter of comfort. It can be a matter of survival.

Listening can be built into a process. It shouldn’t depend on who is paying attention.

## What would change this

The PNAS authors point to practical fixes: computerized decision-support tools that prompt clinicians to record a pain score for every patient, and greater clinician awareness of sex bias in prescribing. These are proposals, not proven cures, and they need testing.

Notice what kind of solutions they are. They are design changes: a required field, a prompt, a protocol, a measure someone is responsible for tracking. Listening can be built into a process. It does not have to depend on whether an individual happens to be paying attention.

## If you are the patient: questions worth bringing

This is general information, not medical advice, and no one should have to out-prepare a system in order to be treated fairly. But if you are heading into an appointment or an emergency visit, these questions can help put your concerns on the record:

- Can you record my pain level in my chart, and tell me what the plan is for it?
- What do you think is causing this, and what else could it be?
- If we are not treating the pain today, what is the plan, and when should I follow up?
- Can you note my concerns in my record?

If you can, bring someone with you who can take notes and ask follow-up questions.

## The question MB keeps asking

At Melanin Bliss Media, we treat information as care. That means asking who designed the system, who was consulted, who profits, and who has to work around its blind spots.

A process that records women’s pain less often, treats it less often, and keeps women waiting longer is not confused by women. It is failing to listen, and it can be redesigned.

Preference is not complication. Needing to be heard is not being difficult.

Women are not complicated. We are varied. Systems that refuse to see the difference are the complicated part.

Question for you

What is something people call “complicated” when they really mean they never asked women what we need?

[More Health Equity reporting](https://www.melaninblissmedia.com/tag/health-equity/)

## Sources

1. Guzikevits M, et al. “Sex bias in pain management decisions.” *Proceedings of the National Academy of Sciences*, 2024; 121(33): e2401331121\. [doi.org/10.1073/pnas.2401331121](https://doi.org/10.1073/pnas.2401331121?ref=melaninblissmedia.com)
2. Healio. “Women less likely to be prescribed pain medications.” August 13, 2024\. [Healio](https://cm.healio.com/news/primary-care/20240813/women-less-likely-to-be-prescribed-pain-medications?ref=melaninblissmedia.com)
3. Hoffman KM, Trawalter S, Axt JR, Oliver MN. “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.” *PNAS*, 2016\. [PubMed](https://pubmed.ncbi.nlm.nih.gov/27044069/?ref=melaninblissmedia.com)
4. National Center for Health Statistics. “Maternal Mortality Rates in the United States, 2024.” Health E-Stat 113, March 2026\. [CDC](https://www.cdc.gov/nchs/data/hestat/hestat113.htm?ref=melaninblissmedia.com)

*This article provides general reporting and education, not individualized medical advice. If you are in pain or have a medical emergency, contact your clinician or emergency services.*