When Ballering worked on a feminist foreign policy during her previous job at the Ministry of Foreign Affairs, she realised that there is also much to be gained in the Netherlands in women's health care. Later, in 2019, when the vacancy for a PhD on health inequalities between women and men comes online, she knows for sure: this is something I should go for.
Ballering investigated the differences between men and women in physical health conditions that are common, from the moment someone develops symptoms to the consultation room at the GP's office. To do so, she used health data from Lifelines biobank and FaMe-net, a registration network of GPs who register everything anonymously on a total of more than 32,000 patients.
These include headaches, back pain, muscle aches, nausea and fatigue, symptoms that everyone has at one time or another, but persist longer in some people. She found big differences between women and men. 'Women experience more and longer-lasting complaints than men, women seek help for their complaints more often, and also receive different care when they go to the GP with the same complaints.'
These include headaches, back pain, muscle aches, nausea and fatigue, symptoms that everyone has at one time or another, but persist longer in some people. She found big differences between women and men. 'Women experience more and longer-lasting complaints than men, women seek help for their complaints more often, and also receive different care when they go to the GP with the same complaints.'
The latter was what Ballering found most striking. 'For example, women are less likely to receive physical examination, an X-ray or ultrasound, and are less likely to be referred to a specialist when they present with physical complaints, such as respiratory symptoms, than men. Women are more likely to receive laboratory tests: taking blood samples or submitting urine to the GP.' Because of these differences in diagnostic tests, women with physical complaints have a 6 per cent lower chance of being diagnosed with a disease. They are more likely to receive a symptom diagnosis, such as 'patient has a persistent headache'. 'Women's complaints therefore remain unexplained more often.'
So do GPs take men more seriously? According to Ballering, this is not necessarily so. 'My research also shows that when GPs do an ultrasound or X-ray on women, they are less likely to come up with a disease diagnosis. Based on that clinical experience, GPs probably make the choice to use this kind of examination less in women.'
Social stereotypes and associated prejudices also play a role. 'A man with complaints is expected to be strong, while it is more socially acceptable for a woman to go to the GP with complaints. It is thought that men have complaints for longer and go to the GP at later stages. As a result, the complaints may already be more developed and the need to act is greater.' Everyone knows these societal stereotypes, so GPs may also unconsciously bring these gender biases into their work.
There is not yet enough attention to gender and sex differences in medical education either, Ballering believes. 'So it is not the fault of GPs, but it is important that they become more aware of this and check with themselves whether they are influenced by stereotypes. Those stereotypes are not necessarily justified and can also work against good care.'
The fact remains that women walk around with persistent physical complaints. How can care for women be improved? According to Ballering, it is time to investigate whether the current diagnostic criteria at GPs are still accurate enough. After all, up to 20 years ago, men were the benchmark in medical scientific research. 'But a woman is not a modified version of a man.'
Ballering received a Rubicon grant from the Dutch Foundation for Scientific Research (NWO) shortly after sh obtained her PhD. This will allow her to continue her research on gender differences in persistent physical complaints at Ghent University. There, she will investigate the stigmas that exist around men and women with persistent physical complaints. A stigma is a negative prejudice based on a stereotype. Such stigmas can worsen symptoms or make people wait longer before seeking help. With her research, Ballering will identify differences between women and men in stigmatization of persistent medically unexplained symptoms, to aid adequate and gender-sensitive interventions that reduce and prevent health-related stigmatization.
Rubicon funding allows scientists to do research at a foreign research institute for up to 24 months. For many scientists, experience abroad is an important step in their career. The Rubicon grant enables young researchers to conduct research at a foreign institute that offers the best environment for the research.
