"Don't get your tests done there — they don't have the reagents!" "The tests are expensive there!" Perhaps because... they do have the reagents? Even though I'm insured, some tests aren't "covered" by insurance. Nor by that additional 10% withheld by the government for health. Anyway! I had read, a few days ago, about the congratulations extended to a team at Botoșani County Council, which had coordinated the modernisation of the maternity hospital in the municipality. That's where I decided to go. I knew the professionalism of the ladies at the blood-drawing station from previous occasions, when I'd had tests done. 7:30 in the morning. There were a few people in the waiting room, the air of "new", televisions with labels. A woman started using a hand fan. I took a few steps around that room. Yes, they hadn't installed air conditioning. I sat down on a chair. How could they forget to do this? It's written HUUUGE at the entrance to this institution: "WE HAVE NO AIR!" I started writing these lines. I stopped. Guess what the people in that waiting room were talking about?! You have exactly one possible answer!

Cristian Stancescu — https://www.facebook.com/cristian.stancescu/

The Female Body as a Zone of Risk

Malpractice, Gender Bias, and Medical Gaslighting in Romania

by Petru Cojocaru

"It's nothing, madam. It's stress. It's hormonal. Get some rest." This sentence, spoken in thousands of variations in thousands of medical consulting rooms, has killed women. Not metaphorically. Literally.

This article is part of the series "Body, Family, Country — Three Crises Romania Refuses to Hear."

There is a type of violence that leaves no visible marks and which, precisely for that reason, never makes it into complete statistics. It does not strike, does not bruise, does not tear. It occurs in the quiet of a medical consulting room with white walls, in the presence of a white coat, in the gentle tone of someone who knows better. It is called, in English-language medical parlance, medical gaslighting — and women bear it, disproportionately, throughout their lives as patients.

Before entering the data from studies and malpractice statistics, something simple must be said, almost banal, but which always gets lost in technical debates: the medical system was built, from anatomy to clinical protocols, on the male body. Woman entered that system as a body deviating from the norm — more emotional, more ambiguous, harder to diagnose, more prone to "exaggerating." This is not occasional feminist rhetoric. It is an academically documented reality that costs lives every day.

Obstetrics, Gynaecology, and Emergency — The Specialities Where Women Pay the Highest Price

Romania is no exception in this equation. If anything, it is a case study aggravated by the chronic underfunding of the healthcare system, the overburdening of doctors, outdated infrastructure, and an institutional culture in which the patient — especially the female patient — is a body to be processed, not a person to be listened to.

A retrospective study conducted by researchers in the Moldova region (published in Medicina, MDPI, 2020), analysing 153 malpractice complaints registered with the Commission for Monitoring and Professional Competence between 2006 and 2019, identified obstetrics-gynaecology as one of the most frequently complained-about medical specialities, alongside emergency medicine, general surgery, and orthopaedics-traumatology. It is no coincidence that, of all these specialities, obstetrics-gynaecology is the only one that treats, by definition, exclusively or predominantly the female body.

Lawyers specialising in medical law confirm the data: the most exposed specialities to malpractice are surgery, orthopaedics, and obstetrics-gynaecology — fields in which damages are typically severe, frequently resulting in the death of the patient. In the case of obstetrics, that patient who dies is, not infrequently, the mother. Or the child. Or both.

The figures on maternal mortality in Romania are well known, periodically invoked with alarm, then forgotten with the same promptitude. Romania has, for years, oscillated at the top of the European ranking for maternal mortality. Maternity hospitals in counties such as Botoșani, Vaslui, or Teleorman operate with outdated equipment, insufficient staff, and neonatology departments that cannot sustain premature babies below a certain weight. Malpractice, in this context, is not always the negligence of an individual doctor. It is, most of the time, the result of a system that has decided that the life of a woman in childbirth does not merit the investment needed to protect it adequately.

But beyond the operating theatre and the delivery room, there is another category of malpractice — more subtle, harder to document, and all the more dangerous.

"It's Nervousness, It's Stress, It's Hormonal" — The Anatomy of Medical Gaslighting

The term gaslighting comes from a 1938 British play — Gas Light — in which a manipulative husband systematically tries to convince his wife that the reality she perceives is a product of her sick imagination. Transferred to a medical context, gaslighting describes the experience of patients — predominantly women — whose symptoms are minimised, dismissed, or reframed psychologically by medical staff, without appropriate investigation.

A systematic review published in 2024 on ResearchGate, Psychological Impact of Medical Gaslighting on Women, synthesised the literature from ten independent studies and identified seven recurring themes: denial and dismissal of symptoms, diagnostic delay, negative experiences with health professionals, gender bias in healthcare, psychologisation of physical symptoms, lack of continuity of care, and the devastating psychological impact of these accumulated experiences.

Medical gaslighting can be unconscious, unintentional, and devoid of malice, the authors write — but it remains a reflection of a pervasive and systemic gender bias, and its impact is brutal. Naming this phenomenon does not mean criminalising all doctors. It means recognising that a system of medical training that has for centuries ignored the specific nature of the female body inevitably produces clinicians who operate with diagnostic patterns built on male symptomatology — and who, in the absence of a familiar equivalent, resort to the label of "stress," "anxiety," or "functional hysteria."

The word "hysteria" deserves a parenthetical note. It derives from the Greek hystera — uterus. For centuries, any emotional, painful, or inexplicable manifestation in a woman was attributed to her uterus. The diagnosis of "hysteria" legitimised neglect, forced institutionalisation, electrotherapy, lobotomy. Today, the diagnosis of "stress" or "anxiety" functions, in far too many consulting rooms, as an unofficial successor to the same cognitive reflex: if I don't know what's wrong with this woman, it must be in her head.

Endometriosis — Ten Years of Pain Before Diagnosis

There are diseases that are, in themselves, documents of this systemic bias. Endometriosis is the most eloquent.

Endometriosis affects approximately 10% of women of reproductive age globally — an estimated 190 million people. It causes severe pelvic pain, heavy bleeding, infertility, and dramatically affects quality of life. It is not a rare disease. It is not an obscure disease. It is one of the most common chronic gynaecological conditions.

And yet, data cited by leading American medical sources show that approximately ten million women endured the pain of endometriosis for an average of ten years before the diagnosis was finally made. Ten years in which the pain was minimised, normalised, or attributed to "normal but heavier periods." Ten years in which appropriate investigations — transvaginal ultrasound, diagnostic laparoscopy — were refused or postponed. Ten years in which the woman received painkillers and advice to "tolerate" what her body was signalling as a medical emergency.

In Romania, the situation is aggravated by limited access to specialists in non-oncological gynaecological pathology, the high cost of private investigations, and a medical culture in which "heavier menstrual pain" is considered a variant of normal until proven otherwise. There are no clear national statistics on the average time to diagnosis for endometriosis in Romania — which, in itself, says something about the system's priorities.

The same picture repeats with uterine fibroids, polycystic ovary syndrome, and ovarian cysts: extremely common conditions, with a major impact on quality of life, which are frequently underdiagnosed or diagnosed late, partly because women's chronic pain remains, in current clinical practice, less urgent than men's acute pain.

The Female Heart Attack — How You Die Because You Are Not the Prototype

If endometriosis illustrates gaslighting in gynaecology, cardiology offers perhaps the most dramatic example of the lethal consequences of diagnostic gender bias.

The prototype of the myocardial infarction that everyone knows — violent chest pain, radiating to the left arm, cold sweats — is the male heart attack prototype. Women have heart attacks differently. More frequently with nausea, profound fatigue, back or jaw pain, a diffuse sensation of heaviness in the chest — symptoms that, in the absence of classic pain, do not trigger the cardiac diagnostic reflex in the clinician's mind.

The result is documented: women who suffer a heart attack are seven times more likely than men to be misdiagnosed and sent home during the cardiac event, according to data cited by Texas Tech University/Laura W. Bush Institute for Women's Health. Data from other medical sources confirm that women are 50% more likely than men to be misdiagnosed in the case of heart attack and 33% more likely to be misdiagnosed in the case of stroke.

These figures do not describe isolated errors by incompetent doctors. They describe a systemic failure of representation: triage protocols, cardiovascular risk algorithms, and even internal medicine textbooks were built on data drawn predominantly from clinical studies conducted on men. Women were systematically excluded from the major clinical trials of the 20th century — partly for reasons of "protection" of fertile women, partly for methodological convenience. The consequence is that medicine does not know, to the same degree, how diseases work in the female body — and that, when it does not know, it tends not to see.

A study published in Academic Emergency Medicine and cited by Northwell Health shows that women who presented at A&E with severe abdominal pain waited 33% longer than men with identical symptoms before receiving help. Not because the triage was busier on the days the women presented. But because women's symptoms are, unconsciously, assessed as less urgent, more likely to be psychological, more likely to be exaggerated.

The Systemic Profile of Malpractice in Romania — the Data That Disturbs

A study published in Medicina (MDPI, 2022), conducted on a sample of 1,684 Romanian doctors, identified the profile of the doctor prone to malpractice complaints: male, senior doctor, from surgical specialities, with a higher number of on-call shifts, working in a county or regional hospital. The statistical conclusion — male doctors receive malpractice complaints significantly more frequently than their female colleagues — should not be read as an exoneration of the system, but as an invitation to a deeper question: why do so few female patients file formal complaints, even when they have been harmed?

The answer lies in several layers. First: access to legal information is limited, especially in rural areas and small towns, where women go to the only available doctor, without alternatives and without representation. Second: the malpractice procedure in Romania is, by design, discouraging. Data show that only about 5% of notifications filed with the malpractice monitoring commissions are confirmed by them — the rest are rejected or subsequently end up in court, in a process that can stretch over years. Third, and perhaps most importantly: women who have lived through the experience of medical gaslighting have often internalised the doubt about their own symptoms. If you've been told for years that what you feel is in your head, you end up believing it — or no longer knowing what to believe. And you don't file a complaint, because you're not sure it's worth it, that you're right, that someone will believe you.

Another national study, conducted on 2,978 doctors in Romania, found that fewer than half of medical practices (46.67%) comply with the legislation in force regarding patients' rights — informed consent, confidentiality, the right to a second opinion. Nearly 94% of doctors admit to living with a form of anxiety about malpractice files. This anxiety does not translate, paradoxically, into greater care for the patient — but, often, into defensive medicine that avoids complicated investigations, prolonged consultations, and difficult cases.

Delayed Diagnosis as a Form of Harm — What Recent Research Says

A narrative review published in 2025 in PMC (Gender Bias and Diagnostic Delays in Young Women) synthesised the literature from neurology, cardiology, autoimmune medicine, emergency medicine, and pain medicine, identifying consistent patterns of misattribution of symptoms and diagnostic delay in young women — with consequences including irreversible disease progression, psychological suffering, increased use of healthcare services, and long-term socio-economic consequences.

Autoimmune diseases — lupus, multiple sclerosis, rheumatoid arthritis, Hashimoto's thyroiditis — affect women at a ratio of 3:1 compared to men. And yet, their diagnosis takes, on average, significantly longer than in men. The diffuse, fluctuating, hard-to-objectify symptoms of autoimmune diseases correspond perfectly to the symptom profile that medicine unconsciously associates with the "anxious female personality." Profound fatigue, joint pain, brain fog, sensitivity to light — all are, too often, "stress" or "depression" or "perimenopause," before they are what they truly are: signs of an immune system attacking itself.

Nor does chronic pain escape this pattern. Studies show that women with chronic pain are more frequently prescribed psychiatric treatment rather than analgesic treatment, that painkiller doses prescribed to women are, on average, smaller than those prescribed to men for the same declared pain intensity, and that the time doctors spend evaluating a female patient's pain is shorter. All of these are measurable. All of these are documented. And all of these continue.

Intersectionality — When You Are a Woman and Poor and from the Provinces

Gender bias in medicine does not operate in a vacuum. It overlaps with socioeconomic bias, geographic bias, and cultural bias — and at the intersection of these layers, vulnerability grows exponentially.

A woman from Botoșani, from a village in the Moldavian Plain, with a low income and no car of her own, who presents to the only family doctor in a commune with several hundred patients on the list, is in a radically different position from a woman in Bucharest with private medical insurance and access to polyclinics with modern equipment. Malpractice and medical gaslighting are not democratic. They strike harder where the patient's power — economic, informational, social — is lower.

The Romanian healthcare system reproduces, internally, the same inequalities that structure the social one. The woman with education, with resources, with enough medical vocabulary to articulate her symptoms in terms the doctor recognises has a better chance of being heard. The woman who comes from a rural background, who does not know how to name what she feels, who is intimidated by the white coat and does not dare to contradict, is almost predestined for gaslighting. The system does not see her. And she does not know she has the right to be seen.

This is not an abstract drama. It is the X-ray of what happens in dozens of consulting rooms and A&E departments in northern Moldova every day.

What Should Change — and Why It Doesn't

The solutions exist. They are documented, tested, implemented in other healthcare systems. Gender-sensitive medical training — compulsory courses on how the symptomatology of cardiovascular, autoimmune, and neurological diseases differs in women compared to men — is practised in medical universities in the Netherlands, Sweden, and the United Kingdom. Revised triage protocols that eliminate the unconscious presumption that women's pain is less urgent. Clinical research that is obligatorily balanced by sex — a requirement introduced relatively recently in the US and the EU, but far from fully implemented. Independent malpractice commissions with gender expertise. Education for patients — the right to seek a second opinion, the right to refuse a diagnosis that does not correspond to one's own experience, the right to insist.

Why doesn't it change? Because change involves admitting that the system was wrong. That current protocols contain, structurally, a bias that has harmed and continues to harm. That current medical training has massive gaps regarding women's health. That mortality statistics would look different if these gaps were addressed. Institutions are not good at acknowledging their structural errors. Especially when acknowledgement would involve resources, reforms, and a redistribution of epistemic authority — that is, the right to know what is going on with one's own body — from doctor to patient.

What All This Means for a Woman Who Goes to the Doctor Tomorrow

If you are a woman reading these words, what follows is not a call for paranoid distrust of your doctors. The great majority of doctors are people who try, in difficult conditions, to do good. But they are people trained in a system with real gaps — and you have the right to know this.

You have the right not to accept a diagnosis of "stress" or "anxiety" without prior, documented exclusion of organic causes. You have the right to request further investigations. You have the right to a second opinion — even if your doctor has not informed you that this right exists (and, according to studies, not even 53% of Romanian doctors do so systematically). You have the right to keep a symptom diary — with dates, intensity, context — that helps you articulate them coherently in the consulting room. You have the right to bring someone with you to the appointment, to support what you describe.

And if you feel you have been seen as a dramatic woman, rather than a patient with real symptoms — that feeling matters. It is not always evidence of malpractice. But it is always information about your experience, and your experience counts.

Conclusion: The Female Body Is Not an Anomaly to Be Treated

I return to the sentence I started from: "It's nothing, madam. It's stress. It's hormonal."

This sentence kills women. Not out of malice, most of the time. Out of inertia. Out of insufficient training. Out of time pressure — eight-minute consultations do not allow for nuanced diagnoses. Out of the infrastructure of a system that has decided, implicitly, that women's health is less urgent, less complex, less worthy of investment.

Medical malpractice against women is not a marginal phenomenon. It is a structural phenomenon, rooted in the history of medicine, in the unconscious biases of clinical training, in the underrepresentation of the female body in medical research, and in the institutional culture of a healthcare system that remains, in too many respects, built for and around the male norm.

Naming it does not mean destroying medicine. It means perfecting it. It means making it what it claims to be: a science of healing people — all people, not just half of them.

Petru Cojocaru is the founder of ABSOLUT WEB EXPERT SRL and writes analytical essays on cojocarupetru.info. This article is part of the series "Body, Family, Country — Three Crises Romania Refuses to Hear."

This article was produced with editorial AI assistance (Claude, Anthropic), in accordance with the author's declared transparency policy.

Sources and Bibliography

1. Medicina (MDPI), 2020 — Reasons for and Facilitating Factors of Medical Malpractice Complaints — https://doi.org/10.3390/medicina56060259
2. Medicina (MDPI/PMC), 2022 — Socio-Demographic, Professional and Institutional Characteristics That Make Romanian Doctors More Prone to Malpractice Complaints — PMC8878102
3. PMC/NCBI, 2023 — Geographic and Specialty-Specific Disparities in Physicians' Legal Compliance: A National-Scale Assessment of Romanian Medical Practice — PMC9957268
4. PMC, 2025 — Gender Bias and Diagnostic Delays in Young Women: A Narrative Review — PMC12829432
5. ResearchGate, 2024 — Psychological Impact of Medical Gaslighting on Women: A Systematic Review
6. Psychology Today, 2022 — How Women Suffer Medical Gaslighting — psychologytoday.com
7. CNN Opinion, 2023 — Medical Gaslighting: Medicine's Gender Problem, Diane O'Leary — cnn.com
8. Northwell Health / Katz Institute for Women's Health — Gaslighting in Women's Health: When Doctors Dismiss Symptoms — northwell.edu
9. Texas Tech / Laura W. Bush Institute for Women's Health, 2022 — Women's Health Needs Help — dailydose.ttuhsc.edu
10. Wikipedia (academic synthesis) — Gender Bias in Medical Diagnosis — with the academic sources cited there
11. LEW.RO, 2025 — Diagnostic Errors and Medical Malpractice — lew.ro
12. Lawyer Andrei Tărău — What Are the Most Frequent Malpractice Cases in Romania? — tarau.ro

Other articles in the series:

• Family — A Sacred Institution, Invisible in Local Media
• The Female Body as a Zone of Risk
• The Figures of a Disaster Foretold

Notes on the adaptation

• "AER" (Cristian Stancescu's short piece): The Romanian wordplay — "Scrie maaare... NU AM AER!" — translates literally as "It's written HUUUGE... WE HAVE NO AIR!" In Romanian, "a nu avea aer" means both "to have no air conditioning" and, colloquially, "to be clueless/out of touch." This double meaning underpins the irony. I've preserved the literal translation as it carries the same sarcastic force in British English ("WE HAVE NO AIR!" being both absurdly literal and darkly funny).

• "Gaslighting medical" → "Medical gaslighting" — already an established term in English-language medical discourse, requiring no adaptation.

• "Comisia de monitorizare și competență profesională" → "Commission for Monitoring and Professional Competence" — translated directly as it refers to a specific Romanian institutional body.

• "Medicină defensivă" → "Defensive medicine" — the established English medical-legal term.

• "A&E" is used for urgjență/urgență in the British context (Accident & Emergency), which is the standard UK equivalent.

• "Ceața mentală" → "Brain fog" — the commonly used English term for this symptom, more natural than the literal "mental fog."

• All medical terminology (transvaginal ultrasound, diagnostic laparoscopy, Hashimoto's thyroiditis, polycystic ovary syndrome, etc.) is rendered in standard British English medical usage.

• Romanian institutional references (Botoșani, Vaslui, Teleorman, Moldova region) are retained with brief contextual cues where helpful for an international reader.