The hospital’s electronic medical record recently underwent some major upgrades, new code written and uploaded, allowing administration to inch ever closer to their singular goal of making my head explode once and for all as the computers are clunkier, buggier, and more sluggish than ever.

Anyhoo, the cosmetic changes to the interface include a colored backdrop for patient names, the previous generic white now shaded blue for boys and pink for girls.  Although I’d never picked up on this before , the new cotton candy colored screens make it strikingly obvious that the female patients substantially outnumber the males, I’d guess by about 2 to 1.

Why is this I wonder, other than my devastatingly good looks?  Women outlive men by a substantial margin, shouldn’t they be healthier than men and therefore have fewer ER visits?

Then again, women’s reproductive parts are fraught with complications.  Women get pregnant far more often, it’s rare not to see at least a patient or two per shift with some sort of pregnancy issue whether it be cramping, bleeding, nausea, or acute ultrasound deficiency.  The number of women showing up with discharge or painful urination dwarfs their male counterparts.  Ovaries are much more prone to painful problems than testicles.  Tampons and IUD strings get lost.  All in all I’ve learned it’s much riskier being a female.  And that I should have been an accountant.

But men have gender specific diseases too, like trauma, they being far more likely to mangle themselves in various creative ways as compared to women.  The root of the ER gender disparity then, I submit, is found not in the pelvis, but instead laying north within the gray and white matter between the ears.

Women are far more prone to somatization, the process of anxiety or stress manifesting itself as a physical symptom.  Women seem to be wired in such a way that their negative emotions lead directly to chest pains, or abdominal pain, or shortness of breath, or headaches, or diarrhea, or weakness, or dizziness far more often than in men.  The discomfort is real, but the root cause is not physiologic but instead psychosomatic.

And then, women are not only more likely to develop symptoms, but they are more likely to do something about them.  Men prefer to put their heads in the sand, dealing with disease in the same way they handle the homeless guy asking for spare change at a stoplight: by looking the other way and hoping it moves on.  Women are far more proactive, their threshold for seeking medical evaluation significantly lower.  It’s never the husband who drags his unwilling macho wife to the ER to be checked out for this or that.

This is all about populations of course and cannot be applied to individuals — there are plenty of guys who show up with anxiety-induced chest pain scared they’re having a heart attack.  But taken as a whole, and applied over thousands of patient interactions, these differences between the sexes have over time have become more and more apparent to me.  And it’s a factor in what the bulk of emergency medicine is in this country: it’s not about taking care of actual emergencies, it’s about offering reassurance that there isn’t one.