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Pain has no color, no gender, no origin. It passes through bodies without a passport. Yet its recognition sometimes seems to be filtered.
The “Mediterranean syndrome” is not a diagnosis. It doesn’t appear in medical manuals. Emerging in hospital slang between the 1970s and 1990s, the expression referred to patients perceived as “being from North Africa or southern Europe” and judged them as “noisy” or “too expressive,” accusing them of exaggerating their symptoms and perception of pain.
But behind this label lies a well-oiled machine based on discrediting patients’ testimonies. Inherited from a colonial mindset by which non-white bodies were perceived as “other,” this categorization continues to haunt medical practice and remains a powerful bias today, at the intersection of racism and sexism.
When bias becomes practice: White men are believed more than Black women
The data supports this observation. According to an analysis published in The Journal of Pain, women wait on average 25% longer than men to receive pain relief in the emergency room, even when reporting equivalent levels of pain.
The European Journal of Emergency Medicine published a 2024 study showing that, with identical symptoms, 62% of male cases are classified as life-threatening emergencies compared to 49% for women.
The gap is also significant according to perceived ethnicity, with 58% for white patients versus 47% for Black patients. In the most contrasting situations, a white man has approximately 50% higher chances of being considered as requiring a life-threatening emergency response compared to a Black woman.
Finally, the Defender of Rights (the administrative authority responsible for defending citizens’ rights) has also, in several reports, raised concerns about persistent discrimination in access to healthcare: refusals of care, longer waiting times, and the minimization of patients’ complaints.
Women wait on average 25% longer than men to receive pain relief in the emergency room, even when reporting equivalent levels of pain.
“They decided, without proof, that she was exaggerating”: The words of a doctor
Dr. Maïssa, a committed general practitioner and health content creator based in La Réunion and specialized in nutrition and women’s health, recounts an episode that marked her during her years of training in a gynecology department. An African patient, operated on for a hysterectomy, was complaining of persistent pain. For days, her symptoms were downplayed by several resident doctors. It was only after the intervention of a senior surgeon that an intestinal obstruction, a surgical emergency, was diagnosed.
“They had decided, without any proof, that she was exaggerating… I was never taught about the ‘Mediterranean syndrome’ in my training. But when I shared this memory on TikTok, many nurses commented and said that it is still being taught in courses. It’s a disgrace… this bias isn’t anecdotal,” she states.
“A 2024 study by the Montpellier University Hospital showed that, faced with the same presentation of chest pain, more than 1,500 healthcare professionals assessed the situation as less severe when the patient was a woman or a Black person. Women were systematically deemed less urgent than men. And when they were also perceived as being of foreign origin, the gap widened even further. What this patient experienced in that hospital corridor was not an isolated incident. It was, without people realizing it, the everyday face of discrimination ingrained in the subconscious of many healthcare workers,” she adds.
“Relieving pain is a fundamental right. We have the means to do so. Every patient should be heard, believed, and treated with the same high standards.”
“He’s quick to call for help”
Mathilde* is a surgical oncology nurse in northeastern France. Her testimony also puts concrete words to these invisible mechanisms.
“During my training and later my career, I encountered what is called the ‘Mediterranean syndrome.’ I first heard this term during my internship. I didn’t even know it existed. Then I realized how widespread it was. This term circulates among healthcare professionals, sometimes implied, sometimes explicitly stated. I’ve heard it from nurses, nursing assistants, physiotherapists, even doctors,” she says.
“In practical terms, it appears mainly in pain management. I’ve already heard colleagues say things like, ‘He’s quick to call for help,’ ‘We can’t seem to relieve his pain,’ ‘He’s probably overdoing it… you know, the Mediterranean syndrome,’” Mathilde adds.
“Of course, these remarks aren’t systematic. The majority of healthcare professionals remain deeply humane and committed,” Mathilde states. “But they are frequent enough to raise alarm. What strikes me is that this term is often associated with patients because of their appearance or name. I have seen these situations involve people with North African, Spanish, Portuguese, or eastern European surnames. For me, this reflects systemic racism. And its consequences are concrete: the patient’s word is more easily doubted, their pain minimized, sometimes ridiculed. Yet relieving pain is a fundamental right. We have the means to do so. Every patient should be heard, believed, and treated with the same high standards.”
The double burden of racialized women
At the intersection of these biases, some patients experience compounded inequalities.
Being a woman already increases the risk of having one’s pain underestimated. Being perceived as “non-white” adds another layer of suspicion. Together, these biases create a double burden: weakened communication, a body less listened to, suffering more often minimized—and the consequences are not theoretical. They translate into delayed diagnoses, unrelieved pain, and a lasting loss of trust in the healthcare system.
This is corroborated by what two patients, Anaïs and Léa, describe.
Anaïs*, 22, says that she has suffered from ENT problems since childhood: recurrent ear infections, perforated eardrums, and several surgeries to restore her hearing. But since becoming an adult, she describes a sudden shift in her care. Now alone in front of the medical system, she constantly has to “prove” her pain.
“I have to convince them that I’m in pain… a lot, a lot of pain!” she laments. Despite a lengthy medical history, her complaints are regularly dismissed. “It doesn’t hurt,” “there’s nothing wrong with you,” “just take some paracetamol,” is the regular response, even when she insists she’s in intense pain or losing her hearing again. The situation sometimes leads her to leave consultations in tears.
It was only during an emergency, one Christmas morning, that a serious diagnosis was made: a perforated eardrum, infection, and fever. The procedure revealed a severely damaged ossicle, requiring extensive surgical reconstruction. Yet even after the operation, pain management remained minimal, limited to anti-inflammatories and paracetamol.
Through her experience, Anaïs describes a healthcare system where the patient’s word, particularly that of a young woman of foreign origin, is perceived as “illegitimate” and must constantly be justified in order to be heard and taken seriously.
Léa became pregnant young, and she had really wanted the pregnancy. She was overjoyed. But three weeks before her due date, her gynecologist informed her that labor would be induced the following day, citing internal scheduling issues. The patient expressed her disagreement.
During the examination, the practitioner deliberately induced cervical dilation without Léa’s explicit consent. “I’ve dilated your cervix, see you tomorrow for induction,” she was told, simply.
Looking back, Léa wonders, “The gynecologist induced my labor to fit her schedule, without giving me a choice… I don’t think she would have dared to do the same thing to an older, white woman.”
Providing care differently: An ethical and, above all, vital imperative
The “Mediterranean syndrome” is therefore not an isolated error. It’s a symptom of an entire system in which biases, sometimes unconscious, still shape clinical practice. To deconstruct them we must first name them. Training healthcare professionals in cognitive biases, integrating issues of discrimination into medical curricula, and valuing patient listening as an essential clinical tool are all levers for bringing about lasting change in practices. Because behind every ignored pain is a person who doubts they will be believed, and a medical system that, at that precise moment, ceases to be universal.
Notes
* Mathilde and Anaïs have requested anonymity.
