How seriously are women's presenting symptoms taken? (original) (raw)
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Differences in clinical communication by gender
Journal of General Internal Medicine, 1999
esearchers have reported contradictory findings re-R garding gender bias in diagnosis and treatment. The majority of findings indicate no such bias, but a sizable literature exists indicating that physicians make more diagnostic errors and initiate less-aggressive interventions with women than with men."? Recent changes, such a s making treatment protocols more sex-specific and including women in major drug trials, have reduced the disparity in treatment, but they have not eliminated it.14 l6 According to an American Medical Association Task Force on Gender Disparities in Clinical Decision-Making, I7 the most common explanation for diagnostic errors observed with women patients is clinicians' readiness to attribute women's symptoms to "overanxiou~ness."~~ Many physicians might assume that the presence or absence of positive test results provides a reliable criterion for separating women with emotional or psychological disturbances from those with organic disease, but this assumption is not supported by research. Women continue to be diagnosed a s overanxious even in the presence of positive test results. l7 The difficulty that physicians experience in correctly evaluating the seriousness of women's symptoms, and evidence that the manner in which the symptoms are reported may be relevant for understanding treatment bias, prompted our investigation of communication differences. This essay reviews what is known about gender differences in communication and explores the extent to which those differences might be implicated in the reported gender bias in clinical diagnosis and treatment. We then address alternative explanations proposed to account for differences in diagnosis and treatment by sex and the research needed to clarify both the disparity and the role of communication in it.
Teaching Gender, Teaching Women's Health: Introduction
Women & Health, 2003
There is an increasing, widespread awareness of the ways in which both biology and culture-sex and gender-affect the risks and prevalence of disease, and health outcomes, of men and women. In a recent issue of the American Journal of Obstetrics & Gynecology, for example, Phillips (2002) drew attention to the need for systematic teaching of gender, as an essential and integral component of medical training, and identified specific educational objectives along these lines. Others have made similar points of the need to incorporate sociological factors such as gender, and other variables such as age and class, in order to ensure appropriate care: Goldstein (2002) makes this same point with respect to the assessment and treatment of mental illness in primary care settings. This awareness coincides with the increase in absolute numbers and proportion of women entering medical school. This trend is virtually worldwide, the result of general trends in gender equity, changes in secondary and pre-medical tertiary education, the encouragement of women into various fields of medicine previously dominated by men, and the demand by women patients for women general practitioners. By the mid 1980s, in countries such as the United States, the number of women enrolling at commencement of a medical
Women's health care issues for medical students: An education proposal
Women's Health Issues, 1996
oices from social, legislative, medical, and educational institutions have expressed dissatisfaction with the current level of general physician competence to deal with women's health issues. In her 1993 article, White described an extremely low level of awareness of issues related to women's health promotion and disease prevention among internal medicine housestaff in her teaching hospital.' Review of hospital admission records of 120 patients revealed notations of tobacco use and rectal examinations on 97% and 72% of charts, whereas histories of Papanicolaou smears and mammograms were noted on only 5%and 4% of the charts. Breast examinations were performed by housestaff on only 33% of patients. The author surmised that "perhaps the housestaff's undergraduate medical training did not standardize consideration of women's health issues as part of the routine patient history and physical examination taught in clinical preparation courses." Similarly, Conway reported relatively low levels of knowledge regarding preconception care among internal medicine resident physicians at Cook County Hospital.' Congresswoman Lowey has described the teaching of women's health as being "fragmented and disjointed throughout the educational process," resulting in gaps in physicians' knowledge about the special health needs of women. She calls for a goal of "educating all physicians in the full range of women's health issues" and proposes that medical schools "be examined with respect to content of curricula for gender differences in disease 0 1996 by The Jacobs Institute and optimal teaching of women's health.
2020
Background: Gender bias induces gender inequality in health. In this study, we evaluated gender bias during a local objective structured clinical examination (OSCE). Methods: We assessed gender bias by using two clinical cases-generalized anxiety disorder (GAD) and ascending aorta dissection (AAD)-during an OSCE performed among fth-year medical students. For each situation, half of the students encountered male and half encountered female standardized patients (SPs). Except for gender, variables were identical in each clinical case. Patients, students, and examiners were blinded to the purpose of the study. Medical history, clinical examination, diagnosis, and management were compared between male and female SPs. The interaction between student and SP gender was analyzed. Results: A total of 110 medical students were observed (55% women). For GAD, students arrived at the correct diagnosis more often for female SPs than for male SPs (diagnosis completed, partially completed, and not completed in 47%, 16%, and 36%, respectively, of female SPs vs. 22%, 20%, and 58%, respectively, of male SPs, p = 0.02). The nature of their symptoms was more often asked of male SPs (completed, partially completed, and not completed in 51%, 4%, and 0% of male SPs, respectively, vs. 38%, 17%, and 0% of female SPs, respectively, p = 0.002), and associated physical symptoms were more often explored in female SPs (completed and not completed in 84% and 16% of female SPs, respectively, vs. 65% and 35% of male SPs, respectively, p = 0.03). For AAD, an emergency was better identi ed in female SPs (95% identi ed in female SPs vs. 76% in male SPs, p = 0.005) and examination of femoral pulses was more often performed in female SPs (88% completed in female SPs vs. 54% in male SPs, p < 0.0001). The interaction between SP and student gender was not signi cant. Conclusion: The gender bias observed supports the need to address unconscious biases and to raise student awareness of gender stereotypes likely to lead to underrecognition or subtreatment of disease in patients of both genders.
Women and Medical Sociology: Invisible Professionals and Ubiquitous Patients
Sociological Inquiry, 1975
Recently, one of my honors students wrote a paper on the socialization of doctors (Lancey, 1974). A feminist, she used the generic ''she" throughout, which I found incongruous because I remembered the published studies of medical education as concentrating exclusively on men. When I reviewed both the classic and more recent sociological studies of medical training for this paper Mei-ton et al., 1957; Miller, 1970; Mumford, 1970), my memory was confirmed: Women were virtually invisible.
BMC Family Practice, 2015
Background: Biological and sociocultural differences between men and women may play an important role in medical treatment. Little is known about the awareness of these differences among general practitioners (GPs) and if they consider such differences in their medical practice. The aim of this study was to explore GPs' perception of sex and gender aspects in medical treatment. Methods: We conducted five focus group discussions (FGDs) with 29 physicians (mainly GPs) in Sweden. A discussion guide with semi-structured questions was used. All FGDs were audio-recorded and transcribed word-byword. Data were analysed through inductive thematic analysis with no predetermined categories. Results: Three main categories emerged from the data. The first category emphasised GPs' experiences of sex and gender differences in diagnosing and assessment of clinical findings. Medical treatment in men and women was central in the second category. The third category emphasised GPs' knowledge of sex differences in drug therapy. Conclusions: The GPs stated they had little knowledge of sex and gender differences in drug treatment, but gave multiple examples of how the patient's sex affects the choice of treatment. Sex and gender aspects were considered in diagnosing and in the treatment decision. However, once the decision to treat was made the choice of drug followed recommendations by local Drug and Therapeutics Committee, which were perceived to be evidence-based. In the analysis we found a gap between perceived and expressed knowledge of sex and gender differences in drug treatment indicating a need of education about this to be included in the curriculum in medical school and in basic and specialist training for physicians. Education could also be a tool to avoid stereotypical thinking about male and female patients.
Health-Related Behaviors of Women Physicians vs Other Women in the United States
Archives of Internal Medicine, 1998
To examine the health-related behaviors of women physicians compared with those of other women of high and not high socioeconomic status and with national goals. Methods: We examined the results of a questionnairebased survey of a stratified random sample, the Women Physicians' Health Study, and a US telephone survey (Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention, Atlanta, Ga). We analyzed 3 samples of women aged 30 to 70 years: (1) respondents from the Women Physicians' Health Study (n=4501); (2) respondents from the Behavioral Risk Factor Surveillance System (n=1316) of the highest socioeconomic status; and (3) all other respondents from the Behavioral Risk Factor Surveillance System (n=35 361). Results: Women physicians were more likely than other women of high socioeconomic status and even more likely than other women not to smoke. The few physicians (3.7%) who smoked reported consuming fewer ciga
The professional attitudes and clinical practices of men and women generalists
Canadian family physician Médecin de famille canadien, 1989
Data from a 1983-84 Quebec generalists' survey were used to compare the professional attitudes and clinical practices of women physicians with those of their male colleagues. The survey was conducted on a random sample of 736 Quebec generalists and achieved a 83.7% response rate. Analyses were performed separately for fee-for-service physicians and for salaried physicians working in local community health centers (CLSCS). Results showed more gender differences among fee-for-service physicians than among salaried physicians. Women in private practice were more likely than their male colleagues to value the multidisciplinary, social, and humanistic aspects of patient care. For their part, women salaried physicians reported being significantly more involved in the social and preventive dimensions of health care than their male colleagues. Important attitudinal differences were observed between fee-for-service and salaried generalists, regardless of gender. This study suggests that ...
Gender and Symptoms in Primary Care Practices
Psychosomatics, 2003
The authors sought to explore gender differences among patients with physical symptoms who came to see internists. The women were younger, more likely to report stress, endorsed more "other, currently bothersome" symptoms, were more likely to have a mental disorder, and were less likely to be satisfied with their care. The men were slower to improve, but there was no difference between the sexes after 3 months. There were no differences in the number, type, duration, or severity of symptoms or in the expectation of care, costs of visits, intervention received, use of health care services, or likelihood of being considered difficult by their physician. The gender of the clinician had no effect on any outcome.