A Comprehensive Assessment of Family Physician Gender and Quality of Care

Dahrouge, Simone; Seale, Emily; Hogg, William; Russell, Grant; Younger, Jaime; Muggah, Elizabeth; Ponka, David; Mercer, Jay

doi:10.1097/mlr.0000000000000480

Cited by 104 publications

(45 citation statements)

References 46 publications

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“…Female GPs were almost twice as likely to request urgent review as their male counterparts and this finding has been seen to a lesser extent in Canadian literature. Three papers found that female primary care physicians made 8% more referrals and were 12 and 15% more likely to refer than males [17][18][19]. The significance of the finding in the present study is not apparent but previous papers have discussed whether this gender disparity represents more appropriate management by female physicians or excessive use of investigations and healthcare resources [19].…”

Section: Discussioncontrasting

confidence: 46%

Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners

et al. 2020

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Background: Lung cancer is the leading cause of cancer mortality in Australia. Guidelines suggest that patients with suspected lung cancer on thoracic imaging be referred for urgent specialist review. However, the term "suspected" is broad and includes the common finding of lung nodules, which often require periodic surveillance rather than urgent invasive investigation. The British Thoracic Society recommends that a lung nodule with a PanCan risk > 10% be considered for invasive investigation. This study aimed to assess which factors influence general practitioners (GPs) to request urgent review for a lung nodule and if these factors concur with PanCan risk prediction model variables. Methods: A discrete choice experiment was developed that produced 32 individual case vignettes. Each vignette contained eight variables, four of which form the parsimonious PanCan risk prediction model. Two additional vignettes were created that addressed haemoptysis with a normal chest computed tomography (CT) scan and isolated mediastinal lymphadenopathy. The survey was distributed to 4160 randomly selected Australian GPs and they were asked if the patients in the vignettes required urgent (less than two weeks) specialist review. Multivariate logistic regression identified factors associated with request for urgent review. Results: Completed surveys were received from 3.7% of participants, providing 152 surveys (1216 case vignettes) for analysis. The factors associated with request for urgent review were nodule spiculation (adj-OR 5.57, 95% CI 3.88-7.99, p < 0.0001), larger nodule size, presentation with haemoptysis (adj-OR 4.79, 95% CI 3.05-7.52, p < 0.0001) or weight loss (adj-OR 4.87, 95% CI 3.13-7.59, p < 0.0001), recommendation for urgent review by the reporting radiologist (adj-OR 4.68, 95% CI 2.86-7.65, p < 0.0001) and female GP gender (adj-OR 1.87, 95% CI 1.36-2.56, p 0.0001). In low risk lung nodules (PanCan risk < 10%), there was significant variability in perceived sense of urgency. Most GPs (83%) felt that a patient with haemoptysis and a normal chest CT scan did not require urgent specialist review but that a patient with isolated mediastinal lymphadenopathy did (75%). Conclusion: Future lung cancer investigation pathways may benefit from the addition of a risk prediction m9odel to reduce variations in referral behavior for low risk lung nodules.

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Section: Discussioncontrasting

confidence: 46%

Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners

et al. 2020

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“…[12][13][14][15] Patients of female primary care physicians also experience fewer emergency department visits compared with patients of male primary care physicians. 38 Data from other industries suggest that men may be less deliberate in their approach to solving complex problems. [39][40][41] If these findings also apply to how male and female physicians approach clinical problems and decisions, these patterns of behavior may provide a plausible mechanism linking physician sex with patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians

2017

Br Dent J

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“…Taken together, these two factors likely indicate that it is difficult for obstetricians to empathize with their patients. Although not specific to gynecological, infertility, and/or obstetric care, multiple recent studies have demonstrated that patients of female physicians fare better mentally and emotionally than patients of male physicians [94–95]. However, the ability of male obstetricians to empathize with their pregnant patients may be affected, not just by firsthand experience, but also by vicarious experience.…”

Section: Implications For Practice Institutional and Public Health Pmentioning

confidence: 99%

Age-Based Reproductive Healthcare Stereotype Threat (HCST) as a Stressor Affecting Prenatal Mental Health in Pregnant Women of Advanced Maternal Age: Measurement, Process, Outcomes, and Interactions with Ethnicity/Race, SES, and Other Social Identities

Abdou

2017

Curr Epidemiol Rep

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Purpose of Review Reproductive health, and pregnancy more specifically, is the first critical link between generations. Beginning with this first critical link, pregnancy acts as a domino, affecting the expression of genes and determining the lifespan mental and physical health and reproductive potential of offspring and, likely, of subsequent generations. Given the powerful intergenerational domino that is pregnancy, the development of innovative models to enhance reproductive health and outcomes is an invaluable public health investment. Recent Findings While U.S. pregnancy and birth outcomes have improved dramatically since the 1960s— including substantial progress within the past 15 years, largely catalyzed by the Healthy People initiative—group-based disparities remain. What’s more, social change and medical advancements have led to an evolving window of female reproductive age. Despite becoming more common, being an older expectant mother remains a stigmatized social identity. The concept of healthcare stereotype threat (HCST) is introduced in relation to reproductive health. Stereotype threat is a situational predicament in which an individual who possesses a stigmatized social identity fears confirming negative group-based stereotypes. HCST is a healthcare-specific form of stereotype threat, arising out of stereotypes that are salient in healthcare settings. It is hypothesized that the experience of age-based reproductive HCST is an overlooked stressor affecting prenatal mental and physical health among women of advanced maternal age. Summary The hypothesized process of age-based reproductive HCST is described; outcomes and consequences are discussed; interactions with ethnicity/race, SES, and other aspects of social identity are considered; and strategies for prevention and intervention are explored, including active and passive shifts in three areas: (1) internally, in both providers and patients; (2) in the external environment, or the physical healthcare setting itself; and (3) within interpersonal interactions that occur within healthcare settings, particularly between physicians and patients. Implications for gynecological, infertility, and obstetric care and improving the reproductive outcomes of older women are discussed.

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A Comprehensive Assessment of Family Physician Gender and Quality of Care

Abstract: The indicators assessed in this study point to a benefit for patients under the care of female physicians. Potential explanations are discussed.

Cited by 104 publications

References 46 publications

Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners

Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners

Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians

Age-Based Reproductive Healthcare Stereotype Threat (HCST) as a Stressor Affecting Prenatal Mental Health in Pregnant Women of Advanced Maternal Age: Measurement, Process, Outcomes, and Interactions with Ethnicity/Race, SES, and Other Social Identities

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