Medical students' and residents' gender bias in the diagnosis, treatment, and interpretation of coronary heart disease symptoms.

Chiaramonte, Gabrielle; Friend, Ronald

doi:10.1037/0278-6133.25.3.255

Cited by 77 publications

(67 citation statements)

References 44 publications

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“…Situational aspects may elicit this aspect of gender bias. Underdiagnosis of CHD and underreferral to cardiologists was exposed among American medical students' and residents when women presented typical CHD symptoms in the context of stressful life events (Chiaramonte and Friend 2006). Women however present more often than men with atypical symptoms, which means that those findings may underestimate gender bias in CHD diagnosis.…”

Section: Gender-role Ideologymentioning

confidence: 92%

From gender bias to gender awareness in medical education

Verdonk

Benschop

Haes

et al. 2008

Adv in Health Sci Educ

166

117

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Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was 'gender blind' by not considering gender whenever relevant. Secondly, medicine is said to be 'male biased' because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in

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Section: Gender-role Ideologymentioning

confidence: 92%

From gender bias to gender awareness in medical education

Verdonk

Benschop

Haes

et al. 2008

Adv in Health Sci Educ

166

117

View full text Add to dashboard Cite

show abstract

“…The construction of gender is done in interaction, involving the patient as well as the doctor or other caregivers. There are several examples from research where identical narratives are interpreted in different ways depending on whether the future science group future science group www.futuremedicine.com narrator was male or female [7,19,20,52]. Translated to clinical situations this means that when male and female patients tell their stories, the doctor, nurse or other member of the healthcare staff is inclined to interpret even identical narratives in different ways because of assumptions and preconceived ideas about women and men.…”

Section: Adding Gender Theorymentioning

confidence: 99%

Gender Bias in Medicine

Hamberg

2008

Womens Health (Lond Engl)

246

146

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Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research. Research has shown that different biological processes, anatomies, conditions in daily life, environmental experiences, risk behaviors and responses to stressful events, may all contribute to variation in health and disease in men and women [1-5]. There is also evidence that women, for no apparent medical reason, are not offered the same treatment as men, a phenomenon that raises the question of gender bias. Many studies, for example, show that women are less likely than men to receive more advanced diagnostic and therapeutic interventions [6-11]. The word bias means 'prejudice' or 'distortion' and is a threatening phenomenon in all kinds of research and human activity. When we talk about gender bias in medicine we usually either mean an unintended, but systematic neglect of either women or men, stereotyped preconceptions about the health, behavior, experiences, needs, wishes and so on, of men and women, or neglect of gender issues relevant to the topic of interest. Gender bias has implications in treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender bias is also a relevant issue in the discussion of clinical and academic advancements and careers [12]; however, that aspect is not the focus of this article. Since there is confusion in medicine about the use of the concept of gender [13], my use of the term is presented below.

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“…20,21 Recent experimental research involving advanced medical students found gender bias in the assessment of written vignettes portraying CHD symptoms in 58-year-old female vs. 48-year-old male patients. 19 However, the observed difference was mediated by the context of the patient presentation, such that only when the presentation indicated psychological distress did women receive significantly fewer CHD diagnoses, and the interpretation of symptom origins shifted from organic to psychogenic.…”

mentioning

confidence: 99%

“…17,18 In this context, the extent to which preconceptions about gender and CHD risk influence the initial diagnosis of CHD remains unclear. 19 Overall, epidemiological data suggest that women, particularly younger women, are underdiagnosed as a result of unrecognized symptoms or faulty symptom interpretation. For example, more women than men who died suddenly of CHD were said to have had no previous symptoms, 11 and twice as many women as men aged 45-64 had undetected MIs.…”

mentioning

confidence: 99%

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

Maserejian

Link

Lutfey

et al. 2009

Journal of Women's Health

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Background: Previous studies have documented the underdiagnosis of coronary heart disease (CHD) in women, but less is known about which alternate diagnoses take precedence and whether additional patient factors modify possible gender bias. Objective: To measure gender variation in clinical decision making, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD. Methods: This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. Results: Physicians (n ¼ 128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age ( p ¼ 0.006), but only among middle-aged women were they significantly less certain of the CHD diagnosis ( p < 0.001). Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts ( p ¼ 0.03). An interaction effect showed that females with high SES were most likely to receive a mental health diagnosis as the most certain ( p ¼ 0.006). Conclusions: Middle-aged female patients were diagnosed with the least confidence, whether for CHD or non-CHD conditions, indicating that their gender and age combination misled physicians, particularly toward mental health alternative diagnoses. Physicians should be aware of the potential for psychological symptoms to erroneously take a central role in the diagnosis of younger women.

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Medical students' and residents' gender bias in the diagnosis, treatment, and interpretation of coronary heart disease symptoms.

Cited by 77 publications

References 44 publications

From gender bias to gender awareness in medical education

From gender bias to gender awareness in medical education

Gender Bias in Medicine

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

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