Physician gender as a source of implicit bias affecting clinical decision-making processes: a scoping review

Abstract

Background The demographic profile of practicing physicians is changing as more female medical students are graduating and practicing in the field. While the education received may not differ by gender, studies have shown that physician practice outcomes vary by provider gender. Various factors could contribute to these differences, including culture and explicit biases which may lead to implicit bias. This study aims to identify the available evidence of gender-based implicit bias throughout the delivery process of medicine. Methods This scoping review evaluated published literature within the PubMed, Ovid MEDLINE, PsychINFO, Web of Science, and BioMed Central databases pertaining to physician’s gender as a factor in the delivery of medicine. Arksey and O’Malley’s six-stage methodology was used as a framework and reported using the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches occurred between May 2020 and June 2020, and the timeframe was not limited. Included articles had gender as a factor in the delivery of medicine and implicit bias. Articles were excluded if they did not include the gender of the physician. After screening by reviewers and a medical librarian, study characteristics were charted and analyzed. Results The initial search resulted in 2420 records. After screening, 162 of the records were selected based on title and keyword relevance. After additional screening, 15 records were ultimately included in the review based on full-text evaluation. Records were organized into sub-topics post hoc focused on clinical qualities, diagnostics, treatment, and outcomes. Conclusion This scoping review found that gender-based implicit bias may be inadvertently acquired from culture and education. Although implicit bias is highly researched, much of the current literature focuses on the gender of the patient. This study found important gaps in the available literature regarding race and gender of the physician. Further studies could explore outcome differences between recent graduates and career physicians, for both female and male physicians.

A cross-sectional analysis of health literacy: patient- versus family doctor-reported and associations with self-efficacy and chronic disease

“…This difference suggests that male and female doctors may have different perceptions about health literacy of male and female patients. This finding is concordant with other studies observing differences in clinical judgements regarding male and female patients based on physicians' sex [46].…”

Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review

“…Testing and referral decisions may be driven by aspects of PCP gender as opposed to sex, but empirical evidence for the effect of sociocultural vs biological factors is lacking. 83 Since suboptimal decisions to investigate cancer are likely precipitated by a combination of factors, 84 future research should examine possible interactions between PCP factors (and patient and health system factors). This is pertinent given the potential for reverse causality among some PCP factors.…”

“…Disentangling the potential involvement of such components for ‘clinical judgement’ and ‘gut feeling’ could foster more understanding of these constructs and facilitate identification of factors to target in future interventions. Testing and referral decisions may be driven by aspects of PCP gender as opposed to sex, but empirical evidence for the effect of sociocultural vs biological factors is lacking 83. Since suboptimal decisions to investigate cancer are likely precipitated by a combination of factors,84 future research should examine possible interactions between PCP factors (and patient and health system factors).…”

The Person’s Care Requires a Sex and Gender Approach

“…Social skills strongly influence professional–patient relationships, and this could influence diagnostic and therapeutic decisions [ 166 ]. Notably, sex–gender influences the relationship between professionals and patients [ 38 , 167 , 168 , 169 , 170 ].…”

“…A small but statistically significant decrease in 30-day mortality was observed in surgically operate females by female physicians [ 6 ] and in elderly hospitalized patients when treated by female internists [ 172 ]. Many other examples can be found in the recent review of Champagne-Langabeer and Hedges [ 166 ]. The above data suggest that physician/patient dyads of the opposite sex could change the outcomes, and the benefits of the same sex–gender dyad seem most evident in female patients.…”