The influence of patient and doctor gender on diagnosing coronary heart disease

Abstract

Using novel methods, this paper explores sources of uncertainty and gender bias in primary care doctors' diagnostic decision-making about coronary heart disease (CHD). Claims about gendered consultation styles and quality of care are re-examined, along with the adequacy of CHD models for women. Randomly selected doctors in the UK and the US (n = 112, 56 per country, stratified by gender) were shown standardised videotaped vignettes of actors portraying patients with CHD. Patients' age, gender, ethnicity and social class were varied systematically. During interviews, doctors gave free-recall accounts of their decision-making, which were analysed to determine patient and doctor gender effects. We found differences in male and female doctors' responses to different types of patient information. Female doctors recall more patient cues overall, particularly about history presentation, and particularly amongst women. Male doctors appear less affected by patient gender but both male and especially female doctors take more account of male patients' age, and consider more age-related disease possibilities for men than women. Findings highlight the need for better integration of knowledge about female presentations within accepted CHD risk models, and do not support the contention that women receive better-quality care from female doctors.

Women and Men with Coronary Heart Disease in Three Countries: Are They Treated Differently?

“…Well-known variations in illness rates by gender are therefore not only a consequence of differences in the biological or behavioral risk structure, but might also be socially constructed (Hor-ton, 2007). In a qualitative work, Adams et al (2007) explored sources of gender bias in the decision making process of primary care doctors in the United Kingdom and United States. During the interviews that were part of the present study, doctors were asked to explain and justify diagnostic and therapeutic decisions for a CHD patient.…”

A contextual approach on sex-related biases in pain judgements: The moderator effects of evidence of pathology and patients’ distress cues on nurses’ judgements of chronic low-back pain

“…Because such models of somatisation (Martin & Lemos, 2002) and more specifically, pain behaviours conveying distress, are more intimately associated with the female stereotype (e.g. Adams et al, 2008;McCaffery & Ferrell, 1992), we have reasons to expect that the influence of the latter on pain judgements depends on the patient's sex.…”

From gender bias to gender awareness in medical education

“…Coronary heart disease is still considered a male disease. In a recent study in primary care conducted in the UK, the view was supported that knowledge about female heart disease is not yet fully integrated into 'received medical wisdom' (Adams et al 2007). In their study, physicians were shown standardized videotaped vignettes and physicians took account of patients' age when diagnosing CHD symptoms in men but not in women.…”

“…Women however present more often than men with atypical symptoms, which means that those findings may underestimate gender bias in CHD diagnosis. In Adams et al (2007) video-vignette study, doctors were more likely to look for psychological cues and search for psychological explanations for key CHD symptoms in women than for symptoms in men. Possibly, when presenting atypical symptoms, women may be even more disadvantaged.…”