Gender in medical encounters: an analysis of physician and patient communication in a primary care setting

The Impact of Trainee and Standardized Patient Race and Gender on Internal Medicine Resident Communication Assessment Scores

BACKGROUND

Standardized patient (SP) encounters are commonly used to assess communication skills in medical training. The impact of SP and resident demographics on the standardized communication ratings in residents has not been evaluated.

OBJECTIVE

To examine the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during postgraduate year (PGY) 1.

METHODS

We performed a retrospective cohort study of all SP assessments of IM PGY-1 residents for a standardized communication exercise from 2012 to 2018. We performed descriptive analyses of numeric communication SP ratings by gender, race, and age (for residents and SPs). A generalized estimating equation model, clustered on individual SP, was used to determine the association of gender (among SP and residents) with communication ratings. A secondary analysis was performed to determine the impact of residents and SP racial concordance in communication scores.

RESULTS

There were 1356 SP assessments of 379 IM residents (199 male residents [53%] and 178 female residents [47%]). There were significant differences in average numeric communication rating (mean 3.40 vs 3.34, P = .009) by gender of resident, with higher scores in female residents. There were no significant interactions between SP and resident gender across the communication domains. There were no significant interactions noted with racial concordance between interns and SPs.

CONCLUSIONS

Our data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. There was not an interaction impact for gender or racial concordance between SPs and interns.

Missed Empathic Opportunities During Hand Surgery Office Visits

Background: Empathy (conveyance of an understanding of a patient's situation, perspective, and feelings) deepens the therapeutic alliance and leads to better health outcomes. We studied the frequency and nature of empathic opportunities and physician responses in patients visiting a hand surgeon. We also sought patient characteristics associated with the number of patient-initiated-clues and missed opportunities by surgeons. Methods: For this prospective cohort study, we enrolled 83 new, adult patients visiting 1 of 3 hand surgeons during a period of 4 months. All visits were audio-recorded, and empathic opportunities (patient-initiated emotional or social clues) and physician responses were categorized using the model of Levenson et al. Before the visit, patients completed the Newest Vital Sign health literacy test; 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity function, Pain Interference, and Depression questionnaires; and a sociodemographic survey. Results: Empathic opportunities were present in 70% of hand surgery office visits. Surgeons responded empathically to about half of the opportunities. Patients with limited health literacy and greater symptoms of depression (small correlation; r = -0.29) were less likely to receive a positive response. Response to an empathic opportunity did not affect visit duration. Conclusions: Hand surgeons often miss empathic opportunities. Future research might address the influence of training physicians to address empathic opportunities on trust, adherence, satisfaction, and outcomes.

Nationwide Study on Practices Related to Screening Among Greek Paediatricians

Objective

The aim of this study was to investigate pediatricians' practices toward screening in Greece.

Materials and Methods

The survey was conducted within a six month period in a stratified random sample of 371 pediatricians. A questionnaire with three sections was created and pilot tested. Socio-demographic characteristics associated with inappropriate screening were identified using multivariable logistic regression models and latent class analysis.

Results

A total of 294 participants completed the telephone survey (response rate 78.6%). The median number of wrong answers to questions related to pediatricians' practice towards screening recommendations was 7±1.57 with minimum 2 and maximum 11 wrong answers. Pediatricians, with less than 15 years of experience, age >50 years old or view more than eighty patients per week, have had significantly higher odds of responding wrong to more than seven questions, hence be less compliant to USPSTF screening guidelines. Latent class analysis has shown that female gender, age <50 years old, and work in the private sector, were associated with a poor practice towards international screening guidelines.

Conclusion

Our survey found gaps in screening practices among a nationwide sample of Greek pediatricians. Moreover considerable variability in reported practices of screening was noted. There is a need for the development of a national childhood screening program in Greece.

Patient satisfaction and gender composition of physicians - a cross-sectional study of community health services in Hubei, China

BACKGROUND

Patient satisfaction is associated with both individual (patients and health workers) and organizational (health facilities) characteristics. This study aimed to establish a link between patient satisfaction and gender composition of physicians in community health service (CHS) organizations.

METHODS

Participants were selected through multistage stratified random sampling: 36 CHS centers were selected from six municipalities in Hubei, China. All physicians on duty and patients visiting the CHS during the study period (from April to October in 2015) were invited to participate in this study: 324 physicians and 865 patients completed a questionnaire survey. Multilevel linear regression analyses were performed to determine the associations of patient satisfaction (scored from 1 to 5) with patient characteristics (gender, age, education, income, medical expense, frequency of visits to the CHS) and organizational features of the CHS (sex ratio of physicians, and gender differences of physicians in education and job satisfaction).

RESULTS

Older patients and those with a higher medical bill had a lower degree of satisfaction (p < 0.05). At the organizational level: a higher proportion of male physicians weakened the negative association between patient age and patient satisfaction (p < 0.05); a larger gap in university qualifications between male and female physicians exacerbated the negative association between patient age and patient satisfaction (p < 0.05).

CONCLUSIONS

The gender composition of physicians in CHSs is associated with patient satisfaction in the Chinese context: a larger gap (in number and qualifications) between male and female physicians is associated with higher patient satisfaction. Further studies are needed to explore the cultural roots of such an association.

Patterns of Signs That Telephone Crisis Support Workers Associate with Suicide Risk in Telephone Crisis Line Callers

Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of suicidality if the caller is unable or unwilling to express suicidal intent. Although signs of suicide are argued to be only meaningful as a pattern, there is a paucity of research that has examined whether TCWs use patterns of signs to decide whether a caller might be suicidal, and whether these are influenced by caller characteristics such as gender. The current study explored both possibilities. Data were collected using an online self-report survey in a Australian sample of 137 TCWs. Exploratory factor analysis uncovered three patterns of suicide signs that TCWs may use to identify if a caller might be at risk for suicide (mood, hopelessness, and anger), which were qualitatively different for male and female callers. These findings suggest that TCWs may recognise specific patterns of signs to identify suicide risk, which appear to be influenced to some extent by the callers’ inferred gender. Implications for the training of telephone crisis workers and others including mental-health and medical professionals, as well as and future research in suicide prevention are discussed.

Physician perspectives on de-intensifying diabetes medications

Guidelines for diabetes care recommend that physicians select individualized glycemic goals based on life expectancy, diabetes duration, comorbidity, and resources/support. When patients have stable hemoglobin A1C (HbA1C) levels, guidelines lack recommendations on when diabetes medications should be de-intensified.To understand physicians' perspectives on de-intensifying diabetes medications in patients with type 2 diabetes.Cross-sectional survey, (February-June, 2015).Academic medical center and suburban integrated health system.Primary care and endocrinology physicians.Physicians' self-reported: awareness, agreement, and frequency of individualizing HbA1C goals; practice of de-intensifying diabetes medications; HbA1C values at which physicians de-intensify diabetes medications; and other patient factors physicians consider when de-intensifying diabetes medications.Response rate was 73% (156/213). Most physicians (78%) responded they were familiar with recommendations to individualize HbA1C goals. For patients with stable HbA1C levels, 80% of physicians reported they had initiated conversations about stopping medications; however, physicians differed in predefined HbA1C levels used to initiate conversations (HbA1C < 5.7%: 14%; HbA1C < 6.0%: 31%; HbA1C < 6.5%: 22%; individualized level: 21%). In multiple logistic regression, women physicians (odds ratio [OR] 3.0; confidence interval [CI] 1.1-8.2; P = 0.03) and physicians practicing fewer than 20 years (OR 2.8; CI 1.01-7.7; P = 0.048) were more likely to report de-intensifying diabetes medications.Individualizing glycemic goals and de-intensifying treatments are concepts well accepted by physicians in our sample. However, physicians vary considerably in reporting how they carry out recommendations to individualize and may be missing opportunities to stop or taper diabetes medications based on patients' individualized glycemic goals.

eGender-from e-Learning to e-Research: a web-based interactive knowledge-sharing platform for sex- and gender-specific medical education

BACKGROUND

Sex and Gender Medicine is a novel discipline that provides equitable medical care for society and improves outcomes for both male and female patients. The integration of sex- and gender-specific knowledge into medical curricula is limited due to adequate learning material, systematic teacher training and an innovative communication strategy. We aimed at initiating an e-learning and knowledge-sharing platform for Sex and Gender Medicine, the eGender platform (http://egender.charite.de), to ensure that future doctors and health professionals will have adequate knowledge and communication skills on sex and gender differences in order to make informed decisions for their patients.

METHODS

The web-based eGender knowledge-sharing platform was designed to support the blended learning pedagogical teaching concept and follows the didactic concept of constructivism. Learning materials developed by Sex and Gender Medicine experts of seven universities have been used as the basis for the new learning tools. The content of these tools is patient-centered and provides add-on information on gender-sensitive aspects of diseases. The structural part of eGender was designed and developed using the open source e-learning platform Moodle. The eGender platform comprises an English and a German version of e-learning modules: one focusing on basic knowledge and seven on specific medical disciplines. Each module consists of several courses corresponding to a disease or symptom complex. Self-organized learning has to be managed by using different learning tools, e.g., texts and audiovisual material, tools for online communication and collaborative work.

RESULTS

More than 90 users from Europe registered for the eGender Medicine learning modules. The most frequently accessed module was "Gender Medicine-Basics" and the users favored discussion forums. These e-learning modules fulfill the quality criteria for higher education and are used within the elective Master Module "Gender Medicine-Basics" implemented into the accredited Master of Public Health at Charité-Berlin.

CONCLUSIONS

The eGender platform is a flexible and user-friendly electronical knowledge-sharing platform providing evidence-based high-quality learning material used by a growing number of registered users. The eGender Medicine learning modules could be key in the reform of medical curricula to integrate Sex and Gender Medicine into the education of health professionals.

Disease-specific self-efficacy in the eosinophilic gastrointestinal disorders

Eosinophilic gastrointestinal disorders (EGIDs) are chronic inflammatory conditions with increasing global prevalence. Self-efficacy is important for patients' ability to manage chronic disease. We sought to evaluate disease-specific self-efficacy in the EGIDs via a modified version of the Inflammatory Bowel Disease Self-Efficacy Scale (IBD-SES). Ninety-one Participants reported demographic, clinical, and psychosocial variables. The IBD-SES demonstrated excellent reliability and validity in this population. Self-efficacy was higher in men, patients with less severe disease, and those who had consulted a dietitian. The IBD-SES is a useful measure of disease-specific self-efficacy in the EGIDs. Further research is necessary to understand the role of self-efficacy in the management of these illnesses.

Using video-based observation research methods in primary care health encounters to evaluate complex interactions

OBJECTIVE

The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient-clinician interaction in primary care settings.

METHODS

We reviewed studies in the literature which used video methods in health care research, and we also used our own experience based on the video studies we conducted in primary care settings.

RESULTS

This paper highlighted the benefits of using video techniques, such as multi-channel recording and video coding, and compared "unmanned" video recording with the traditional observation method in primary care research. We proposed a list that can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles, researchers should anticipate when using video recording methods in future studies.

CONCLUSION

With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilised as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches.

Intersectionality and underrepresentation among health care workforce: the case of Arab physicians in Israel

Background

An intersectionality approach that addresses the non-additive influences of social categories and power structures, such as gender and ethnicity, is used as a research paradigm to further understanding the complexity of health inequities. While most researchers adopt an intersectionality approach to study patients’ health status, in this article we exemplify its usefulness and importance for studying underrepresentation in the health care workforce. Our research objectives were to examine gender patterns of underrepresentation in the medical profession among the Arab minority in Israel.

Methods

We used both quantitative and qualitative methodologies. The quantitative data were obtained from the 2011 Labor Force Survey conducted by the Israeli Central Bureau of Statistics, which encompassed some 24,000 households. The qualitative data were obtained through ten semi-structured, in-depth interviews conducted during 2013 with Arab physicians and with six nurses working in Israeli hospitals.

Results

The findings indicate that with respect to physicians, the Arab minority in Israel is underrepresented in the medical field, and that this is due to Arab women’s underrepresentation. Arab women’s employment and educational patterns impact their underrepresentation in medicine. Women are expected to enter traditional gender roles and conform to patriarchal and collectivist values, which makes it difficult for them to study medicine.

Conclusions

Using an intersectionality approach to study underrepresentation in medicine provides a foundation for action aimed at improving public health and reducing health disparities.

Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns

BACKGROUND

African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups.

OBJECTIVE

To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care.

METHOD

A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013.

RESULTS

African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training.

CONCLUSION

It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.

The effect of physician gender on length of patient consultations: observational findings from the UK hospital setting and synthesis with existing studies

OBJECTIVES

To investigate the effect of physician gender on consultation length in UK hospital outpatient clinics and compare this, through meta-analysis, with previous studies outside the UK.

DESIGN

Observational data on clinic times were analysed and findings were combined in a meta-analysis with existing studies investigating the effect of physician gender on consultation length.

SETTING

UK hospital practice.

PARTICIPANTS

A total of 174 observations of outpatient consultations with 10 hospital specialists (consultants) from different specialties in two UK hospital trusts.

MAIN OUTCOME MEASURES

Clinic times were recorded and analysis of consultation length was undertaken with physician gender as a covariate. Data were then synthesised through meta-analysis with 10 existing studies in this field.

RESULTS

No statistically significant difference was found in the length of consultations for male and female doctors in these UK hospital settings. When pooled with existing studies, consultations with women doctors were found to be approximately two minutes longer than with men (p = 0.01).

CONCLUSIONS

Findings from this analysis of clinic consultations in the UK National Health Service do not support previous studies, which were undertaken predominantly in North America and primary care settings. Overall, meta-analysis suggests doctors' gender may influence consultation length. Gender differences in communication should be considered in training clinicians and in overall clinical practice.

Exploring gender differences in the working lives of UK hospital consultants

OBJECTIVE

Internationally, increasing numbers of women are practising medicine. Gender differences in doctors' working hours, specialty choices and communication styles are well documented, but studies often neglect contextual factors such as the role of socialised gender expectations on behaviours in the workplace and the medical profession. These may be important as recent studies have reported gender differences in doctors' activity rates that cannot be explained by specialty or contracted hours, suggesting other sources of variation. This study sought to explore the working lives of hospital doctors and how their work is negotiated according to gender and context.

DESIGN

Gender differences in the day-to-day work of hospital specialists (consultants) in the NHS were investigated using a qualitative approach, including observation and interview methods. Data were analysed inductively using qualitative observation and interview methods.

SETTING

Two NHS hospital trusts in England.

PARTICIPANTS

Data were collected from 13 participants working in a variety of specialties and in a range of clinical and non-clinical settings.

MAIN OUTCOME MEASURES

Various behaviours, attitudes and experiences were explored, such as doctor-patient communication, interactions with colleagues and workload.

RESULTS

Influences at both individual and situational levels, appear to affect differentially the work of male and female doctors. Female consultants described awareness of the impact of behaviours on relationships with colleagues, and their interactions appeared to be more carefully performed. Nurses and other colleagues tend to demonstrate less cooperation with female consultants. Gender differences also exist in patient communication, feelings of work-family conflict and barriers to career progression.

CONCLUSIONS

These variations in hospital consultants' work may have implications for both the quantity and quality of care provided by male and female consultants. This is timely and of importance to the medical workforce as the gender composition approaches parity.

Increased pain intensity is associated with greater verbal communication difficulty and increased production of speech and co-speech gestures

Effective pain communication is essential if adequate treatment and support are to be provided. Pain communication is often multimodal, with sufferers utilising speech, nonverbal behaviours (such as facial expressions), and co-speech gestures (bodily movements, primarily of the hands and arms that accompany speech and can convey semantic information) to communicate their experience. Research suggests that the production of nonverbal pain behaviours is positively associated with pain intensity, but it is not known whether this is also the case for speech and co-speech gestures. The present study explored whether increased pain intensity is associated with greater speech and gesture production during face-to-face communication about acute, experimental pain. Participants (N = 26) were exposed to experimentally elicited pressure pain to the fingernail bed at high and low intensities and took part in video-recorded semi-structured interviews. Despite rating more intense pain as more difficult to communicate (t(25)  = 2.21, p =  .037), participants produced significantly longer verbal pain descriptions and more co-speech gestures in the high intensity pain condition (Words: t(25)  = 3.57, p  = .001; Gestures: t(25)  = 3.66, p =  .001). This suggests that spoken and gestural communication about pain is enhanced when pain is more intense. Thus, in addition to conveying detailed semantic information about pain, speech and co-speech gestures may provide a cue to pain intensity, with implications for the treatment and support received by pain sufferers. Future work should consider whether these findings are applicable within the context of clinical interactions about pain.

Thin-slice judgments in the clinical context

Clinicians make a variety of assessments about their clients, from judging personality traits to making diagnoses, and a variety of methods are available to do so, ranging from observations to structured interviews. A large body of work demonstrates that from a brief glimpse of another's nonverbal behavior, a variety of traits and inner states can be accurately perceived. Additionally, from these "thin slices" of behavior, even future outcomes can be predicted with some accuracy. Certain clinical disorders such as Parkinson's disease and facial paralysis disrupt nonverbal behavior and may impair clinicians' ability to make accurate judgments. In certain contexts, personality disorders, anxiety, depression, and suicide attempts and outcomes can be detected from others' nonverbal behavior. Additionally, thin slices can predict psychological adjustment to divorce, bereavement, sexual abuse, and well-being throughout life. Thus, for certain traits and disorders, judgments from a thin slice could provide a complementary tool for the clinician's toolbox.

Evaluating the content of the communication items in the CAHPS(®) clinician and group survey and supplemental items with what high-performing physicians say they do

BACKGROUND

A doctor's ability to communicate effectively is key to establishing and maintaining positive doctor-patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS(®)) Clinician and Group Survey is the standard for collecting and reporting information about patients' experiences of care in the USA.

OBJECTIVE

To evaluate how well CAHPS(®) Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor-patient communication.

DATA SOURCES/STUDY SETTING

Eleven of the 40 highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan.

STUDY DESIGN

Data were obtained via semi-structured interviews. Specific behaviors, practices, and opinions about doctor communication were coded and compared to the CG-CAHPS items.

PRINCIPAL FINDINGS

CG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of nonverbal communication; greeting patients and introducing oneself; and tracking personal information about patients.

CONCLUSIONS

CG-CAHPS survey items capture many of the most commonly mentioned doctor-patient communication behaviors and practices identified by high-performing physicians. Nonverbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor-patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patients' perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor-patient communication. Enriching the content of the CAHPS communication measure can help health-care organizations improve doctor-patient communication and interactions.

Gender differences in health-related quality of life of Australian chronically-ill adults: patient and physician characteristics do matter

BACKGROUND

The aims of this study were to explore the health-related quality of life (HRQoL) in a large sample of Australian chronically-ill patients (type 2 diabetes and/or hypertension/ischaemic heart disease), to investigate the impact of characteristics of patients and their general practitioners on their HRQoL and to examine clinically significant differences in HRQoL among males and females.

METHODS

This was a cross-sectional study with 193 general practitioners and 2181 of their chronically-ill patients aged 18 years or more using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) were derived using the standard US algorithm. Multilevel regression analysis (patients at level 1 and general practitioners at level 2) was applied to relate PCS-12 and MCS-12 to patient and general practitioner (GP) characteristics.

RESULTS

Employment was likely to have a clinically significant larger positive effect on HRQoL of males (regression coefficient (B) (PCS-12) = 7.29, P < 0.001, effect size = 1.23 and B (MCS-12) = 3.40, P < 0.01, effect size = 0.55) than that of females (B(PCS-12) = 4.05, P < 0.001, effect size = 0.78 and B (MCS-12) = 1.16, P > 0.05, effect size = 0.16). There was a clinically significant difference in HRQoL among age groups. Younger men (< 39 years) were likely to have better physical health than older men (> 59 years, B = -5.82, P < 0.05, effect size = 0.66); older women tended to have better mental health (B = 5.62, P < 0.001, effect size = 0.77) than younger women. Chronically-ill women smokers reported clinically significant (B = -3.99, P < 0.001, effect size = 0.66) poorer mental health than women who were non-smokers. Female GPs were more likely to examine female patients than male patients (33% vs. 15%, P < 0.001) and female patients attending female GPs reported better physical health (B = 1.59, P < 0.05, effect size = 0.30).

CONCLUSIONS

Some of the associations between patient characteristics and SF-12 physical and/or mental component scores were different for men and women. This finding underlines the importance of considering these factors in the management of chronically-ill patients in general practice. The results suggest that chronically ill women attempting to quit smoking may need more psychological support. More quantitative studies are needed to determine the association between GP gender and patient gender in relation to HRQoL.

Non-verbal communication between primary care physicians and older patients: how does race matter?

BACKGROUND

Non-verbal communication is an important aspect of the diagnostic and therapeutic process, especially with older patients. It is unknown how non-verbal communication varies with physician and patient race.

OBJECTIVE

To examine the joint influence of physician race and patient race on non-verbal communication displayed by primary care physicians during medical interviews with patients 65 years or older.

DESIGN, SETTING, AND PARTICIPANTS

Video-recordings of visits of 209 patients 65 years old or older to 30 primary care physicians at three clinics located in the Midwest and Southwest.

MAIN MEASURES

Duration of physicians' open body position, eye contact, smile, and non-task touch, coded using an adaption of the Nonverbal Communication in Doctor-Elderly Patient Transactions form.

KEY RESULTS

African American physicians with African American patients used more open body position, smile, and touch, compared to the average across other dyads (adjusted mean difference for open body position = 16.55, p < 0.001; smile = 2.35, p = 0.048; touch = 1.33, p < 0.001). African American physicians with white patients spent less time in open body position compared to the average across other dyads, but they also used more smile and eye gaze (adjusted mean difference for open body position = 27.25, p < 0.001; smile = 3.16, p = 0.005; eye gaze = 17.05, p < 0.001). There were no differences between white physicians' behavior toward African American vs. white patients.

CONCLUSION

Race plays a role in physicians' non-verbal communication with older patients. Its influence is best understood when physician race and patient race are considered jointly.

Patient-centered care: the influence of patient and resident physician gender and gender concordance in primary care

BACKGROUND

Patient-centered care (PCC) is thought to significantly influence the process of care and its outcomes and has been identified as part of a comprehensive strategy for improving our nation's healthcare delivery system. Patient and physician gender, as well as gender concordance, may influence the provision of PCC.

METHODS

Patients (315 women, 194 men) were randomized to care by primary care resident physicians (48 women, 57 men). Sociodemographic information, history of health risk behaviors (tobacco use, alcoholism, and obesity), and self-reported global pain and health status were collected before the first visit. That visit and subsequent patient visits to the primary care physician (PCP) were videotaped during the year-long study period. PCC was measured by coding all videotapes using a modified version of the Davis Observation Code.

RESULTS

No significant gender differences in PCC were found between the male and female patients; however, female physicians provided increased PCC to their patients. The greatest amount of PCC was seen in the female patient-female physician gender dyad. Regression analyses, controlling for other patient variables, confirmed that female concordant dyads were associated with a greater amount of PCC. There was no significant relationship for the male patient-male physician concordance (vs. disconcordance).

CONCLUSIONS

These findings highlight the influence of gender in the process of care and provision of PCC. Gender concordance in female patient-female physician dyads demonstrated significantly more PCC. Further research in other clinical settings using other measures of PCC is needed. A public mandate to provide care that is patient-centered has implications for medical education.

Does satisfaction with information equate to better anticoagulant control?

OBJECTIVES

This study examined how satisfaction with information about warfarin related to demographic and clinical factors including therapeutic outcome.

SETTING

This study took place in the Outpatient clinic of the Mercy University Hospital, Cork, Rep. of Ireland.

METHOD

Patients attending an anticoagulation clinic completed the Satisfaction with Information about Medicines (SIMS) Scale. This was examined in line with clinical and demographic information including: age, gender, diagnosis, number of weeks taking warfarin, and INR control.

MAIN OUTCOME MEASURE

The level of satisfaction with information was measured and in addition the association between anticoagulation control and satisfaction level was examined.

RESULTS

One hundred and nineteen patients (61.3% male), participated in the study. The majority of patients were prescribed warfarin for atrial fibrillation (53.8%). Satisfaction with information about warfarin was inversely related to age (ρ = -0.33, P < 0.01). Patient-reported satisfaction with information pertaining to the question "what is your medicine for?" was significantly associated with anticoagulation control (χ(2) = 7.27, P < 0.01).

Expressive behavior in Parkinson's disease as a function of interview context

OBJECTIVE

Parkinson's disease affects the ability to express motivation through face, body, and voice; contextual factors may facilitate or inhibit expressive behavior. The purpose of this study was to determine whether qualities of the interview context are associated with client motivational behavior in Parkinson's disease.

METHOD

Men and women with Parkinson's disease (N = 106) discussed 2 topics (enjoyable activity vs. frustrating activity) during an assessment with a female or male interviewer. From videotaped clips, displays of 4 categories of motivation and 12 verbal and 18 nonverbal, behavioral patterns were rated.

RESULTS

During the discussion of enjoyable activities, participants used more positive words, smiled more, and were more facially expressive. Participants were less talkative about their negative feelings and appeared to be more apathetic with the same-gender interviewer.

CONCLUSION

Occupational therapy practitioners should vary the emotional tone of their questions to improve the validity of motivation assessments.

Family physicians' personal and practice characteristics that are associated with improved utilization of bone mineral density testing and osteoporosis medication prescribing

Family physicians' personal and practice characteristics may influence how osteoporosis is managed. Thus, we evaluated the impact of family physicians' personal and practice characteristics on the appropriate use of bone mineral density testing and osteoporosis therapy. The physician questionnaire assessed 13 personal and practice characteristics of the physicians. The patient questionnaire was used to collect data to ascertain how family physicians managed osteoporosis. A total of 225 family physicians from 7 provinces across Canada completed both the physician and patient questionnaires. The family physicians evaluated a total of 5601 patients. The generalized estimating equations technique was utilized to model the associations between family physicians' personal and practice characteristics and appropriate use of bone mineral density testing and osteoporosis therapy. Odds ratios (OR) and corresponding 95% confidence intervals (CI) are reported. Findings indicated that female family physicians have higher odds of administering appropriate bone density testing compared to male family physicians (OR: 1.28; 95% CI: 1.05, 1.55), and that physicians who have hospital privileges (OR: 0.77; 95% CI: 0.62, 0.97) and who graduated more recently from medical school (OR: 0.87; 95% CI: 0.77, 0.99) have lower odds of administering appropriate bone mineral density tests. Physicians who use electronic health records have higher odds of administering appropriate therapy (OR: 1.30; 95% CI: 1.06, 1.59) as compared to physicians who do not use them. Several family physicians' personal and practice characteristics are associated with appropriate utilization of bone mineral density testing and therapy. The education of both clinicians and policy makers regarding these new insights may translate to enhanced individual practices and an improved overall health care system to optimize the environment for managing osteoporosis.

The influence of GP and patient gender interaction on the duration of certified sickness absence

BACKGROUND

Little research has focused upon how GP and patient gender interact to influence the outcome of consultation. In particular, no UK studies have investigated the effect of gender interaction on the duration of patients' certified sickness.

OBJECTIVE

To investigate associations between the four GP-patient gender interaction categories and patient risk of intermediate or long-term work incapacity.

DESIGN

Use of carbonized sickness certificates to collect routine sick note data over a 12-month collection period.

SETTING

Nine general practices in the Mersey Primary Care R&D Consortium.

SUBJECTS

A total of 3906 patients, certified sick by 67 GPs (including 45 GP principals).

MAIN OUTCOME MEASURES

The effect of gender interaction was measured against two outcomes: intermediate (6-28 week) and long-term (28 weeks or over) periods of certified sickness.

RESULTS

After univariate and multivariate analyses, it was discovered that certification of male patients by male GPs was significantly associated with increased prevalence of intermediate (6-28 week) certified sickness outcomes, compared with females certified by females (OR=1.38 P=0.009). This result was replicated in the subgroup of patients with mild mental disorder-related sickness absence. However, no association was demonstrated between gender interaction and long-term (>or=28 week) outcome, in the total patient group or within diagnostic subcategories.

CONCLUSION

GP and patient gender appear to have most impact upon sickness certification in the intermediate period. This period is already recognized as the optimum time for interventions to prevent onset of long-term incapacity, particularly in cases where the cause of sickness absence is reversible (as in psychological-related certified sickness absence). Further research is needed (particularly focusing upon attitudes and content of consultations) in order to shed more light on the gender differences found in this study.

Physician-identified barriers to intimate partner violence screening

BACKGROUND

Intimate partner violence (IPV) causes approximately 2 million injuries and 1300 deaths each year. Despite the high frequency of IPV among women seeking healthcare, only a small proportion report being asked by healthcare professionals about abuse. This study examined perceived barriers to IPV screening among obstetricians/gynecologists, family physicians, and internists, so that protocols for IPV training can be tailored to those particular areas of difficulty.

METHODS

A cross-sectional survey of 143 obstetricians and gynecologists, family practice physicians, and internists in a medium-sized upstate New York city was conducted. Factor analysis was performed. Two IPV barrier domains emerged and were examined using a multivariate analysis to determine associations between the domains and physician characteristics.

RESULTS

For general knowledge, there were greater perceived barriers if the respondent was male but fewer perceived barriers if the respondent was an obstetrician/gynecologist and fewer perceived barriers if the respondent had 5-10 years in practice. For practice policy, there were greater perceived barriers if the physician was in a private practice setting and fewer perceived barriers if the physician was an obstetrician/gynecologist.

CONCLUSIONS

These findings provide direction for training in IPV recognition. They support a need for continued training throughout the physician's career. More importantly, the findings support a need for better practice systems to encourage routine screening for IPV by healthcare providers.

Physician gender and antihypertensive prescription pattern in primary care

OBJECTIVES

To determine: (i) the gender-based differences of physicians in prescribing antihypertensive drugs in the management of hypertension; (ii) the influence of patient comorbidity such as diabetes mellitus on the gender-based pattern of antihypertensive prescription, and (iii) gender-based prescription patterns among family physicians (FPs) and general practitioners (GPs).

METHODS

A survey study was carried out at 15 out of 20 health centres in Bahrain during May and June 2000. A total of 3971 prescriptions, issued to 2705 patients with uncomplicated hypertension and 1266 patients with diabetic hypertension by 77 FPs (female = 54, male = 23) and 41 GPs (female = 11, male = 30), were analysed.

RESULTS

As monotherapy, female physicians preferred ACE inhibitors (OR: 0.82, CI: 0.68-0.98, P = 0.033). In terms of overall drug utilization (monotherapy + combination therapy): (i) male physicians preferred beta blockers (OR: 1.17, CI: 1.03-1.31, P = 0.014) and diuretics (OR: 1.15, CI: 1.00-1.32, P = 0.047), while female physicians preferred methyldopa (OR: 0.73, CI: 0.56-0.94, P = 0.019); (ii) in uncomplicated hypertension, female physicians preferred calcium channel blockers (OR: 0.83, CI: 0.69-0.99, P = 0.038) and methyldopa (OR: 0.69, CI: 0.49-0.98, P = 0.042), and (iii) in diabetic hypertension, male physicians preferred beta blockers (OR: 1.26, CI: 1.00-1.57, P = 0.047). While female FPs prescribed methyldopa more extensively (OR: 0.66, CI: 0.47-0.92, P = 0.018), male GPs prescribed beta blockers (OR: 1.28, CI: 1.00-1.62, P = 0.046).

CONCLUSIONS

Within the same practice setting, gender-based differences in the prescription of antihypertensive drugs were seen. Such preference for a particular class of antihypertensives was also influenced by the presence of comorbidity in patients and, to a limited extent, by the training level of primary care physicians.