Determinants of women's choice of obstetrician/gynecologist

Understanding the needs of women undergoing breast ultrasound: Are male radiologists still needed?

INTRODUCTION

A trend towards less male radiologists specializing in breast ultrasound was observed. A common notion in the field of breast radiology is, that female patients feel more comfortable being treated by female radiologists. The aim of the study was to understand and report the needs of women undergoing breast ultrasound with regards to the sex of the radiologist performing the investigation.

METHODS

Informed consent was obtained from all patients prior to inclusion in a prospective bi-center quality study. At center 1 (72 patients), the women were examined exclusively by female radiologists, at center 2 (100 patients) only by male radiologists. After the examination the patients were asked about their experiences and their wishes for the future.

RESULTS

Overall, women made no distinction between female and male radiologists; 25% of them wanted a female radiologist and 1.2% wanted a male radiologist. The majority (74%) stated that it made no difference whether a female or male radiologist performed the examination. The majority of women in group 2, who were investigated exclusively by male radiologists, stated that they had no preferences with regard to the sex of the radiologist (93%); 5% of the women wished to be investigated solely by a female radiologist and 2% exclusively by a male radiologist.

DISCUSSION

The majority of women undergoing breast ultrasound are unconcerned about the radiologist's sex. It would appear that women examined by male radiologists are less selective about the sex of the examining radiologist.

TRIAL REGISTRATION

Written informed consent was obtained from all patients. All patient data were anonymized. The physicians had no access to any further personal data. National regulations did not require dedicated ethics approval with anonymized lists or retrospective questionnaires.

Do breast cancer patients have a gender preference when choosing a breast surgeon?

Introduction

There is a paucity of data on breast cancer (BC) patients' gender preferences when it comes to choosing their surgeon, unlike in other specialties like gynaecology and obstetrics, where women tend to prefer a female physician. The aim of this trial was to examine if there are any gender preferences in women with BC at the time of choosing their breast surgeon.

Material and methods

A cross-sectional, observational and descriptive study with 528 patients, older than 18 years, at the Breast Department 'Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales', from January to June 2022. We applied an anonymous questionnaire to evaluate patients' gender preferences when it comes to choosing their breast surgeon.

Results

The average age of the patients was 56 ± 11 years. 89.4% did not have gender preferences, whereas 6.5% and 4.1% chose to be treated by female surgeons and male surgeons, respectively. The most important characteristics chosen by the patients when they decided to choose their breast surgeon were experience (75%), knowledge (54%) and hospital-based (41%).

Conclusion

Personal and professional skills are the most important factors when it comes to patients choosing their breast surgeon, gender does not have any impact on expertise or competence.

Pelvic organ prolapse: The lived experience

BACKGROUND

Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman's life. This study explores the lived experience of women with POP.

METHODOLOGY

A qualitative study was undertaken. Following institutional ethical approval women from an online peer support group (n = 930 members) were recruited to participate in semi-structured interviews. Inclusion criteria stipulated women (> 18years), pre-menopausal, at least one-year post-partum, diagnosed with POP and aware of their diagnosis. Semi-structured interviews were undertaken with a clinician specialising in pelvic health. A battery of questions was designed to elicit discussion on their experience of being diagnosed with POP and its impact on daily life and relationships. Interviews were carried out via Zoom, recorded and transcribed. Thematic analysis was undertaken.

FINDINGS

Fourteen women (32-41 years), para 1-3 participated. All had at least one vaginal birth; three had vacuum, four had forceps operative births. All had Grade 1-3 POP. Interviews lasted 40-100 minutes. Three core themes with subthemes were identified; biological/physical, psychological and social. Women were particularly affected in terms of sport and exercise participation, their own perceptions of their ability as mothers and fear of their condition worsening. They described societal attitudes, reporting stigma around POP and women's pelvic health in general, expectations placed on women to put up with their symptoms and an idealised perception of new motherhood.

CONCLUSIONS

The impact of POP from a biopsychosocial perspective reflects other chronic conditions. Prevention, early education and supports for developing strong self-management approaches would be beneficial for long term management of this condition.

Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review

Background

The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions.

Objective

This systematic review examines: (i) female patients’ gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students’ education and career decisions.

Search strategy

We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research.

Selection criteria

We restricted the review to original research from the United States between 2000–2021.

Data collection

Fifteen studies met inclusion criteria, categorised into three groups: (i) patient’s gender preference for Ob/Gyns; (ii) patient’s gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions.

Main results

Patients prioritised their physician’s care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post‐clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity.

Conclusions

Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.

Gender differences in the medical industries’ payments to physicians: a systematic review

Purpose

This paper aims to explore gender differences in payments made to physicians by the pharmaceutical and medical device industries via the performance of a systematic review of articles based on the Open Payments Database (OPD).

Design/methodology/approach

Three databases (Scopus, Web of Science and PubMed) were searched for articles published from September 30, 2014 to May 10, 2019, using two search terms: “Sunshine Act” and “Open Payments.” The systematic review is reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Findings

The search identified 359 abstracts. Thirty-nine articles were selected for full review, and 17 of these met the inclusion criteria. Although the articles considered are based on the same database, they adopt diverse approaches and analyses are conducted in different ways. A substantial proportion of the studies show total payments from the two industries to be higher for male physicians than for female physicians. However, a few exceptions exist, higher female mean or median values occurring for payments involving research, ownership, honoraria, grants, royalties/licenses and travel/lodgings. Also, in the case of obstetric–gynecological specializations, a higher proportion of women than men are shown to cooperate with the industries.

Originality/value

There is gender inequality in terms of industries’ funding for doctors. While analyses of secondary OPD data show that a gender inequality exists, they do not provide an understanding of why this occurs. However, from the exceptions identified, it can be speculated that this phenomenon is connected with greater adherence to ethical standards on the part of female physicians and/or the likelihood that fewer opportunities for industrial cooperation are extended to them.

How Relevant is Obstetrician and Gynecologist Gender to Women in Saudi Arabia?

Background

The patient–doctor relationship is one of the most important factors in determining the outcome of healthcare. The first step in establishing this relationship is choosing a physician. This study sought to identify patient preferences concerning the gender of their obstetrics and gynecology (OB-GYN) physician and the effect of religion and society on these choices.

Methods

A cross-sectional study was conducted at the OB-GYN outpatient clinics at King Abdulaziz University Hospital in Jeddah between February 2017 and June 2017. A total of 227 female patients were recruited. Eligible were women ages 18 years or older who had attended the clinic at least three times. A 30-item questionnaire was administered.

Results

Significantly, more female doctors were preferred for pelvic examination in lower income group (p=0.003), while male doctors were preferred for surgery (p=0.010) in higher income group. Significantly more male doctors were preferred for pelvic examination and gynecological surgery in >35-year age group (p=0.015 and p=0.017, respectively). With regard to predictors, embarrassment was the most significant factor reported for not choosing a male obstetrician/gynecologist (OB-GYN) in the younger age group. Nearly three-quarters (71.2%) of respondents with age ≤35 reported embarrassment as a factor for not choosing a male OB-GYN; 79.7% of this subgroup indicated that female doctors were more knowledgeable about women’s health issues.

Conclusion

Participants expressed a strong preference for female providers overall, although some women preferred male providers during certain circumstances (gynecologic surgery). Despite these gender preferences, more important to women in their choice of OB-GYN provider was the doctor’s experience, qualifications, and reputation. Such trends are consistent with those culturally similar countries and in line with trends worldwide. These findings have the potential to significantly impact the personal health for women in Saudi Arabia and elsewhere in the Middle East where religious and cultural traditions are so important in decision-making.

Variation in Practice Patterns and Reimbursements Between Female and Male Urologists for Medicare Beneficiaries

Importance

Previous assessments of practice patterns and reimbursements for female urologists relied on surveys or board certification logs. A current evaluation of the geographic distribution and practice patterns by female urologists would reveal contemporary patterns of access for Medicare beneficiaries.

Objective

To characterize the variation in practice patterns and reimbursements by urologist sex and the regional deficiencies in care provided by female urologists.

Design, Setting, and Participants

This population-based cohort study used the publicly available Centers for Medicare & Medicaid Services Provider Payment database to evaluate payments for US urologists. The cohort (n = 8665) included urologists who provided and were paid for 11 or more services to Medicare beneficiaries in 2016. Data collection and analysis were performed from October 3, 2018, through June 19, 2019.

Main Outcomes and Measures

Proportion of female-specific services, payments per beneficiary, and payments per work relative value unit (wRVU) by urologist sex were assessed. Density of female urologists across hospital markets was also identified.

Results

Among the 8665 urologists who received payments in 2016, 7944 (91.7%) were men and 721 (8.3%) were women. Female urologists, compared with male urologists, saw a lower proportion of patients with cancer (mean [SD], 16.3% [9.2%] vs 22.7% [8.8%]; P < .001) and a greater proportion of female Medicare beneficiaries (mean [SD], 52.8% [23.2%] vs 24.4% [10.3%]; P < .001). Female urologists generated a greater proportion of wRVU from urodynamics (median [IQR], 2.88% [1.26%-4.84%] vs 1.07% [0.31%-2.26%]; P < .001) and gynecological operations (median [IQR], 0.68% [0.45%-1.07%] vs 0.41% [0.20%-0.81%]; P < .001) than male urologists. In addition, female urologists, compared with their male counterparts, received lower median payments per beneficiary seen ($70.12 [interquartile range (IQR), $60.00-$84.81] vs $72.37 [IQR, $59.63-$89.29]; P = .03) and lower payments per wRVU ($58.25 [IQR, $48.39-65.26] vs $60.04 [IQR, $51.93-$67.88]; P < .001). One-third (103 [33.7%]) of 306 hospital referral regions had 0 female urologists, and 80 (26.1%) had only 1 female urologist.

Conclusions and Relevance

Female urologists were more likely to provide care for female Medicare beneficiaries, to receive lower payments per wRVU generated and beneficiaries seen, and to be difficult to access in certain geographic areas; these findings have policy-related implications and highlight the regional deficiencies in urological care and reimbursement discrepancies according to urologist sex.

Bedouin Women's Gender Preferences When Choosing Obstetricians and Gynecologists

Patients' preferences in choosing obstetricians/gynecologists are widely investigated, but studies among traditional populations are lacking. Bedouins comprise a traditional Arab Muslim society in the Arabian Peninsula (Saudi Arabia), The Levant (Syria, Jordan and Israel) and North Africa (Egypt). Most of the Bedouins in Israel populate several villages, mostly in the southern part of the country. This cross-sectional study compared 200 Bedouin and 200 Jewish women who responded to an anonymous questionnaire. Queried on gender alone, more Bedouin responders preferred female obstetricians/gynecologists (59.5 vs. 33% Jewish responders, p value <0.0001). Bedouin women preferred a female obstetrician/gynecologist for intimate procedures [feeling more comfortable (66.3%) and believing that females were more gentle (50%)]. However, they and the Jewish participants ranked ability, experience and knowledge as the top 3 qualities of an obstetrician/gynecologist, putting reputation in 4th place and gender in 5th place. Bedouin women strongly preferred female obstetricians/gynecologists, although professional skills were an important factor in their choice of caregiver. The ideal obstetrician/gynecologist for Bedouin women would be a skilled, knowledgeable, and experienced female.

Choosing a Surgeon: An Exploratory Study of Factors Influencing Selection of a Gender Affirmation Surgeon

Purpose: Selecting a healthcare provider is often a complicated process. Many factors appear to govern the decision as to how to select the provider in the patient–provider relationship. While the possibility of changing primary care physicians or specialists exists, decisions regarding surgeons are immutable once surgery has been performed. This study is an attempt to assess the importance attached to various factors involved in selecting a surgeon to perform gender affirmation surgery (GAS). It was hypothesized that owing to the intimate nature of the surgery, the expense typically involved, the emotional meaning attached to the surgery, and other variables, decisions regarding choice of surgeon for this procedure would involve factors other than those that inform more typical healthcare provider selection or surgeon selection for other plastic/reconstructive procedures.

Methods: Questionnaires were distributed to individuals who had undergone GAS and individuals who had undergone elective plastic surgery to assess decision-making.

Results: The results generally confirm previous findings regarding how patients select providers.

Conclusion: Choosing a surgeon to perform gender-affirming surgery is a challenging process, but patients are quite rational in their decision-making. Unlike prior studies, we did not find a preference for gender-concordant surgeons, even though the surgery involves the genital area. Providing strategies and resources for surgical selection can improve patient satisfaction.

Using Best-Worst Scaling to Understand Patient Priorities: A Case Example of Papanicolaou Tests for Homeless Women

PURPOSE

Best-worst scaling (BWS) is a survey method for assessing individuals' priorities. It identifies the extremes-best and worst items, most and least important factors, biggest and smallest influences-among sets. In this article, we demonstrate an application of BWS in a primary care setting to illustrate its use in identifying patient priorities for services.

METHODS

We conducted a BWS survey in 2014 in Boston, Massachusetts, to assess the relative importance of 10 previously identified attributes of Papanicolaou (Pap) testing services among women experiencing homelessness. Women were asked to evaluate 11 sets of 5 attributes of Pap services, and identify which attribute among each set would have the biggest and smallest influence on promoting uptake. We show how frequency analysis can be used to analyze results.

RESULTS

In all, 165 women participated, a response rate of 72%. We identified the most and least salient influences on encouraging Pap screening based on their frequency of report among our sample, with possible standardized scores ranging from+1.0 (biggest influence) to -1.0 (smallest influence). Most important was the availability of support for issues beyond health (+0.39), while least important was the availability of accommodations for personal hygiene (-0.27).

CONCLUSIONS

BWS quantifies patient priorities in a manner that is transparent and accessible. It is easily comprehendible by patients and relatively easy to administer. Our application illustrates its use in a vulnerable population, showing that factors beyond those typically provided in health care settings are highly important to women in seeking Pap screening. This approach can be applied to other health care services where prioritization is helpful to guide decisions.

Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study

The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.

Israeli Druze women's sex preferences when choosing obstetricians and gynecologists

Background

Consideration and better understanding of patients’ needs on the part of the healthcare system might help increase the number of people seeking necessary medical care. Many studies have been conducted on patients’ preferences in choosing their health care provider, but the majority of them were conducted in modern western societies, establishing a need to explore other populations. The present study was performed in the Israeli Druze community which is composed of a uniquely traditional and religious population.

We assessed the sex preference of Israeli Druze women regarding obstetricians/gynecologists, and identify other features that affect their choice.

Method

We conducted a cross-sectional study that included 196 Israeli Druze women who anonymously completed a 36-item questionnaire between January-July, 2011.

Results

Most (63.8%) of the responders preferred female obstetricians/gynecologists, while 74.5% had no sex preference for their family physicians. 68.6% of the religious women preferred female obstetricians/gynecologists as compared to 51.76% of those women who self-identified as secular. Most of the women (65%) preferred female obstetricians/gynecologists for intimate procedures, such as pelvic examination and pregnancy follow-up. The main reasons given were: feeling more comfortable with a female practitioner (69.7%), the belief that females are more gentle (56.6%), and being more embarrassed with male obstetricians/gynecologists (45.4%). Three factors were associated with the responders’ preferences for female obstetricians/gynecologists: their age and religious status, and the sex of their regular obstetricians/gynecologists. Women who preferred a female obstetrician/gynecologist assigned a lesser weight to the physician’s knowledge when choosing them. Older and religious women as well as those who attributed less weight to the physician’s professional knowledge were more likely to prefer a female obstetrician/gynecologist.

Conclusions

The majority of responders to our survey (Israeli Druze women), like those in other communities where religiousness and modesty are deeply rooted, prefer female obstetricians/gynecologists, with the overwhelming reasons given being feeling more comfortable and less embarrassed with females, and the notion that female obstetricians/gynecologists are more gentle during intimate procedures.

Physician's gender, communication style, patient preferences and patient satisfaction in gynecology and obstetrics: a systematic review

OBJECTIVE

Review of studies published in the last 10 years about women seeking gynecological- or obstetrical care and physician's gender in relation to patient preferences, differences in communication style and patient satisfaction.

METHODS

Studies were identified by searching the online databases PubMed, PsycINFO, Embase and the Cochrane Library. The search strategies 'gender'; 'obstetrics' and 'gynecology' were combined with 'communication'; 'physician-patient relations'; 'patient preference' and 'patient satisfaction'.

RESULTS

After screening title and abstract, evaluating full text and quality assessment, 9 articles were included in this review. Most patients preferred a female rather than a male gynecologist-obstetrician. This was partly explained by a more patient-centered communication style used by female gynecologists-obstetricians. Also experience and clinical competence were important factors in choosing a gynecologist-obstetrician. It was not clear whether patient's age or ethnicity influenced patients gender preference. Patient satisfaction increased when gynecologists-obstetricians used a patient-centered communication style.

CONCLUSION

Preference for a female gynecologist-obstetrician might be explained by a more patient-centered communication style used by female gynecologists-obstetricians. Using a patient-centered communication style increases patient satisfaction.

PRACTICE IMPLICATIONS

To increase patient satisfaction, gynecologists-obstetricians should learn to integrate patient-centered communication style into the consultation.

Determinants of patient choice of healthcare providers: a scoping review

BACKGROUND

In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice.

METHODS

We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information.

RESULTS

Our review shows that patients' choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics.

CONCLUSIONS

There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.

The effect of student gender on the obstetrics and gynecology clerkship experience

OBJECTIVES

To explore the effects of the students' gender on their perception of quality and quantity of teaching, the amount of experiential learning, and their interest in obstetrics and gynecology.

METHODS

Anonymous, self-administered surveys to third-year medical students rotating on the obstetrics and gynecology clerkship.

RESULTS

Eighty-one of 91 students participated (89% response rate): 33 men, 46 women, 2 declined to reveal their gender. No significant gender differences existed regarding number of interactions with residents and faculty; number of deliveries, surgeries, or examinations performed; perceived quality of teaching; or feeling included as part of the clinical team. Male students were more likely to report performing specific surgical procedures, such as operating the bovie cautery during gynecological surgeries (p = 0.005). More men experienced patients refusing to allow them to participate in the clinical interview (p < 0.0001) and physical examination (p < 0.0001). Male students were also more likely to report feeling that their gender negatively impacted their clerkship experience (p < 0.0001). Although less likely to report preclerkship and postclerkship career interest in obstetrics and gynecology, male students were more likely to report that their interest increased at the end of the clerkship.

CONCLUSIONS

Male students were more likely to experience gender bias from patients on the obstetrics and gynecology service. Male students also described feeling socially excluded from female-dominated clinical teams. Obstetrics and gynecology educators need to consider methods of encouraging patients to accept medical student participation regardless of gender. Obstetrics and gynecology faculty and residents need to be sensitive to subtle forms of gender bias and ensure equal inclusion for both male and female medical students.

Unpredicted gender preference of obstetricians and gynecologists by Muslim Israeli-Arab women

OBJECTIVES

To investigate the gender preference of Muslim Israeli-Arab women regarding obstetricians/gynecologists, and identify other features that affect their choice.

METHODS

The study included 167 responders to an anonymous questionnaire.

RESULTS

Around one-half of the responders had no gender preference regarding family physicians, but most (76.6%) preferred a female gynecologist. Likewise, most responders preferred pelvic examinations (85.6%) and pregnancy follow-up (77.8%) by female gynecologists. Additionally, 61.7% preferred consulting female physicians for major obstetrical and gynecological (OB/GYN) problems. The reasons for female preference were embarrassment (67.7%), feeling comfortable with female gynecologists (80.8%) and the notion that female gynecologists are more gentle (68.3%). The three most important factors which affected actual selection, however, were experience (83.8%), knowledge (70.1%) and ability (50.3%), rather than physician gender (29.3%). Multivariate analysis revealed that other qualities and importance of background variables of the gynecologist were independent predictors of gender preference.

CONCLUSIONS

Although Muslim Arab-Israeli women express gender bias regarding their preference for gynecologists/obstetricians, personal and professional skills are considered to be more important factors when it comes to actually making a choice.

PRACTICE IMPLICATION

We suggest that the ideal obstetrician/gynecologist for these women would be female, though skilled, knowledgeable, and experienced male would be appropriate.

'About as comfortable as a stranger putting their finger up your nose': speculation about the (extra)ordinary in gynaecological examinations

In public health education, gynaecological examinations are presented as a routine and ordinary procedure. Medical research addressing women's reasons for screening reluctance emphasises underlying psychological categories of 'anxiety' and 'poor coping'. Minimal attention is paid to the effects of clinicians' interventions upon women's decision-making. Normalising promotes women's participation as speculum examinations are an essential part of many contemporary diagnostic and treatment procedures. In-depth email interviews were conducted with 26 women with diagnosis of either of the two commonest viral sexually transmitted infections, human papilloma virus and herpes simplex virus, and 12 sexual health clinicians. Data were analysed thematically. Findings indicate that women's screening compliance is influenced by clinicians' (in)attention to power relations, rapport-building, attentiveness to bodily (dis)comfort, technical skill and gender. Women's feedback is a valuable resource in devising interventions that may promote participation in examinations.

The role of expectations in preferences of patients for a female or male general practitioner

OBJECTIVE

to determine, for five health problems, whether preference for a male or female general practitioner (GP) is related to patient gender, GP gender and/or patient expectations of GP behaviour.

METHODS

cross-sectional study in 14 health centres in Spain, administering a questionnaire to 360 patients. Outcome variables were: preference for male GP, female GP or no preference in consultations for five hypothetical health problems.

RESULTS

mean age was 47.3 ± 16.5 years, 51% were female. Preference was more frequently expressed by females. Odds ratios (ORs) for a woman preferring a female to male GP ranged from 3 to 508, according to the hypothetical problem, and ORs for a patient with female GP preferring a female GP ranged from 2.8 to 9.1. Patient gender and GP gender had no interactive effect on preferences. Expectations of GP behaviour were related to preferences, except for chest pain. Higher expectations of communication or technical care were associated with greater preference for female or male GP, respectively.

CONCLUSIONS

patient gender and current GP gender are related to preferences in five hypothetical clinical situations and expectations of GP behaviour to preferences in four of them.

PRACTICE IMPLICATIONS

educational strategies are needed to adjust clinical encounters to patients' preferences.

What young African American women want in a health care provider

The Institute of Medicine's report on racial and ethnic disparities in health care encourages enhancing patient-provider relationships by building trust. We explored factors important to 19- to 24-year-old African American women (N = 40) in choosing a health care provider. Eight focus groups were held in seven Ohio counties. Discussion was aided by photographs of client-provider interactions: two African American and two White providers (man or woman in each); in similar settings, attire, and pose; with a young African American woman client. Participants commented on what was happening in the photographs, how the woman felt, and their perceptions of each provider. Fongwa's Quality of Care model guided analysis. Women providers were favored; race was not of primary concern. Provider proximity, perceived interest, and understandability were persistent preferences. Trust, awareness of body language, interest in client, and conveying information clearly are critical for providers caring for young African American women.

Muslim women and medical students in the clinical encounter

CONTEXT

Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation.

METHODS

Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors.

RESULTS

Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004).

CONCLUSIONS

As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.

Cervical cytology in vulnerable pregnant women

PURPOSE

To identify the prevalence of abnormal Papanicolau (Pap) smears in pregnancy in a vulnerable urban family practice, determine the percentage of abnormal Pap smears that persist into the postpartum period, and identify associated risk factors.

DATA SOURCES

A retrospective chart review of all prenatal patients (N = 192) from a large urban family practice in upstate New York from 2000 to 2004. Descriptive statistic analysis was performed on demographic information, risk factors for abnormal Pap smears, and disposition of the patients.

CONCLUSIONS

This study provides information on the risk factors associated with abnormal Pap smears in pregnancy in a population at high risk. A significant relationship was seen between a positive marijuana toxicology screen and an abnormal Pap smear. In addition, the younger the patient age, the higher the probability of having a positive toxicology result. As expected, human papillomavirus (HPV) was the only sexually transmitted infection associated with an abnormal Pap smear in those that had reflex testing with liquid based cytology. Patients with primary care providers were much more likely to return for cervical cancer screening within 1 year of previous testing.

IMPLICATIONS FOR PRACTICE

There are many barriers to screening and prevention for cervical cancer in vulnerable populations. Newer technologies with HPV testing have helped to identify those women at highest risk for cervical cancer. Implementing strategies among healthcare providers to avoid missed opportunities for screening, assessment and education of risk factors, and offering vaccination against HPV are needed. Empowering women may begin to reduce disparities through the development of educational programs that reduce cultural and linguistic barriers to screening and awareness that socioeconomic factors may be impediments to care and adherence.

Importance of gender, socioeconomic status, and history of abuse on patient preference for endoscopist

OBJECTIVES

Patients have previously expressed preference for the gender of their endoscopist. Most of these patients were Caucasian women of predominantly high socioeconomic status. No study has evaluated the gender preferences of both women and men from a diverse but predominantly low socioeconomic background. The aim of this study was to evaluate gender preferences for endoscopists within an inner-city, tertiary care population.

METHODS

Consecutive patients scheduled for elective outpatient upper or lower endoscopy were prospectively asked to complete a questionnaire. Data included patient demographics, income level, education level, medical history, social history, abuse history, and gender preferences toward various health-care professionals.

RESULTS

A total of 500 patients completed the study (286 women, 214 men). Overall, 33% of patients surveyed had a preference for the gender of their endoscopist (165/500; CI: 29-37%). Women were significantly more likely to have a gender preference vs. men (42.3 vs. 21%; P<0.001). Female gender, lower income level, and history of physical/emotional abuse were significant factors for gender preference, as shown by multivariate analysis. Of our patients, 88 (18%) reported a history of abuse. A history of abuse significantly increased the percentage of patients with a gender preference for endoscopist (P<0.001).

CONCLUSIONS

Women in our inner-city tertiary care center expressed gender preference for their endoscopist at rates similar to those seen in previous studies. A higher percentage of men had a gender preference than previously reported. Both men and women with a history of abuse are significantly more likely to prefer a woman endoscopist. Physicians should be aware of these high preference rates to increase compliance and optimize patient care.

Care-seeking behavior of women with reproductive health problems from low-income areas of Beirut

OBJECTIVE

To examine the patterns of care-seeking behavior and provider choice of women with self-reported reproductive health problems from 3 urban communities in Beirut.

METHODS

The study was based on a sample of 1869 completed questionnaires from 2051 eligible women (married or had been married, and between 15 and 59 years) obtained during the Urban Health Survey. Associations between community of residence, other background characteristics, and two outcome measures (health care usage and choice of provider) were assessed using logistic regression.

RESULTS

Of the 1869 women assessed, 439 (23.5%) reported reproductive health problems; of these, 273 (62%) women sought care for their problems, with the majority (52.5%) using private providers. Younger age, health insurance, and severity and duration of problems were associated with use. Women with higher parity and those with financial problems were significantly more likely to use public and subsidized services.

CONCLUSION

The private health sector needs to be more involved in planning, implementing, and offering reproductive health care in low-income communities.

Women's preferences for their gynecologist or obstetrician

OBJECTIVE

The objective of this study was to evaluate women's preferences in selecting their gynecologist or obstetrician.

METHODS

This cross-sectional study was performed at the Women's Health Center "Netka", Tel Aviv over a 1-month period in 2006 and included 287 participants. Women were asked to complete an anonymous questionnaire.

RESULTS

Most women (60.3%) reported that the gender of their gynecologist or obstetrician was not an important consideration when choosing a gynecologist or an obstetrician. The major determinants in their choice of a gynecologist or an obstetrician included professionalism (98.9%), courtesy (96.6%) and board certification (92%). The rating of the two most important factors in their choice revealed the following order: professionalism (45.3%), courtesy (25.8%), board certification (10.8%), availability (10.1%), comprehension (6.5%) and communication (1.5%).

CONCLUSION

Israeli women's model of choice of their gynecologist involved physicians' professionalism and courtesy while availability and physician's gender was significantly less important.

PRACTICE IMPLICATIONS

The presented data may help health providers during patients' education and counseling along with facilitating better understanding of patients' needs.

Patient choice: comparing criteria for selecting an obstetrician-gynecologist based on image, gender, and professional attributes

OBJECTIVE

The purpose of this study was to compare gender, humanistic qualities or technical competence (HQTC), and age when an obstetrician-gynecologist is selected.

STUDY DESIGN

Participants saw photographs (2 women, 2 men) without descriptors then the same photographs with descriptors. To test whether HQTC were more important than gender, the men in the photographs were given HQTC descriptors. Female patients, visitors, and staff at Hartford Hospital along with community and outpatient sites were recruited. Demographic information was collected.

RESULTS

From 901 participants, 83% chose a woman, 59% of whom selected gender or age as the reason. Single and younger patients were more likely to choose female and younger providers, respectively. With descriptors, 62% of the women chose a male provider. A significant number chose a different gender provider (P < .001) and made their selection for a different reason (P < .001).

CONCLUSION

More women chose a female provider when no additional information is known. A significant number changed their selection when male providers were described with HQTC.

Postgraduate medical training: getting patients on board

OBJECTIVES

To survey family planning clinic (FPC) patients who may be involved in the Diploma of the Faculty of Family Planning (DFFP) practical training; to obtain their views about the process of giving consent to their involvement; and to compare their views with current practice.

METHODS

Questionnaire surveys of 103 female FPC patients and 40 DFFP instructing doctors. Patients were recruited from the waiting room of a community FPC, and DFFP instructing doctors from the North West of England were recruited at an updating meeting.

RESULTS

Patients felt strongly that they wanted to know what to expect before deciding whether to agree to be involved in the training. Several items of information were requested. The most important of these were whether the training doctor would be seeing the patient alone; the gender of the training doctor; and the training doctor's level of experience. Patients had not always been given this information.

CONCLUSIONS

Clinical experience is an important part of postgraduate medical training and patients need to be able to give fully informed consent to their involvement. The information currently given to patients may be insufficient. A reluctance to see male training doctors may have implications as regards the breadth of experience gained by male training doctors; this needs further investigation. Further research including different patient populations could inform guidelines for patient involvement in training.

Practitioner Gender Preference Among Gynecologic Patients in Iraq

As the number of female practitioners increases, patients have expanding options from which to choose the gender of their practitioner. This study was conducted to uncover the attitudes of female patients toward obstetricians and gynecologists (ob/gyns) of different gender and the factors associated with their attitudes. A cross-sectional sample of 500 randomly chosen females was recruited and administered a questionnaire. Among respondents, 428 were married, 72 were unmarried, and they were ages 17-70 years. Most respondents (73%) prefer a female gynecologist and (79%) a female obstetrician. Eight percent preferred a male ob/gyn and 18% had no gender preference. Most female clients had a strong preference for a female ob/gyn. This was associated with social tradition and religious beliefs. The preference for female practitioners declined with rising educational levels.

"Doctor" or "doctora": do patients care?

BACKGROUND

The topic of gender and medical care is receiving increased attention but has not been studied in children. We noticed that several children undergoing laceration repair in emergency department requested to be sutured by a female physician. This study attempted to find gender preferences of children and parents for the physician in the emergency department.

OBJECTIVE

We undertook this study to determine whether pediatric patients or their parents have a preference for physicians of a particular gender. We also tried to determine whether they would be willing to wait longer to be seen to accommodate their choice.

METHODS

A total of 200 children aged between 8 and 13 years presenting to our pediatric emergency department for laceration repair were enrolled. With the knowledge and consent of their parents, the enrolled children were given a short questionnaire. They were asked, if they had a choice, would they prefer to have a male or a female doctor or would they prefer the doctor with the most experience. Their parents were also then given the questionnaire. They were also asked if they would be willing to wait longer to be seen by the doctor of their choice.

RESULTS

The study sample comprised 200 children, 139 boys and 61 girls. Among boys, 78% (n = 109) said they would prefer a female physician. Only 21% (n = 30) preferred a male physician. Among girls, 80% (n = 49) reported they would prefer a female physician, 20% (n = 12) preferred a male physician. None of the children surveyed wanted the "best" physician. When the parents were surveyed, 60% (n = 120) preferred a male physician as compared with 19% (n = 38) who expressed a preference for female physician. Only 21% (n = 42) of parents desired the most experienced physician of either sex to repair the laceration. All the parents who expressed a preference for the "most experienced" physician said they were willing to wait (42/42) until that physician was available as compared with less than a third of parents who were willing to wait for the physician of a specific gender (44/158).

CONCLUSIONS

Most children (79%) preferred a female physician for their sutures, whereas parents overall (60%) appeared to prefer a male physician. The children did not appear to care if the physician was the "best." Surprisingly, many parents also chose physician gender rather than physician experience. One hundred percent of the parents who chose the most experienced physician were willing to wait longer to be seen as compared with 29% who preferred a physician of a particular gender.

Patient gender preferences in a large military teaching hospital

OBJECTIVE

To quantify preferences for female providers among obstetric-gynecology patients in a large military teaching hospital in California.

METHODS

A questionnaire regarding patient preferences for female provider was distributed to and collected from 1,544 obstetric-gynecology patients over a two-month period. Responses were tabulated overall and for several demographic subgroups.

RESULTS

Sixty percent of respondents indicated they had no provider gender preference or they preferred a male. Significant ethnic preferences were noted among Asian, Pacific Islander, and Native-American women. Junior officers, wives, and daughters of service members also showed a greater preference for a female physician provider.

CONCLUSION

The majority of obstetric-gynecology patients surveyed had no strong preferences for female providers. In the interest of patient satisfaction, where strong gender preferences exist, attempts to accommodate could be made without overburdening female staff.

LEVEL OF EVIDENCE

III.

Syrian women's preferences for birth attendant and birth place

BACKGROUND

Women's preferences for type of maternity caregiver and birth place have gained importance and have been documented in studies reported from the developed world. The purpose of our study was to identify Syrian women's preferences for birth attendant and place of delivery.

METHODS

Interviews with 500 women living in Damascus and its suburbs were conducted using a pretested structured questionnaire. Women were asked about their preferences for the birth attendant and place of delivery, and an open-ended question asked them to give an explanation for their preferences. We analyzed preferences and their determinants, and also agreement between actual and preferred place of delivery and birth attendant.

RESULTS

Only a small minority of women (5-10%) had no preference. Most (65.8%) preferred to give birth at the hospital, and 60.4 percent preferred to be attended by doctors compared with midwives (21.2%). More than 85 percent of women preferred the obstetrician to be a female. The actual place of delivery and type of birth attendant did not match the preferred place of delivery and type of birth attendant. Women's reasons for preferences were a perception of safety and competence, and communication style of caregiver.

CONCLUSIONS

Most women preferred to be delivered by female doctors at a hospital in this population sample in Syria. The findings suggest that proper understanding of women's preferences is needed, and steps should be taken to enable women to make good choices. Policies about maternity education and services should take into account women's preferences.

Determinants of women's choice of their obstetrician and gynecologist provider in the UAE

BACKGROUND

The objective of this study is to evaluate women's priorities and preferences in selecting their obstetrician and gynecologist in a non-Western society.

METHODS

Consecutive sample of 508 patients attending the obstetric and gynecologic services of AL-Ain Hospital; AL-Ain; United Arab Emirates during 4 months was recruited. Participants were interviewed by using a structured 26-item questionnaire administered by means of face-to-face interview within 24 h of admission in the ward or before consultation in the outpatient clinic. Respondents were asked about their preferences, priorities, determinants of choice of their obstetrician and gynecologist, their view of his/her role as a medical provider, and their perception of importance of each of provider's characteristics and roles on a five-point Likert scale.

RESULTS

Four hundred thirty-nine (86.4%) participants preferred female physicians. Sixty-one (12%) had no preference and eight (1.6%) preferred male physicians. Reasons for female selection were privacy during intimate examination (89.1%) or counseling (68.8%), religious beliefs (74.3%), and cultural traditions (45.3%). Female preference was significantly associated with higher parity (P = 0.002), religion (P = 0.005), nationality (P = 0.01), occupation (P = 0.02), education (P = 0.04), and poor recognition of physician's role as professional/expert (P < 0.00001). Male preference was significantly associated with experience at previous encounter (P = 0.03), obstetric consultation (P = 0.04), and perceiving physician's role as skilled communicator (P = 0.01) or health educator (P = 0.04). Other physician characteristics affecting choice were professionalism, bedside manners, empathy, communication, competence, availability, and religion.

CONCLUSIONS

Physician's attitude, professional profile, sex, and religious faith determine women's choice of obstetricians and gynecologists. Most women prefer female providers because of embarrassment during pelvic examination and reproductive counseling, religious beliefs, and sociocultural values.