Physicians' gender and clinical opinions of reproductive health matters

Provision of contraceptives by Brazilian general gynaecologists: a nationwide online survey

OBJECTIVE

To assess the provision of contraceptives by Brazilian obstetricians and gynaecologists (Obst/Gyns) during medical consultation and associated factors.

METHODS

An anonymous online survey was conducted with Obst/Gyns regarding age, gender, training, method counselling about and provision of long-acting reversible contraception (LARC).

RESULTS

Of 16,000 Obst/Gyns, 610 (3.8%) answered the survey. After multiple regression analysis, female Obst/Gyns (reference) (OR male was 0.53 [95%CI 0.28-0.98], p = 0.044) and Obst/Gyns aged between 20 and 39 were more likely to provide an IUD. For hormonal-IUDs, Obst/Gyns who had had theoretical training in hormonal-IUD insertion (reference no training) (OR = 2.13 [95%CI 1.14-3.99], p = 0.018), those who work in a private facility or public hospital, and those that allowed more time during consultations (reference) (OR short time = 0.33 [95%CI 0.17-0.63], p < 0.001) were more likely to provide them. Obst/Gyns who were hands-on trained were more likely to provide subdermal implant (OR = 2.04 [95%CI 1.45-2.87], p < 0.001).

CONCLUSIONS

There is a gap between theoretical and practical training received by this cohort of Obst/Gyns regarding LARCs, mainly contraceptive implants and hormonal-IUDs. The identification of barriers to offering contraceptives is essential to providing client-centred contraceptive care.

Serbian gynaecologists' views on contraception and abortion

OBJECTIVES

To examine Serbian gynaecologists' attitudes and practices related to contraception and abortion, as the principal alternative to contraception.

METHODS

A self-reported questionnaire was administered to a convenience sample of gynaecologists attending educational meetings of a medical society from October 2012 to October 2013. The data gathered were assessed by means of univariate and multivariate analyses.

RESULTS

Almost half of the respondents had ethical objections and would refuse to provide certain contraceptives to patients. Two thirds of the gynaecologists (63%) considered fertility awareness methods to be a poor option for most women. Twenty-three percent objected to abortion. Those who objected to contraceptives were less likely to object to abortions (OR: 0.422). This attitude was more prevalent in Southern and Eastern Serbia, where gynaecologists were more likely to object (OR: 4.892) and to refuse to prescribe contraceptives (OR: 4.161), but less likely to object to abortion (OR: 0.278) than in other regions.

CONCLUSIONS

A large proportion of Serbian gynaecologists objected to some contraceptive methods and were more in favour of abortions, especially in the least developed regions.

Attitudes of the new generation of Canadian obstetricians: how do they differ from their predecessors?

BACKGROUND

Attitudes drive practice, perhaps more than evidence. The objective of this study was to determine if the new generation of Canadian obstetricians has attitudes differing from those of their predecessors.

METHODS

  Employing a cross-sectional, Internet, and paper-based survey, we conducted an in-depth study of obstetricians responding to the Canadian National Maternity Care Attitudes Survey.

RESULTS

Of the 800 Canadian obstetricians providing intrapartum care, 549 (68.6%) responded. Participants were stratified by age less than or equal to 40 years compared with those over 40 years; 81 percent of those 40 years or younger were women versus 40 percent over 40 years of age. Younger obstetricians were significantly more likely to favor use of routine epidural analgesia and believed that it did not interfere with labor or lead to instrumentation; were more concerned and feared the perineal and pelvic floor consequences of vaginal birth compared with cesarean section; and were significantly less supportive of vaginal birth after prior cesarean section, home birth, birth plans, routine episiotomy, and routine electronic fetal monitoring as providing maternal or fetal benefits. They were less positive than the older generation about a range of approaches to reducing the cesarean section rate, the importance of maternal choice and role in their own birth, and peer review, and they were more likely to believe that women having a cesarean section were not missing an important experience. No significant generational differences were found for ambivalent attitudes to vaginal breech birth.

CONCLUSIONS

Younger obstetricians were more evidence-based for some issues and less for others. In general younger obstetricians were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, and they were less appreciative of the role of women in their own birth. They saw cesarean section as a solution to many perceived labor and birth problems. Results suggest a need to examine how obstetricians acquire their favorable attitudes to birth technology in normal birth.

An Analysis of the Impact of Gender on Physician Practice Patterns

Through analysis of Community Tracking Study Physician Survey, a nationally representative survey of U.S. physicians, we find that women physicians are significantly less satisfied with time for patients than their male colleagues. Among primary care physicians, about one third of the gender difference is explained by physician attributes, practice characteristics, geographical location and patient profiles. Control variables explain all of the gender gap among specialist physicians. Among primary care physicians, the effects of practice type and perceptions of patient complexity on satisfaction with time for patients are mediated by physician gender. Among specialist physicians, gender interacts with practice ownership and hours spent in medically related activity to determine satisfaction with time for patients.

Physicians' opinions on patients' requests for specific treatments and examinations

OBJECTIVE

The number of technologies used in health care is growing, patients' educational level has risen, health and drug information is increasingly available and patients today are actively looking for information from different sources. The aim of the study was to investigate physicians' opinions on patients' requests for specific treatments and examinations.

DESIGN

The data were gathered as part of an annual physician's survey sent to all Finnish physicians (n=16,698) by the Finnish Medical Association in March 2002. The response rate was 85% (n=14,157). Physicians involved in clinical work were selected for this study (n=12,255).

RESULTS

Half (53%, n=6,521) of the clinicians reported either 'very often', or 'often' receiving requests from patients for specific treatments or examinations, and of them, 76% (n=4,972) reported an increase in such requests. The younger clinicians received more often patient requests. Women physicians, those working in health centres, and non-specialized clinicians reported more experience of, and an increase in patients making requests. Of those clinicians who received patient requests 'very often' or 'often', 24% (n=1,595) considered such requests as having a positive, and 43% (n=2,808) a negative, effect on patient care and interaction; clinicians who did not receive many patient requests had similar opinions. Older, men, those working in private practice and specialized clinicians had a more positive attitude towards such requests than other clinicians. The reasons given for the positive and negative opinions were varied.

CONCLUSIONS

Active patients (consumer patients) are a reality in the Finnish health care system. Physicians have varying opinions on this phenomenon.

Gender Differences in the Practice of Adult Primary Care Physicians

OBJECTIVE

This study investigates how physician gender affects reactions to six model patients.

METHODS

Telephone interviews with 3205 internists and family or general physicians were completed between 1996 and 1997 for the Community Tracking Study. Physicians responded to six vignettes describing model patients with presentations designed to have multiple appropriate treatment plans: a 50-year-old man with a 1-month history of exertional chest pain who may need a referral to a cardiologist, a 60-year-old man with a normal digital rectal examination (DRE) who may benefit from a prostate-specific antigen (PSA) test, a 40-year-old married woman with vaginal itching and discharge who may benefit from an office visit, a 60-year-old man with symptoms of benign prostatic hypertrophy (BPH) who may benefit from a urological consultation, a 35-year-old man with back pain and a new left footdrop who may benefit from an MRI, and a 50-year-old man with elevated cholesterol and no other cardiac risk factors who may benefit from cholesterol-lowering agents.

RESULTS

Female physicians are significantly more likely than males to refer a patient with BPH to a urologist (37.5% vs. 24.9%, p < 0.001). Male physicians are significantly more likely to recommend that a woman with vaginal itching and discharge have an office visit (52.7% vs. 40.6%, p < 0.001). Male physicians recommend cholesterol-lowering agents slightly more often than women physicians (39.4% vs. 36.4%, p < 0.03) and recommend a PSA test more often than female physicians (73.1% vs. 64.4%, p < 0.001). Neither physician attributes, practice characteristics, referral patterns, nor geographical traits account for the disparity between male and female physicians in the treatment of BPH. Approximately 40% of the gender gap in treatment of vaginal itching and discharge can be attributed to physician attributes. The association between provider gender and the decision to prescribe cholesterol-lowering agents and the association between provider gender and recommending a PSA test are explained by physician attributes.

CONCLUSIONS

Gender differences in treatment seem to appear most strongly for genital-specific conditions. The results may suggest that physicians use fewer resources to treat the genital-specific conditions of patients who share their sex.

Gender as a variable in the assessment of final year degree-level communication skills

AIM

To investigate possible bias due to gender combination of students, role players and examiners in a high-stakes assessment.

SETTING

Valid oral interactive contextualized examinations (VOICEs) is a long-station OSCE-style exam in general practice (GP). At the time of writing it consisted of 65% of the student's final GP mark.

METHOD

In the VOICE, students undertake six tasks--four vivas and two role-plays. "Patient" roles are taken by professional role players who work regularly on the undergraduate curriculum. During the role-play, the student's clinical competence is assessed by an observing GP examiner. The communication skills marks are awarded by the role player and the examiner together, by negotiation. Data have been recorded detailing the role player's initial marks, the examiner's initial marks and their final (awarded) agreed marks for 1024 consultations.

SAMPLE

512 final year medical students, 28 role players and 48 examiners. There were no inclusion or exclusion criteria. All those present on exam day became part of the data.

RESULTS

There was a significant relationship between gender and performance for some, but not all, stations. Correlations for multiple comparisons removed the significance. Female students perform better across the board than male students. While not always significant, this did affect grading. There was no significant association between the genders of role players and examiners with the question choices. There has been a significant worsening of male results since 1999. Differences exist in the way that pairs of mixed or single genders score students.

Physician-patient interaction: a gynecology clinic in Turkey

Evidence for gender differences in physicians' communication with their patients comes primarily from Western countries. Little is known about whether these gender differences would also be observed in Turkey, where there are explicit rules about male-female conduct. The purpose of this study was to observe male and female gynecologists' communication with their patients in a gynecology clinic at a state hospital in Istanbul, Turkey. Four male and three female gynecologists were observed in their interaction with 70 patients over 10 days. The observations were conducted during both the history taking and the actual examination sessions by a woman researcher. The results reported in this paper are based on the extensive field notes taken during the observations. Important differences were revealed in interactions between male vs female gynecologists and their patients. Namely, interactions differed in terms of conversation initiation, communication style, use of technical and colloquial language, frequency of eye contact, patience, and provision of information. Communication characteristics specific to interactions between male gynecologists and their patients included a 'blaming the victim' approach, differential treatment of patients, and underestimation of patients' abilities. Environmental factors that affected physicians' interaction with their patients are reported in conjunction with physicians' use of these external factors to explain the problems they experienced in physician-patient interaction. The discussion focuses on alternative explanations for and future research implications of the observed differences between male and female gynecologists in this setting.

Determinants of women's choice of obstetrician/gynecologist

INTRODUCTION

There has been a reported increase in women's desires to have female medical providers. It is unclear if this finding extends to obstetrician/gynecologists or how important gender is relative to other factors in choosing a provider. This study seeks to address these issues.

METHODS AND MATERIALS

In community locations in Brooklyn, New York, 537 women completed a questionnaire regarding demographics, gender of their current provider, and whether they considered age, gender, experience, location, or cost to be the most important factor in choosing an obstetrician/gynecologist. They rated their current experience and the importance of gender using a 10-point Likert scale.

RESULTS

Overall, 61% of participants preferred a female provider. The proportion did not vary with gender of the interviewer or participants' age. A female provider was preferred by 56% of Protestants, 58% of Catholics, and 58% of Jews and by 74% of Hindus and 89% of Muslims (p = 0.02). Regardless of whether a woman preferred a male or a female provider, 38% of participants felt strongly (7-10 on Likert scale) that gender was important. There was no difference in satisfaction with current provider between women who preferred a male or female provider. Gender was as important in choosing an obstetrician as experience or cost. Almost as many women with a female provider indicated a preference for a male (46%) as women with a male provider who preferred a female provider (54%).

CONCLUSIONS

A slight majority of these women, particularly those who are Hindu or Moslem or currently use a female, prefer female providers. Only a minority of these women feel strongly about their preference, and women with male providers are as satisfied as are women with female providers. Gender of provider was about as important as a physician's experience in choice of clinician.

Gender differences in gynecologist communication

The intimate nature of gynecological health problems requires the physician's specific attention. On the basis of previous findings in primary care, female gynecologists are expected to communicate more affectively than men. This study addressed gender differences in gynecologist communication behavior by comparing videotapes of real-life outpatient encounters with female (N = 107) and male (N = 196) gynecologists by means of bivariate and multilevel analysis. Only a few gender differences were found: female gynecologists performed longer physical examinations, showed more global attentiveness, and asked fewer medical questions. Either the duration of the medical education or the type of statistical analysis may account for this lack of gender differences.

Communication during gynecological out-patient encounters

The intimate nature of women's health problems presented during gynecological encounters places great demands on gynecologists' communicative behavior. The present study examined what patients expect from their gynecologist, how gynecologists and patients actually communicate during out-patient encounters, and what factors shape the structure and process of the encounter. Twenty-one gynecologists (13 consultants and eight residents) videotaped 303 consecutive out-patient encounters. Multilevel analysis was used to take into account the similarity among encounters with the same gynecologist. The results showed that gynecological patients expected foremost to receive clear and understandable information. One-third of the patients expected support and understanding. Psychosocial issues were hardly ever the topic of conversation. The length of the out-patient visits increased in the presence of patients' partner, with the type of problem presented, and with the frequency with which the patient disagreed with the gynecologist. The visit was also longer when gynecologists provided more medical information and asked more psychosocial questions. Although gynecological encounters focus almost exclusively on medical issues, talking about non-somatic aspects does not seem to prolong the visit as much as the presence of the patient's partner or whether or not the gynecologist and patient had met before. In view of patients' affective needs, it would be worthwhile to examine whether gynecologists can be taught to handle patients' psychosocial needs as well.