The Effect of Gender Bias on Patient Care
By Elizabeth Kaplan and Sachi Sengupta
Gender bias can be defined as the preference of one gender over another; this bias is based on generalizations and stereotypes. Bias can be characterized as either implicit or explicit. Explicit is a type of bias that an individual recognizes while implicit is a type of bias that occurs unknowingly.
There are two main ways gender bias affects patient care: disbelief of symptoms and gaps in medical research.
The most common discrepancy caused by gender bias is the perceived pain difference between men and women. A public health analyst Anke Samulowitz conducted a study in 2018 analyzing the influence of gender bias in diagnosing patients. Samulowitz selected 77 articles concentrating on pain differences and there was a clear pattern. A physician stated,
“All participants attributed men’s lack of contact with health services to their need to appear ‘brave and manly’ which made them reluctant to admit weakness”. (Samulowitz, 2018)
Due to these generalizations, men are less likely to actively seek out medical intervention. Among the 77 articles, women were expected to find alternative ways to cope with the pain. The article states,
“Women with chronic pain have to learn to prioritize their duties and explain their reduced physical capacity to their close ones and at work and to set limits for others’ expectations”. (Samulowitz, 2018)
In addition to worrying about their duties, women have stated that their self-esteem deters greatly during recovery.
Unfortunately, this implicit bias is reinforced via journal articles, school, and workplace superiors. From the start, males were seen as inherently better test subjects since they do not have menstrual cycles and cannot get pregnant. This bias has caused a limitation on research available that focuses on females and most research dating back to the 1990s is flawed.
“Compared with male patients, women who present with the same condition may not receive the same evidence-based care. In several key areas, such as cardiac care and pain management, women may get different treatment, leading to poorer outcomes.” (Paulsen, 2020)
Luckily, women now make up 50% of NIH-supported clinical research and there are other means to address the issue as well. Discourse concerning gender bias must occur within the healthcare field and training can help clinicians realize their own implicit biases when they are put into practice situations.
According to a study on the Health Maintenance Organization (HMO) in Northern California, a correlation does exist between patient satisfaction and the gender of both the patient and physician.
There does seem to be a discrepancy in primary practice styles between female and male physicians, specifically in that female doctors are more likely to practice preventative medicine, consider lifestyle and social aspects when treating patients, provide background medical knowledge for context in treatment, and create a space where patients feel comfortable in participating in the discussion of their treatment. A study recently published in The New England Journal of Medicine found that female doctors spend an average of 2.4 minutes more with their patients than male physicians-time that can be attributed to establishing this “rapport”, as author Mara Gordon describes in her article for NPR.
Not only is there a disparity between female and male physicians, but also male and female patients. It has been found that male patients present less personal history and symptom descriptions than females, as well as value less time and attention from their physicians.
These gender differences have a real effect on healthcare. Patients are more likely to seek out female physicians to obtain a more empathetic and sensitive style of care (Schmittdiel, Grumbach, et al.). However, due to a competitive health environment focused on efficiency, these expectations from patients place a great burden on female doctors, especially since female physicians are more likely to work part-time.
The expectations placed on female physicians put a great strain on them, contributing to physician burnout.
The study obtained some significant results that are important to take note of. It found that female patients who chose female physicians were less satisfied than others, while male patients who chose female physicians were most satisfied. This is important to recognize as it means that these inconsistencies are affecting healthcare and patient satisfaction.
In addition to impacting patient care, these gender biases are also leaving a financial impact on women doctors. Because female physicians spend approximately 15% more time with patients during each visit in comparison to male doctors, they see fewer patients over the course of the year (Gordon 2020).
“In the U.S. healthcare system where most insurance companies pay doctors based on the number of patients they see — not how much time they spend with them — this means that women physicians generated about 11% less annual revenue for their practices than their male colleagues.” (Gordon 2020)
This pay gap in healthcare, $86,000 on average, is something we as a nation have been battling for too long. Future research should seek to overcome these gender disparities both in care expectations of patients and treatment by physicians. If we continue to disregard these differences, not only will patient care be at risk of being compromised, but we will never resolve the pay gap between male and female doctors.
Sources
[1] Schmittdiel, J., Grumbach, K., Selby, J. V., & Quesenberry, C. P., Jr (2000). Effect of physician and patient gender concordance on patient satisfaction and preventive care practices. Journal of general internal medicine, 15(11), 761–769. https://doi.org/10.1046/j.1525-1497.2000.91156.x
[2] “Physician Burnout a ‘Public Health Crisis’: Report.” Safety+Health Magazine, Safety+Health Magazine, 13 Nov. 2019, https://www.safetyandhealthmagazine.com/articles/18172-physician-burnout-a-public-health-crisis-report.
[3] Gordon, Mara. “Female Doctors Spend More Time with Patients, but Earn Less Money than Men.” NPR, NPR, 28 Oct. 2020, https://www.npr.org/sections/health-shots/2020/10/28/925855852/female-doctors-spend-more-time-with-patients-but-earn-less-money-than-men.
[4] Anke Samulowitz, Ida Gremyr, Erik Eriksson, Gunnel Hensing, ““Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain”, Pain Research and Management, vol. 2018, Article ID 6358624, 14 pages, 2018. https://doi.org/10.1155/2018/6358624
[5] Paulsen, E. (2020, January 14). Recognizing, addressing unintended gender bias in patient care. Duke Health Referring Physicians. https://physicians.dukehealth.org/articles/recognizing-addressing-unintended-gender-bias-patient-care
Elizabeth Kaplan is a second year Physiological Science major at UCLA and is a THINQ 2021–2022 clinical fellow.
Sachi Sengupta is a second year Neuroscience major at UCLA and is a THINQ 2021–2022 clinical fellow.
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