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Women and men with coronary heart disease in three countries : are they treated differently?

By Markus Bönte, Olaf von dem Knesebeck, Johannes Siegrist, Lisa Marceau, Carol Link, Sara Arber, Ann Adams and John B. McKinlay

Abstract

Non-medical determinants of medical decision making were investigated in an international research project in the US, in the UK and in Germany. The key question in this paper is whether and to what extent doctors' diagnostic and therapeutic decisions in coronary heart disease (CHD) are influenced by the patients' gender.\ud A factorial experiment with a videotaped patient consultation was conducted. Professional actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patient-actors of different sex, age, race and socio-economic status. The videotapes were presented to a randomly selected sample of 128 primary care physicians in each country. Using an interview with standardized and open-ended questions, physicians were asked how they would diagnose and treat such a patient after they had seen the video.\ud Results show gender differences in the diagnostic strategies of the doctors. Women were asked different questions, a CHD was mentioned more often as a possible diagnosis for men than for women, and physicians were less certain about their diagnosis with female patients. Moreover, results indicate that gender differences in management decisions (therapy and lifestyle advice) are less pronounced and less consistent than in diagnostic decisions. Magnitude of gender effect on doctors' decisions varies between countries with smaller influences in the US.\ud Although patients with identical symptoms were presented, primary care doctors’ behavior differed by patients' gender in all three countries under study. These gender differences suggest that women may be less likely to receive an accurate diagnosis and appropriate treatment than men

Topics: RC
Publisher: Elsevier
Year: 2008
OAI identifier: oai:wrap.warwick.ac.uk:185

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