Johannes Siegrist

Women and Men with Coronary Heart Disease in Three Countries: Are They Treated Differently?

BACKGROUNDnNonmedical determinants of medical decision making were investigated in an international research project in the United States, the United Kingdom, and 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 patient gender.nnnMETHODSnA 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 gender, age, race, and socioeconomic 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.nnnRESULTSnResults show gender differences in the diagnostic strategies of the doctors. Women were asked different questions, 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. 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 United States.nnnCONCLUSIONnAlthough patients with identical symptoms were presented, primary care doctors behavior differed by patients gender in all 3 countries under study. These gender differences suggest that women may be less likely to receive an accurate diagnosis and appropriate treatment than men.

Hausärztliche Entscheidungenbei Symptomen für Diabetes mellitus Typ 2

BACKGROUNDnPatient and physician attributes influence medical decisions as non-medical factors. The current study examines the influence of patient age and gender and physicians gender and years of clinical experience on medical decision making in patients with undiagnosed diabetes type 2.nnnMETHODnA factorial experiment was conducted to estimate the influence of patient and physician attributes. An identical physician patient encounter with a patient presenting with diabetes symptoms was videotaped with varying patient attributes. Professional actors played the patients. A sample of 64 randomly chosen and stratified (gender and years of experience) primary care physicians was interviewed about the presented videos.nnnRESULTSnResults show few significant differences in diagnostic decisions: Younger patients were asked more frequently about psychosocial problems while with older patients a cancer diagnosis was more often taken into consideration. Female physicians made an earlier second appointment date compared to male physicians. Physicians with more years of professional experience considered more often diabetes as the diagnosis than physicians with less experience.nnnCONCLUSIONnMedical decision making in patients with diabetes type 2 is only marginally influenced by patients and physicians characteristics under study.