Gendered Uncertainty and Variation in Physicians' Decisions for Coronary Heart Disease: The Double-Edged Sword of "Atypical Symptoms"

被引:14
作者
Welch, Lisa C. [1 ]
Lutfey, Karen E. [1 ]
Gerstenberger, Eric [1 ]
Grace, Matthew [1 ]
机构
[1] New England Res Inst, Ctr Qualitat Res, Watertown, MA 02472 USA
关键词
disparities; gender; mixed methods; narrative analysis; physician decision making; ACUTE MYOCARDIAL-INFARCTION; QUALITY-OF-CARE; STATISTICAL DISCRIMINATION; CARDIOVASCULAR-DISEASE; PATIENT COMMUNICATION; DISPARITIES; HEALTH; DIAGNOSIS; WOMEN; MANAGEMENT;
D O I
10.1177/0022146512456026
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.
引用
收藏
页码:313 / 328
页数:16
相关论文
共 58 条
[1]   The influence of patient and doctor gender on diagnosing coronary heart disease [J].
Adams, Ann ;
Buckingham, Christopher D. ;
Lindenmeyer, Antje ;
McKinlay, John B. ;
Link, Carol ;
Marceau, Lisa ;
Arber, Sara .
SOCIOLOGY OF HEALTH & ILLNESS, 2008, 30 (01) :1-18
[2]  
[Anonymous], 2001, Exploring the Biological Contributions to Human Health: Does Sex Matter? Sex Begins in the Womb
[3]  
[Anonymous], 2000, Sexing the Body
[4]  
[Anonymous], 2007, Narrative Methods for the Human Sciences
[5]  
[Anonymous], 2007, INCLUSION POLITICS D, DOI DOI 10.7208/CHICAGO/9780226213118.001.0001
[6]   Patient characteristics and inequalities in doctors' diagnostic and management strategies relating to CHD: A video-simulation experiment [J].
Arber, S ;
McKinlay, J ;
Adams, A ;
Marceau, L ;
Link, C ;
O'Donnell, A .
SOCIAL SCIENCE & MEDICINE, 2006, 62 (01) :103-115
[7]   Testing for statistical discrimination in health care [J].
Balsa, AI ;
McGuire, TG ;
Meredith, LS .
HEALTH SERVICES RESEARCH, 2005, 40 (01) :227-252
[8]   Statistical discrimination in health care [J].
Balsa, AI ;
McGuire, TG .
JOURNAL OF HEALTH ECONOMICS, 2001, 20 (06) :881-907
[9]  
Balsa AI, 2003, AM J LAW MED, V29, P203
[10]   Myocardial infarction in women: A critical appraisal of gender differences in outcomes [J].
Bell, DM ;
Nappi, J .
PHARMACOTHERAPY, 2000, 20 (09) :1034-1044