Do gender and race affect decisions about pain management?
Do gender and race affect decisions about pain management?
复制标题
DOI：
10.1046/j.1525-1497.2001.016004211.x
复制
发表时间：
2001-04-01
影响因子：
5.7
通讯作者：
Syat, BL
中科院分区：
文献类型：
--
作者：
Weisse, CS;Sorum, PC;Syat, BL
目的：为了确定患者的性别和种族是否影响疼痛管理的决策，设计，设置和参与者：实验设计使用医疗小插曲，以评估治疗决策。111名初级保健医生的便利样本（61名男性，50名女性）在东北部被要求治疗3名假设的疼痛患者（肾结石、背痛）或对照疾病（鼻窦炎），症状表现和严重程度保持不变，但患者的性别和种族是不同的。初始和回访时处方的麻醉性镇痛药（氢可酮）的最大允许剂量通过将mg/片乘以每天的药丸数x天数x再填充次数计算。在决定治疗或最大允许剂量方面，没有发现患者性别或种族的总体差异，但是，对于肾绞痛，男性医生对白色患者开具的氢可酮剂量高于黑人患者（426 mg vs 238 mg），而女性医生给黑人开了更高的剂量（335 mg vs 161 mg：F-1.85 = 9.65，P = .003）。对于持续性肾结石疼痛，重复这种模式，对于持续性背痛，男性医生对男性比女性开更高剂量的氢可酮（406 mg vs 201 mg），但女性医生给女性开的处方剂量更高（327 mg vs 163 mg; F-128 = 5.50，P = .03）。在治疗疼痛时，只有当医生性别的作用被检查时，性别和种族差异才是明显的，这表明男性和女性医生可能对性别和/或种族线索有不同的反应。
OBJECTIVE: To determine if patient gender and race affect decisions about pain management.DESIGN, SETTING, AND PARTICIPANTS: Experimental design using medical vignettes to evaluate treatment decisions. A convenience sample of 111 primary care physicians (61 men, 50 women) in the Northeast was asked to treat 3 hypothetical patients with pain (kidney stone, back pain) or a control condition (sinusitis), Symptom presentation and severity were held constant, but patient gender and race were varied.MEASUREMENTS AND MAIN RESULTS: The maximum permitted doses of narcotic analgesics (hydrocodone) prescribed at initial and return visits were calculated by multiplying mg per pill x number of pills per day x number of days x number of refills. No overall differences with respect to patient gender or race were found in decisions to treat or in the maximum permitted doses, However, for renal colic, male physicians prescribed higher doses of hydrocodone to white versus black patients (426 mg vs 238 mg), while female physicians prescribed higher doses to blacks (335 mg vs 161 mg: F-1.85 = 9.65, P = .003). This pattern was repeated for persistent kidney stone pain, For persistent back pain, male physicians prescribed higher doses of hydrocodone to males versus females (406 mg vs 201 mg), but female physicians prescribed higher doses to females (327 mg vs 163 mg; F-128 = 5.50, P = .03).CONCLUSION: When treating pain, gender and racial differences were evident only when the role of physician gender was examined, suggesting that male and female physicians may react differently to gender and/or racial cues.