Patient characteristics and inequalities in doctors' diagnostic and management strategies relating to CHD: A video-simulation experiment
Patient characteristics and inequalities in doctors' diagnostic and management strategies relating to CHD: A video-simulation experiment
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DOI：
10.1016/j.socscimed.2005.05.028
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发表时间：
2006-01-01
影响因子：
5.4
通讯作者：
O'Donnell, A
中科院分区：
文献类型：
--
作者：
Arber, S;McKinlay, J;O'Donnell, A
许多研究探讨了性别、年龄、阶层和种族方面的健康不平等，但很少涉及初级保健医生的行为。这项析因实验研究了四种患者特征如何影响初级保健医生关于冠心病 (CHD) 的决策。初级保健医生观看了脚本咨询的视频片段，其中患者出现了标准化的 CHD 症状。除了不同的患者性别、年龄（55 岁与 75 岁）、阶级和种族外，录像带都是相同的，从而消除了咨询的社会背景或患者症状或行为的其他方面的任何混杂因素。英国和美国 256 名初级保健医生的概率样本在随机实验设计中观看了这些视频片段。患者的性别显着影响了医生的诊断和管理活动。然而，没有社会阶层或种族的影响。没有证据表明医生的行为存在年龄歧视。女性被问到的问题较少，接受的检查也较少，接受的先心病诊断测试也较少。有人提出“性别年龄歧视”，因为中年妇女被问到的问题最少，开出的适合先心病的药物也最少。初级保健医生的行为因患者性别的不同而存在显着差异，这表明医生的行为可能会导致健康方面的性别不平等。 (c) 2005 Elsevier Ltd. 保留所有权利。
Numerous studies examine inequalities in health by gender, age, class and race, but few address the actions of primary care doctors. This factorial experiment examined how four patient characteristics impact on primary care doctors' decisions regarding coronary heart disease (CHD).Primary care doctors viewed a video-vignette of a scripted consultation where the patient presented with standardised symptoms of CHD. Videotapes were identical apart from varying patients' gender, age (55 versus 75), class and race, thereby removing any confounding factors from the social context of the consultation or other aspects of patients' symptomatology or behaviour. A probability sample of 256 primary care doctors in the UK and US viewed these video-vignettes in a randomised experimental design.Gender of patient significantly influenced doctors' diagnostic and management activities. However, there was no influence of social class or race. and no evidence of ageism in doctors' behaviour. Women were asked fewer questions, received fewer examinations and had fewer diagnostic tests ordered for CHD. 'Gendered ageism' was suggested, since midlife women were asked fewest questions and prescribed least medication appropriate for CHD. Primary care doctors' behaviour differed significantly by patients' gender, suggesting doctors' actions may contribute to gender inequalities in health. (c) 2005 Elsevier Ltd. All rights reserved.