Cori B. knew that disrobing and having her feet in stirrups during her first gynecologist appointment would be awkward. Still, she never expected the doctor’s comments to be the most uncomfortable part of the experience.
“He made some inappropriate comments during the exam like … 'Your future husband will be lucky to have you!’ even with his nurse in the room,” recalls Cori, 42. “I remember being so humiliated I cried when I got home … I honestly didn’t ever want to go to the gynecologist again.”
A few months later, Cori made an appointment with a different provider for a suspected urinary tract infection (UTI). The male physician attributed her symptoms to a painful period and never performed a urinary culture; Cori later went to an urgent care center near her Cary, North Carolina, home, where she was diagnosed with a UTI and a bladder infection. She never felt comfortable booking an appointment with a male physician again.
While Cori’s first experience is harassment, it’s not surprising she would come away with a preference for a female healthcare provider. Several studies suggest that both men and women are more likely to request a primary care physician of the same gender. And the reasons can be as simple as a bad experience with one gender or the other, the patient’s comfort levels, and religious beliefs to outright bias.
Understanding Gender Preferences
During interactions with patients, Alaska Pendleton, MD, MPH, a vascular surgery resident at Massachusetts General Hospital, has been asked to provide blankets and remove food trays, asked out on dates, and had her skill and competence questioned. The experiences were both “confusing and stressful” and made it more difficult to provide optimal care.
“You’re contemplating their course of care and how to operate, and it comes out of the blue,” Pendleton says. “It’s hard, in the moment, to respond when it shocks you so badly.”
Pendleton also once received a request for a female surgical team from a Muslim woman who needed an angiogram. The patient knew the procedure would expose her groin and made the request on religious grounds. Pendleton assembled a team that included a female attending and a female junior resident to help the patient feel more comfortable.
Uncovering why patients request physicians of the same gender can help providers determine how to respond.
Scott R., 52, didn’t realize he had a gender preference when it came to his primary care physician until his first appointment with a new doctor.
“I made the appointment [with a female doctor], and when we started talking, I thought, ‘This is going to be uncomfortable if there’s ever a genitalia issue,’” he recalls. “It had nothing to do with her competence; it was all related to my comfort level.”
Arghavan Salles, MD, PhD, clinical associate professor and special advisor for diversity, equity, and inclusion programs at Stanford University, Stanford, California, acknowledges that some patients request providers of the same gender. “It’s important for there to be a therapeutic alliance between patients and their doctors,” she says. “To the extent it is possible, it is likely beneficial for all involved to try to support such requests.”
In hospital settings or clinics with multiple providers, the solution can be as simple as referring patients to another provider. However, when gender preferences are rooted in discrimination, the course of action is different.
Addressing Gender Discrimination
Surgeon Mark Hoofnagle, MD, PhD, FACS, assistant professor at Washington University in St. Louis, Missouri, has witnessed patients treating his female colleagues with less respect.
“It’s pretty typical [for patients] to misidentify female physicians as nurses or to assume they have different training or lower tiers of training,” said Hoofnagle. “[Female] physicians have to do more work to convince patients that they are legitimate, knowledgeable, and experienced.”
In Medscape Physicians’ Views on Gender Discrimination Issues Report 2022: Strong Emotions, Contrary Opinions, female physicians report that gender discrimination is a top social issue.
Among physicians polled, 57% of women and 19% of men have witnessed patients showing gender discrimination. And additional research from Massachusetts General Hospital found that 100% of female physicians experienced gender-based discrimination during their residencies.
Dealing with gender discrimination from patients can take a toll. Female physicians were significantly more likely than their male colleagues to report that the experience influenced their risk of burnout, job satisfaction, personal safety, and well-being. It might also impact their quality of care.
“Data suggest women physicians provide better care, particularly to women patients [but] anecdotally, when men request not to be cared for by a woman, it may be because they don’t believe women are as qualified as men,” says Salles.
Indeed, research shows that men are more likely to choose male doctors but are more honest about their medical symptoms with female doctors. A study in Preventive Medicine found men may underreport symptoms with male doctors for fear of being perceived as weak. In this case, male doctor preference among men could be problematic, impeding early detection of medical problems. On the other hand, accommodating reasonable requests for a healthcare provider of a specific gender could increase the odds that patients will seek care.
“It’s not uncommon for patients to have a specific gender preference for a urologist or gynecologist,” Hoofnagle says. “There’s a certain amount of these requests that are about comfort, not competence, and we don’t want that to get in the way of them seeking medical care.”
However, when discrimination is behind a request for a physician of a particular gender, physicians must stand up to patients.
“If a patient needs their appendix out and is concerned that the trainee is female, [as the attending], it’s up to me to say, ‘The physicians here are all well-trained and excellent. Your choice is to get care from us or seek care from another facility,’” said Hoofnagle. “We’re not accommodating sexism toward other physicians.”
The study was funded by Merck. Smith reports receiving grant funding from Merck. Jones reports no relevant financial relationships.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE Health.
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Cite this: Does Your Gender Matter? Why Some Patients Prefer a Same-Sex Doctor - Medscape - Sep 26, 2022.