THE FEMALE PATIENT pps

1

Most providers treasure their ability to care for patients. The joy

derived from the provider–patient relationship remains intact

despite additional individuals (e.g., employers, insurers, benefit

managers, billing and collection specialists, utilization reviewers,

etc.) and regulations interposed by the current evolution of health

care.

Additionally, providers appear to be accommodating to

longer-term alterations that materially affect overall patient–

provider relationships. One feature of the changing relationship

is increasing patient autonomy. Many factors likely have assisted

this societal change, but the extraordinary impact of readily avail￾able medical information on the Internet certainly plays a role.

Concurrently, the paternalistic care model (marked by the inter￾action goal being determined by the provider, the provider role

being motivated by being a guardian, alignment of patient values

with the providers, and patient acceptance of recommendations)

is waning.

Providers continue the search to improve the science of health

care, while also seeking to improve the art of caring for patients.

Indeed, during this decade there has been notable progress in both

the science and art of caring for women. Included in that progress

is the long overdue scientific recognition that men and women are

different.

There is now scientific recognition of both therapeutic dispar￾ities attributable to gender as well as marked differences in gender

inclusion in clinical trials. Additionally, there is a renewed appre￾ciation that women frequently have different symptoms, risk factors,

and drug reactions than do men. For example, recent changes, mak￾ing drug protocols more gender-specific and including women in

major drug trials have reduced the disparity in treatment; however,

the disparities are not yet eliminated.

Advances in the art of medicine include acknowledgment of

difference in the way the two sexes approach problems. This

sociolinguistic gender difference in problem solving affects the

1

THE FEMALE PATIENT

CHAPTER

Copyright 2001 The McGraw-Hill Companies. Click Here for Terms of Use.

BENSON & PERNOLL’S

2 HANDBOOK OF OBSTETRICS AND GYNECOLOGY

process of medical care. In general, men prefer to solve problems

themselves. Male patients present problems that they expect the

physician to resolve, whereas women seek opinions or suggestions

from others and then solve the problem with this consensus. Female

patients may want to discuss a problem but do not necessarily ex￾pect their doctor to resolve it. Male physicians tend to think that

problems presented must be solved. Women regard interview dis￾cussions with their physicians as opportunities to clarify problems

and to obtain information about the implications of problems and

treatments in their lives. This expectation can frustrate men, in￾cluding male physicians.

For some time, providers have recognized certain complexities

in communicating with female patients (v. male patients), includ￾ing: lengthier and more detailed patient histories, more complaints

expressed less succinctly in symptomatic interviews, and a greater

variety of illnesses reported by female patients. Some of the other

gender difference observations concerning the provider–patient re￾lationships are summarized as follows:

● Providers spend more time with female patients. ● More diagnostic errors are made with women patients. The

most common explanation for diagnostic errors observed

with female patients is the clinician’s readiness to attribute

women’s symptoms to “overanxiousness.” ● Interventions with women patients by physicians tend to be

less aggressive. ● Generally, providers give more explanations to female

patients. ● Providers impart more explanations rephrased from medical

terms into lay terms when talking to women. ● When talking to women, providers give more responses to

questions at the level of speech of the patient. ● In negotiation of treatment plans, male physicians may ex￾plain the meaning of a female patient’s comments back to

her and then attempt to guide her behavior through sugges￾tions or instructions. ● Female patients may make overt attempts to share the control

of the discussion by insisting on validating their symptoms

with repetition, becoming more dramatic in their presentation

of symptoms, switching to new symptoms, or reporting symp￾toms of questionable severity.

Other elements influencing the provider–patient relationship in￾clude: provider gender, the nature of the interaction, the nature of

the communication, understanding the patient’s perspective, com￾munication training, and awareness of gender issues.