Might physician-patient gender concordance influence clinical outcomes in primary care? Findings from a large unannounced standardized patient study

• Published in: Journal of psychosomatic research Vol. 145; p. 110460
• Main Authors: Rogers, Heather, Dumenci, Levent, Siminoff, Laura A.
• Format: Journal Article
• Language: English
• Published: London Elsevier Inc 01.06.2021; Elsevier Science Ltd
• Subjects: African Americans; Appropriateness; Clinical outcomes; Colonoscopy; Colorectal cancer; Colorectal carcinoma; Family physicians; Gender; Generalizability; Medical diagnosis; Medical history; Medical records; Medical referrals; Medical screening; Patients; Physicians; Primary care; Psychiatric/Mental Health; Sigmoidoscopy; Standardized patients; Symptoms
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2021.110460

Objective: Given that disparities in incidence and mortality in colorectal cancer (CRC) continue to persist, despite provision of widespread screening and improved treatments for CRC. we examined the relationship between patient and physician characteristics and appropriate clinical outcome of a primary care consultation for colorectal cancer (CRC) symptoms. Methods: Unannounced standardized patients (USPs) consulted 207 general practitioners (GPs) in two US states (Virginia and Ohio). The USPs of both genders were Caucasian or African American and presented as new patients with symptoms of CRC. GPs were blinded to the diagnosis and consented to audiotaping the encounter. Medical records were obtained and the audiotapes were coded by trained observers. Results: 141 of the 367 consultations (38%) resulted in an appropriate clinical outcome | recommendation for colonoscopy/ sigmoidoscopy/FOBT or gastroenterologist referral]. Appropriate clinical outcome was associated with male USP gender, longer visits, thorough examination of medical history, thorough exploration of patient symptoms, positive USP evaluation of GP performance, and GP-USP gender concordance (p's<0.05). No physician or clinic factors were significant. A logistic regression model with the USP. visit, and physician-patient factors showed that gender concordance was the sole significant independent predictor of appropriate clinical outcome (OR = 1.63. p = 0.04). Conclusions: Physician-patient gender concordant primary care consultations (e.g.. man-to-man and woman-to-woman) were more likely to result in appropriate visit outcomes, regardless of other significant factors associated with these outcomes. Further research to determine generalizability of the findings beyond CRC symptoms and to examine potential mediators of the gender concordance -appropriate clinical outcome relationship is warranted.