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“I am solely a professional – neutral and genderless”: on gender bias and gender awareness in the medical profession
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: During the last decades research has reported seemingly unjustified differences between how women and men are perceived as patients, medical students and physicians. Most studies have been performed outside Scandinavia. The overall aim of this thesis is to illustrate, analyse and discuss aspects of gender bias and gender awareness in clinical medicine, medical research and medical education, all in a Swedish setting.

Material and methods: Physicians’ ways of reasoning and reflecting on different professional arenas were investigated from a gender perspective in three cross-sectional studies: A. Written answers from a national examination for 289 Swedish interns where the examinees were allocated to suggest management of a common health problem - irritable bowel syndrome - in either a male or a female paper-patient with identical case descriptions. B. Assessments from 682 physicians, in structured assessment forms, of the scientific quality of two fictive research abstracts - one with a quantitative and one with a qualitative design – where authorship was assigned to either a woman or a man. C. Answers from 303 physician teachers to a questionnaire where they, on scales, assessed the importance of gender in different professional relationships and also gave open-ended comments.

Most analyses were quantitative, using chi2-tests and multivariate logistic regression as statistical methods. Differences were discussed in relation to gender theory. Qualitative method, by way of open and selective coding, was used to explore the open-ended answers in the questionnaire and to create codes from the written answers in the national exam.

Results: A. There were differences in outcome for male and female cases in history taking and in proposed diagnoses, investigations and treatment, e.g. more questions about and tests for alcohol were suggested for men and more tests for thyroid function for women. Both men and women physicians contributed to the gender bias but showed different patterns. B. The quantitative abstract was judged the same regardless of the gender of the assessor or author. The qualitative abstract was not ranked as scientific as the quantitative, but as more accurate, trustworthy, relevant and interesting with a female author especially by women assessors. C. Men physicians, especially in the surgical group, expressed low awareness of gender compared to women physicians. The qualitative analysis rendered a picture of how the physicians perceive ‘gender’, problems they connect with gender and their attitudes to gender issues. Some important concepts identified were ‘inequity’, ‘difference’, ‘delicate situations’, and ‘resistance’. To get an overview and better understanding of various expressions of gender bias, a theoretical model was developed, on the basis of the findings in the qualitative analysis. The main findings of the thesis are discussed in relation to this model where equity/inequity and sameness/difference are important points of departure.

Conclusions: The findings of gendered outcome in the national exam call attention to ‘knowledge-mediated gender bias’, a phenomenon implying that once knowledge of gender differences in a condition has been established this might cause gender biased assessments of individual patients in the clinical situation. Gender appears to affect scientific evaluations. This has implications for situations where research is assessed and interpreted: in medical tutoring, research guidance, peer reviewing, and in forming evaluation committees for research funding. Physician teachers seem little aware of gender as an area of competence and knowledge and tend to connect gender issues with women. Depending on how ‘difference’ and ‘equity’ are apprehended various forms of resistance to gender emerge, each with plausible bias risks. Educational programmes for faculty members, encouraging continuous reflections on gender attitudes and supporting male participation, are suggested. Besides providing a more comprehensive understanding of patients and their health problems, increased gender awareness among physicians might improve the working climate and help reduce the gendered division of labour in the medical profession.

Place, publisher, year, edition, pages
2004. , 71 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 907
Keyword [en]
Gender, gender bias, gender awareness, physicians, clinical decision-making, research evaluation, medical education, medical teachers, tutors, division of labour
Research subject
hälso- och sjukvårdsforskning
Identifiers
URN: urn:nbn:se:umu:diva-300ISBN: 91-7305-701-0 (print)OAI: oai:DiVA.org:umu-300DiVA: diva2:142999
Public defence
2004-09-17, Rosa salen, 9B, 13:00
Opponent
Available from: 2004-09-07 Created: 2004-09-07 Last updated: 2016-09-05Bibliographically approved
List of papers
1. Male and female physicians show different patterns of gender bias: a paper-case study of management of irritable bowel syndrome.
Open this publication in new window or tab >>Male and female physicians show different patterns of gender bias: a paper-case study of management of irritable bowel syndrome.
2004 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, no 2, 144-152 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Research has raised concerns about gender bias in medicine, i.e. that men and women might be treated differently due to gender-stereotyped attitudes among physicians. The authors investigated gender differences in medical management of a common health problem, irritable bowel syndrome (IBS). METHOD: In a national examination for Swedish house officers, the examinees were allocated to suggest management of IBS in either a male or female paper-patient. The case description was identical in both genders with the exception of prior prostate and gynaecological symptoms. The open answers were coded for analysis. A total of 289 physicians (45% women) participated. Chi-squared tests were used to measure differences in proportions. RESULTS: In variables focusing on medication, weight, gynaecological problems, tobacco, alcohol, thyroid function, proposed diagnoses, X-ray of the colon, and advice about lifestyle, significant or close to significant gender differences were seen. Both male and female physicians made gender differences but they did not show the same pattern of differences. CONCLUSIONS: The results suggest that gender bias is involved in medical management of IBS but men and women physicians may show disparate patterns of gender bias. There is a need for larger studies on gender differences in medical management with designs making it possible to consider the gender of both the patient and the physician. Furthermore, the results call attention to 'knowledge-mediated gender bias', a phenomenon implying that once knowledge about gender differences in a condition has been established, this might in fact cause gender-biased assessments of individual patients in clinical practice.

Keyword
Adult, Female, Humans, Irritable Bowel Syndrome/diagnosis/*therapy, Male, Medical History Taking, Middle Aged, Physician's Practice Patterns, Prejudice, Sex Distribution, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-5834 (URN)10.1080/14034940310015401 (DOI)15255504 (PubMedID)
External cooperation:
Available from: 2007-11-30 Created: 2007-11-30 Last updated: 2016-09-05Bibliographically approved
2. Gender bias in female physician assessments: Women considered better suited for qualitative research
Open this publication in new window or tab >>Gender bias in female physician assessments: Women considered better suited for qualitative research
2002 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 20, no 2, 79-84 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To analyse whether physician assessment of scientific quality is biased by gender. DESIGN: Two fictive research abstracts on back pain treatment were constructed, one with a quantitative and one with a qualitative design. Authorship was assigned to either a woman or a man. SUBJECTS: 1637 randomly selected Swedish physicians were asked to judge the scientific quality of the two designs in a structured assessment form. MAIN OUTCOME MEASURES: The assessments of 1364 abstracts (286 female and 394 male assessors) were analysed by chi-square test and logistic regression. RESULTS: The quantitative design was judged the same, regardless of the gender of the author or assessor. The qualitative design, however, was ranked as more accurate, trustworthy, relevant and interesting with a female author. Women assessors upgraded female authors more than male authors, while male assessors reflected no gender differences. Assessor speciality interacted with judgement; physicians in primary care appreciated the qualitative abstract more than hospital physicians did (OR 2.78; 95% CI 1.97-3.92). CONCLUSION: Gender seems to affect scientific evaluations. The results are worth considering in situations where research is judged and interpreted, in medical tutoring, research guidance, peer reviewing and certainly in forming evaluation committees for research funding.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4043 (URN)10.1080/02813430215553 (DOI)12184717 (PubMedID)
External cooperation:
Available from: 2004-09-07 Created: 2004-09-07 Last updated: 2016-09-05Bibliographically approved
3. Gender in medicine - an issue for women only? A survey of physician teachers' gender attitudes.
Open this publication in new window or tab >>Gender in medicine - an issue for women only? A survey of physician teachers' gender attitudes.
2003 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 2, no 1, 10- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. METHOD: Questionnaires were sent to all 468 senior physicians (29 % women), at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. CONCLUSIONS: To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in gender issues should be involved in this work. Further research is needed to find out how such male-oriented endeavours should be outlined.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-6113 (URN)10.1186/1475-9276-2-10 (DOI)14613502 (PubMedID)
External cooperation:
Available from: 2007-12-06 Created: 2007-12-06 Last updated: 2016-09-05Bibliographically approved
4. Gender awareness among physicians - the effect of speciality and gender: A study of teachers at a Swedish medical school
Open this publication in new window or tab >>Gender awareness among physicians - the effect of speciality and gender: A study of teachers at a Swedish medical school
2003 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 3, no 8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. METHOD: Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. CONCLUSIONS: There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4045 (URN)10.1186/1472-6920-3-8 (DOI)14577837 (PubMedID)
External cooperation:
Available from: 2004-09-07 Created: 2004-09-07 Last updated: 2016-09-05Bibliographically approved
5. "I would like to think that we are all human beings and can understand each other.”: Qualitative analysis of attitudes towards gender issues among physician teachers
Open this publication in new window or tab >>"I would like to think that we are all human beings and can understand each other.”: Qualitative analysis of attitudes towards gender issues among physician teachers
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4046 (URN)
External cooperation:
Available from: 2004-09-07 Created: 2004-09-07 Last updated: 2016-09-05Bibliographically approved

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