The effect of patient gender on medical decision making : the influence of decisional stress
This research investigated the influence of patient gender as a nonclinical variable on treatment decisions made in general practice. Responses to exploratory interviews carried out with 34 GPs supported the relevance of decisional stress in general practice. Decisional conflict theory therefore provided a theoretical basis for predicting that gender differences in management would be most likely to occur under conditions of decisional stress. This is because GPs are likely to rely on gender stereotypes to simplify decision tasks as this allows them to selectively search and appraise information. Responses to interview questions regarding the influence of patient gender on decision making were analysed in order to establish a set of collective GP expectations about the characteristics and behaviour of male and female patients. Following the interview study, a subset of 23 GPs supplied information for each patient seen over approximately six surgeries, providing data for 1380 consultations in all. GPs recorded information about presenting complaints, management decisions, a range of patient characteristics, three measures of decisional stress and a measure of feeling towards patients. Log-linear analysis of these data suggested that when not feeling positively towards patients, GPs managed male and female patients presenting with certain complaints differently. Women were more likely to be prescribed drugs while men were more likely to be given advice or referral. This disparity only occurred for patients presenting with psychological and musculo-skeletal complaints. In order to identify whether consultation processes mediated these differences, corresponding audio-taped consultations also collected from the 23 GPs were analysed. Verbal interaction between GP and patient was coded according to the functional style and content of communication. However, no significant differences in either of these aspects of the consultation process emerged to explain differences in management outcome. This may be because treatment differences are mediated by implicit processes rather than by observable consultation behaviour. Research carried out in the thesis furthers the understanding of medical decision making by recognising that non-clinical factors such as patient gender and feeling towards patients, as well as medical factors influence the way that GPs manage their patients.