Gender and Medicine

[Eydawn]

Just wanted some general discussion on the issue of gender in medicine with specific emphasis (this time) on physicians. This was prompted by the fact that it gets really hard for us to function on the floor when some of our residents absolutely refuse care from a provider of a specific gender even though they know and like the provider.

Thoughts? Does it matter to you, personally, what gender your physician is? I know I prefer male doctors because I've had more success in open honest communication with the male doctors in my experience and had a lot harder time getting female doctors to listen to what I have to say. Perhaps I have become conditioned by my selective experience and am now prejudiced against female doctors (with regard to choosing my PCP, for example...)

On the other side of the coin, for those of us that are actively working in the medical field, does it bother you when a patient refuses you on the basis of your gender alone? How do you react to that? What do you do to be able to work around it? Should gender matter? Should a patient (assuming no history of sexual trauma) be able to refuse a provider solely on the basis of gender?

Wendy

CO EMT-B

[scubanurse]

I've always had male PCP's my whole life and have had mixed results with them. Some are easy to talk to and be honest with and other's not so much. My actual PCP in the practice back in MD was an ass who would spend <5 minutes with you, and when I got my diagnosis of a genetic disorder from Johns Hopkins, he didn't believe it and actively tried to challenge the diagnosis. There was a younger doc in that practice who was the pediatrician but would see young adults too who was very very good and thorough and picked up on the joint problems I was having in one visit with him, while 10 years with the other PCP revealed nothing.

As for women's issues, no way in hell would I have a male doctor check out down there. I appreciate that there might be some good male OB/GYN's out there, but I just would not be comfortable with them examining me.

From my experience, the older population does seem to have a problem with female doctors. Mostly I think this is because when they were younger, women just weren't common as physicians. Elderly gentleman seemed to have an even bigger issue because often questions of prostate and male urogential problems would come up and it was viewed as improper for them to discuss this with a perhaps younger woman.

When my grandfather was still alive, he was a WII and Korea veteran and very set in his ways, we had to take him to a psychopharmacologist to get his dementia and anxiety medications situated and she happened to be a female doctor just out of residency (the type you want in such a fast changing and evolving field) and he just sat there and asked her if it was past her bed time yet and told her that little girls shouldn't play dress up in men's clothing. Granted he was in the middle stages of Alzheimer's at the time and just a crochity old man, but still he just had zero respect for her. Took him to a urologist who was a man in his 50's and he answered the doctors questions with absolute respect and honesty. All in the same day too... it amused my aunt and my mom and just confused me completely.

I do remember when I ran with a male partner and it was a male, I would ask if the patient would feel more comfortable with him doing the exam and some would say yes. I've also been on calls as a basic where the female was not comfortable with the male medic placing the 12-lead cables so they stepped out of the room briefly and I placed the leads and did the 12-lead for them and then they came back into the room and the patient was much more at ease.

In EMS and medicine in general, patient comfort should be one of the higher priorities. After the critical points of course. The patients and their families call us at what could be their worst time in their lives and their stress and anxiety level is already very high, we do not need to add to this by making them uncomfortable. Sometimes the gender issues are unrealistic to resolve on scene, but when possible, taking that extra step to see if the patient would be more comfortable with a provider of their own gender might go a long way in opening the communication between patient and provider and provide essential links and information to patient care.

[speedygodzilla]

I have always had a male PCP so I find myself naturally being more comfortable with a male doctor. This being said, I really don't have a problem receving care from a female PCP and now that I think of it I have seen a few Nurse Practitioners at my PCP off when apparently he was too busy, and I don't remember it even dawning to me than.

I am not 100% sure why it makes any difference to me now that I think of it. I guess I just find it more comfortable being exam by a male doctor.

What would I do? How would I feel? What do you do to be able to work around it?

For the most part I don't beleive I would be bother by a refusal of a procedure from a patient due to gender, especially for a particular procedure like an 12-Lead. In my years of as a tech even in the ER I never had a female patient refuse to let me preform the procedure. I do my best to keep their privacy. But if they ask that a female preform the procedure I would understand. I would always do my best to work around it but many times males are the only ones on scene as my full time partner is a male and most of the firefighters are male. If the patient refuse based off of that I would try to limit the procedure to one person to see this would make them more comfortable. I can't see the patient refusing transport base off of gender but if they did I guess I would have to consider another unit. I would probably feel kind of annoyed if they refuse all care based of off my gender. Now if there were other things involved, like assault or sexual truama I would understand.

Should gender matter? Should a patient (assuming no history of sexual trauma) be able to refuse a provider solely on the basis of gender?

I don't see much reason why gender should matter in our field, but I can understand it becoming an issue for those few patients. I honestly have not had any patients refuse base of off gender that I know off. I try to explain the procedure, what I am doing, and what I am looking for. I really think that helps a lot. Should the patient be able to, well that is kind of tricky. Why I don't think it should hault our care in EMS, I beleive it is up to our patient and that we don't always have to agree with their decisions. We should respect their decision when at all possible and appropriate.

[chbare]

Don't care. Male or female, may the most qualified provider win. Had a female provider present when I got fixed, cannot say I had any issues. Nor do I care if people do not want me taking care of them on the account of my genetic disorder. Nothing personal IMHO.

Take care,

chbare.

[Kiwiology]

I am male and have had a female GP my whole life. I do not have a preference between male or female health care professionals dealing with me personally.

My experience is that females (especially older) perfer female and that younger males perfer male Ambulance Officers.

[uglyEMT]

As far as GPs no preference, just be good at it. I can understand older generations reluctance to some things, folks just get set in their ways.

As an EMT I do see the gender issue come up alot unfortunatly. Thankfully I run with an all girl, except me, crew so it is helpful. Just as an example we recently had a rollover with submersion. Female driver tossed around unrestrained so as the FD was making extracation preperations I drew the short straw and went in to the vehicle to collar her and talk her through it. After a few minutes of her puking on me and talking with me in freezing cold water we seemed to have a report (as much of one as rescuer and patient can have). Finally after extrication and getting her strapped and boarded into the rig we went to cut the garments and as I reached for the shears she freaked and asked that I not be present. My crew chief explained to her we dont look at men and women in that way we just treat patients. Anyways, after a minute of talking with her I just got out of the back and got in the drivers seat just so she would be more comfortable. I know it shouldn't have mattered who was in the back but she didnt want a man (her words not mine) seeing her naked. I know it made me feel kinda off after talking with her during the extracation, her appologizing to me for puking, her crying and telling me her life story while under the fire blanket then like a light switch didnt want me to do the rest of my job. Thankfully for her there was 3 females in the back to take care of her.

I do feel patients should have the right to request male or female to check them out if possible but if it is an all male or all female crew then sorry, just be glad we are there to help. When I had an all male crew and we were transporting an uncomfortable female we usually requested a female officer (LEO) to ride in the back with us. Usually calmed the patient down.

[tcripp]

Interesting question. For me, gender doesn't matter so much...but competence does. But, in retrospect, it appears that I'm mostly seen male physicians.

I'm female and it just so happens that both my PCP and Gyn are male. The only thing that matters to me is that I only have one person doing my gyn exams - which means I've seen the same physician for 20+ years, while my PCP changes based on insurance.

I agree with UGLy; the patient should be able request other options if and when available.

[akflightmedic]

Very good topic!

While some have commented on competence, I will take it a step further and dig deeper within myself and see if I can give a response based on personal psychology.

I prefer female doctors and no, not just cause some think I am a perv. I truly admire females making it in the world. I like strong personalities, smart brains and confidence within themselves. Female doctors typically posses theses qualities whether it be my perception or reality (all the same anyways), therefore it instills confidence in me for them.

I trust them more readily with my healthcare needs. Aside from this, they also reflect compassion more than male doctors I have interacted with. While a male and female doctor may give same treatment for same condition, my perception has been the females are more genuinely concerned and empathize.

I have no problem getting hernia checks or prostate checks with a female doctor. Only time I was 'almost' embarrassed was when I had testicular tortion and the ultrasound girl was same age and very hot. Despite the pain I was experiencing, warm jelly and gentle rubs by a pretty girl was most interesting.

As for a patient refusing me based on gender, I have worked a lot of remote locations where no alternative was available. I have had them make requests but I simply could not honor them ,so they were stuck with me. Building rapport and displaying confidence and competence with a caring attitude went a long way in convincing them I could handle their particular needs.

Within EMS, I do not think I have ever had a true emergency reject me based on gender, even the sexual assault cases. A lot of times it is pointless to even ask, because to do so immediately puts them in a defensive mindset. Again if you proceed with explanation of everything you are going to do and use the above listed skills, it is rarely if ever an issue. It may sound rude but seriously, simply do not ask or give them an option and then give the best care possible. When you go to an ER, does the male doctor ask if you need a female doctor? No. You get who you get, same with the nurse who has you assigned bed. Sure there are exceptions on case by case but for majority this would seem true. So why should EMS be any different? It isn't.

[n3qtrtme]

Concerning myself, I have no issue with either male or female... I want the best at what they do, period.

On the ambulance, there are times when accomodating privacy or gender preference is not going to affect the patient care process. If it can be done and the patient is more comfortable, great! If it's going to decrease the care we can provide, not good.

On a side note, when I used to work for a private service, we had an area hospital that was popular with foreign sheiks. Whenever they called asking for an ambulance, they stipulated that the crew MUST be male. Their religious views impacted the decision. Granted, they were usually going from airport to hospital or vice versa, but what if they were involved in an emergency situation that required treatment by a female? I always wondered...

[HERBIE1]

Well, I've had male PCP's my whole life. As a kid, and for the last 30 years as an adult, I've had the same family practice guy. I can call him and tell him I need more Flexeril for my back, or Zithromax for a nasty infection. He scolds me when I need it, he applauds me when appropriate. He still gives me grief for not going to medical school, but he also treats me as a health care professional- when discussing issues. Point is, we have an excellent relationship, which is what you want with your doctor. It happens he's a male, but I don't think I would have a problem with a woman, but I've never dealt with one in that capacity. I can certainly see why some women would be more comfortable with a female OB/GYN- for obvious reasons.