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Published on: August 9, 2024
[Influence of patient's age and gender on doctors' decision making about coronary heart disease]
M Bönte1, O von dem Knesebeck, J Siegrist
1Institut für Medizin-Soziologie, Universitätsklinikum Hamburg Eppendorf, Hamburg. m.boente@uke.uni-hamburg.de
Insights
Patient age and gender significantly impact German primary care physicians' decisions for diagnosing and managing coronary heart disease (CHD), irrespective of symptoms. Older patients and men received more consistent CHD care.
Area of Science:
- Cardiology
- Medical decision-making
- Health services research
Context:
- International studies reveal variations in coronary heart disease (CHD) diagnosis and management.
- Patient and physician factors influence medical decisions beyond presented symptoms.
- This study focuses on the German healthcare context.
Purpose:
- To investigate the influence of patient gender and age on primary care physicians' diagnostic and management decisions for CHD in Germany.
- To analyze how demographic factors affect clinical judgment in CHD care.
Summary:
- An experimental study used videotaped patient scenarios with varying gender and age (55 vs. 75 years).
- 128 primary care physicians evaluated the cases and described diagnostic and treatment plans.
- Results indicate gender and age bias in CHD assessment and management.
Impact:
- Physicians were less likely to diagnose CHD in women and refer them to specialists.
- Younger patients received less focus on pain symptoms but more on history and smoking.
- Older patients were more frequently diagnosed with CHD, with higher certainty and appropriate medication prescription.
Background:
Studies from the United Kingdom und the United States show that there are variations in doctors' decision making regarding coronary heart disease (CHD) and that patient attributes as well as physician characteristics have an impact on medical decisions regardless of the presented symptoms. This study examines how gender and age of patients influence primary care doctors' diagnostic and management decisions regarding CHD in Germany.
Methods:
An experimental design with portrayed videotapes is used. Professional actors play the role of patients with symptoms of CHD. Videotapes were identical apart from varying patients' gender and age (55 vs. 75 years). A randomly selected sample of 128 primary care physicians viewed these videotapes in their practices. Afterwards physicians were asked to describe how to diagnose and treat the patient.
Results:
Women were less likely to be asked about health related behaviours, less likely to get a CHD diagnosis and less likely to be referred to a cardiologist or other specialist. Younger patients were asked about medical history and smoking more frequently, but they were less likely to be asked about symptoms of pain and discomfort. Moreover, among older patients CHD diagnosis was mentioned more often and with higher certainty and medication appropriate for CHD was prescribed more often.
Discussion:
Age and gender of patients influence primary care doctors' diagnostic and management strategies relating to CHD in Germany regardless of the presented symptoms.
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