Lisbon University Institute (ISCTE-IUL), Lisbon, Portugal.
J Pain. 2013 Sep;14(9):931-40. doi: 10.1016/j.jpain.2013.03.004. Epub 2013 May 23.
The impact of physician sex on dimensions of medical care such as treatment prescriptions and referrals has been underexplored, especially in a pain context. Also, few studies have analyzed whether physician sex moderates the influence of patients' or clinical situations' characteristics on pain management practices or its mediating processes. Therefore, our goal was to explore whether physician sex moderates the effects of patient (distressed) pain behaviors and diagnostic evidence of pathology (EP) on treatment prescriptions and referrals for chronic low-back pain, and to explore the mediating role of pain credibility judgments and psychological attributions on these effects. A total of 310 general practitioners (GPs; 72.6% women) participated in a between-subjects design, 2 (patient pain behaviors) × 2 (EP) × 2 (GP sex) × 2 (patient sex). GPs were presented with vignettes depicting a fe(male) chronic low-back pain patient, with(out) distress and with(out) EP (eg, herniated disc). GPs judged the patient's pain and the probability of treatment prescriptions and referrals. Results showed that EP had a larger effect on male than on female physicians' referrals to psychology/psychiatry. Also, GP sex moderated the pain judgments that accounted for the effect of EP and pain behaviors on prescriptions. These findings suggest framing medical decision-making as a process influenced by gender assumptions.
This paper shows that physician sex moderates the influence of clinical cues on pain management practices and the mediating role of pain judgments on these effects. It may potentially increase clinicians' awareness of the influence of gender assumptions on pain management practices and contribute to the development of more gender-sensitive services.
医生性别对医疗护理的各个方面（如治疗处方和转诊）的影响尚未得到充分探讨，尤其是在疼痛背景下。此外，很少有研究分析医生性别是否会调节患者或临床情况特征对疼痛管理实践或其中介过程的影响。因此，我们的目标是探讨医生性别是否会调节患者（痛苦）疼痛行为和病理证据（EP）对慢性下腰痛治疗处方和转诊的影响，并探讨疼痛可信度判断和心理归因对这些影响的中介作用。共有 310 名全科医生（GP；72.6%为女性）参与了一项被试间设计实验，2（患者疼痛行为）×2（EP）×2（GP 性别）×2（患者性别）。GP 被呈现出描述一位慢性下腰痛女性（男性）患者的案例，有（无）痛苦和有（无）EP（例如，椎间盘突出）。GP 对患者的疼痛和治疗处方和转诊的可能性进行判断。结果表明，EP 对男性 GP 的转诊到心理/精神病学的影响大于对女性 GP 的影响。此外，GP 性别调节了疼痛判断，这些判断解释了 EP 和疼痛行为对处方的影响。这些发现表明，医学决策制定可以被视为一个受性别假设影响的过程。
本文表明，医生性别会调节临床线索对疼痛管理实践的影响，以及疼痛判断在这些影响中的中介作用。它可能会提高临床医生对性别假设对疼痛管理实践影响的认识，并有助于开发更具性别敏感性的服务。
