Ahmad Sarah R, Ahmad Tessnim R, Balasubramanian Vidhya, Facente Shelley, Kin Cindy, Girod Sabine
Division of Headache Medicine, Department of Neurology, University of California, San Francisco, San Francisco, California, USA.
Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA.
J Womens Health (Larchmt). 2022 Apr;31(4):521-532. doi: 10.1089/jwh.2021.0169. Epub 2021 Nov 5.
In contrast to physician implicit bias toward patients, bias and microaggressions from patients toward physicians have received comparatively less attention. We captured physician experiences of gendered microaggressions from patients by conducting a mixed-methods survey-based study of physicians at a single academic health care institution in May 2019. A quantitative portion assessed the frequency of gendered microaggressions (microaggression experiences [ME] score) and the association with measures of perceived impacts (job satisfaction, burnout, perceived career impacts, behavioral modifications). A one-tailed Wilcoxon rank sum test compared distributional frequencies of microaggressions by gender, and by gender and race. Chi-square tests measured the associations between gendered microaggressions and perceived impacts. Welch two-sample -tests assessed differences in ME scores by rank and specialty. Linear regression assessed the association of ME scores and job satisfaction/burnout. A qualitative portion solicited anecdotal experiences, analyzed by inductive thematic analysis. There were 297 completed surveys (response rate 27%). Female physicians experienced a significantly higher frequency of gendered microaggressions ( < 0.001) compared with male physicians. Microaggressions were significantly associated with job satisfaction (chi-square 6.83, = 0.009), burnout (chi-square 8.76, = 0.003), perceived career impacts (chi-square 18.67, < 0.001), and behavioral modifications (chi-square 19.96, < 0.001). Trainees experienced more microaggressions ( = 0.009) and burnout ( = 0.009) than faculty. Higher ME scores predicted statistically significant increases in burnout ( < 0.0001) and reduced job satisfaction ( = 0.02). Twelve microaggressions themes emerged from the qualitative responses, including role questioning and assumption of inexperience. The frequency of microaggressions did not vary significantly by race; however, qualitative responses described race as a factor. Physicians experience gendered microaggressions from patients, which may influence job satisfaction, burnout, career perceptions, and behavior. Future research may explore the multidirectionality of microaggressions and tools for responding at the individual and institutional level.
与医生对患者的隐性偏见形成对比的是，患者对医生的偏见和微侵犯受到的关注相对较少。2019年5月，我们在一家学术医疗保健机构对医生进行了一项基于调查的混合方法研究，以了解医生遭遇患者性别微侵犯的经历。定量部分评估了性别微侵犯的频率（微侵犯经历[ME]得分）以及与感知影响指标（工作满意度、职业倦怠、感知到的职业影响、行为改变）之间的关联。单尾Wilcoxon秩和检验比较了按性别、性别和种族划分的微侵犯分布频率。卡方检验衡量了性别微侵犯与感知影响之间的关联。Welch双样本检验评估了按职级和专业划分的ME得分差异。线性回归评估了ME得分与工作满意度/职业倦怠之间的关联。定性部分收集了轶事经历，并通过归纳主题分析进行分析。共完成297份调查问卷（回复率27%）。与男医生相比，女医生经历性别微侵犯的频率显著更高（<0.001）。微侵犯与工作满意度（卡方值6.83，P = 0.009）、职业倦怠（卡方值8.76，P = 0.003）、感知到的职业影响（卡方值18.67，<0.001）和行为改变（卡方值19.96，<0.001）显著相关。实习生比教员经历了更多的微侵犯（P = 0.009）和职业倦怠（P = 0.009）。较高的ME得分在统计学上预示着职业倦怠的显著增加（<0.0001）和工作满意度的降低（P = 0.02）。定性回复中出现了12个微侵犯主题，包括对角色的质疑和对缺乏经验的臆断。微侵犯的频率在不同种族之间没有显著差异；然而，定性回复将种族描述为一个因素。医生会遭遇患者的性别微侵犯，这可能会影响工作满意度、职业倦怠、职业认知和行为。未来的研究可以探索微侵犯的多向性以及个体和机构层面的应对工具。
