Lurie N, Margolis K L, McGovern P G, Mink P J, Slater J S
Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
J Gen Intern Med. 1997 Jan;12(1):34-43. doi: 10.1046/j.1525-1497.1997.12102.x.
Women are more likely to receive breast and cervical cancer screening if they see female physicians. We studied whether this is due to differences between male and female physicians, or to differences in their patients.
Large midwestern, independent practice association style of health plan.
We surveyed male and female primary care physicians matched for age and specialty and a stratified random sample of three of each physician's women patients. Physicians reported on their practice setting, their attitudes and practices regarding prevention, and their comfort and skill with various examinations. Patients reported on their sociodemographic characteristics, their attitudes and practices regarding prevention, and their preferences for physician gender. Claims data were used to calculate mammography and Pap smear screening rates for the physicians.
We studied 154 female and 190 male internists and family physicians and 794 of their patients.
We compared the responses of male and female physicians and their patients and used multivariable analysis to identify the patient and physician factors that accounted for the differences in screening rates between male and female physicians. Female physicians were more likely to ask new patients about components of prevention, to believe in the effectiveness of mammography, to feel more personal responsibility for ensuring that their patients received screening, and to report more comfort in performing Pap smears and breast examinations. Patients of female physicians were more educated and less likely to be married, but did not differ in other sociodemographic characteristics. They had similar attitudes and practices regarding prevention, except that patients of male physicians were more likely to smoke. Significantly more patients of female physicians preferred a female for some component of care. In multivariable analyses, practice organization, patient preference for a female physician, and prevention orientation of female physicians accounted for up to 40% of screening rate differences between female and male physicians for Pap smears, and 33% for mammography.
Differences in beliefs of male and female physicians and patient preference for a female provider contribute independently to the higher rate of breast and cervical cancer screening by female physicians.
如果女性看女医生，她们更有可能接受乳腺癌和宫颈癌筛查。我们研究了这是由于男性和女性医生之间的差异，还是由于他们患者的差异。
中西部大型独立执业协会式健康计划。
我们对年龄和专业相匹配的男性和女性初级保健医生以及每位医生的三名女性患者的分层随机样本进行了调查。医生报告了他们的执业环境、对预防的态度和做法，以及他们对各种检查的舒适度和技能。患者报告了他们的社会人口特征、对预防的态度和做法，以及他们对医生性别的偏好。索赔数据用于计算医生的乳房X线摄影和巴氏涂片筛查率。
我们研究了154名女性和190名男性内科医生和家庭医生以及他们的794名患者。
我们比较了男性和女性医生及其患者的回答，并使用多变量分析来确定导致男性和女性医生筛查率差异的患者和医生因素。女医生更有可能询问新患者预防的组成部分，相信乳房X线摄影的有效性，对确保患者接受筛查感到更个人责任，并报告在进行巴氏涂片和乳房检查时更舒适。女医生的患者受教育程度更高，结婚的可能性更小，但在其他社会人口特征方面没有差异。他们在预防方面有相似的态度和做法，只是男医生的患者吸烟的可能性更大。明显更多女医生的患者在某些护理方面更喜欢女性。在多变量分析中，执业组织、患者对女医生的偏好以及女医生的预防导向占女医生和男医生之间巴氏涂片筛查率差异的40%，乳房X线摄影差异的33%。
男性和女性医生信念的差异以及患者对女性医疗服务提供者的偏好独立地导致了女医生乳腺癌和宫颈癌筛查率更高。
