Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

Abstract

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 physicians 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: a) effects of patient's (distressed) pain behaviors and diagnostic evidence of pathology (EP) on treatment prescriptions and referrals for chronic low-back pain (CLBP), and b) mediating role of pain credibility judgments and psychological attributions on these effects. 310 general practitioners (GPs; 72.6% women) participated in a betweensubjects design, 2 (patient's pain behaviors) x 2 (EP) x 2 (GP sex) x 2 (patient sex). GPs were presented with vignettes depicting a fe(male) CLBP patient, with(out) distress and with(out) EP (e.g., 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 is a postprint version of a manuscript published in THE JOURNAL OF PAIN available at http://dx.doi. org/10.1016/j.jpain.2013.03.004 3 Perspective 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.

“Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain

“…Thirteen articles [ 6 , 8 , 22 , 53 , 69 – 71 , 75 , 77 , 80 – 82 , 84 ] in this review classified “medically unexplained” conditions in 19 different ways, for example, as pain without organic, observable, and objective symptoms [ 6 ]. The classifications are listed in Table 3 .…”

Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014Academic Emergency MedicineConsensus Conference Pain Section

“…71 Several studies suggest patient and provider gender may interactively contribute to variation in ED provider pain treatment practices. For example, Bernardes et al found that gender of the treating practitioner influenced pain management practices in the treatment of back pain in clinical vignettes, 72 and another study found that nurses were more likely than physicians to rate pain higher and more willing to administer opioid analgesics to male patients. 73 Marquie et al found a three-way interaction among physician expertise, physician gender, and patient gender.…”

Gender differences in the nonverbal communication of pain: A new direction for sex, gender, and pain research?

“…Physician-patient interactions require good interpersonal skills to elicit and provide core information, and there are gender differences in the nonverbal behaviours exhibited during such transactions [26]. The relevance of gender context becomes even more interesting when combined with the knowledge that patient gender affects how health care providers assess and treat pain [6,28,46,55]. However, such studies are few in number, and there are inconsistencies [33,57,76].…”