How Should Physicians Respond When Patients Distrust Them Because of Their Gender?

Abstract

There are many reasons why gender-concordant care benefits patients and is requested by them. For training hospitals, however, such requests present challenges as well as opportunities in providing patient-centered care. Responding to a case in which a female patient who is having a routine exam refuses care from a male medical student, we discuss ethical principles involved in gender-concordant care requests, when it is appropriate to question such requests, and a team-based approach to responding to them. CaseA male medical student on his obstetrics-gynecology clerkship is assigned a 35-year-old female patient in the outpatient clinic who comes in for a routine well-woman exam, including a pelvic examination and Pap test, clinical breast examination, and discussion about contraception management. The student enters the examination room and introduces himself, but the patient straightforwardly tells him that she would prefer a woman student. The student feels conflicted and confused. He is committed to patientcentered care and wants to be respectful of the patient's wishes, but he also feels some frustration at not being able to conduct clinical activities that are a routine part of education in the rotation. He is unclear about what is appropriate to discuss with patients, or even with the attending physician, about his involvement in the care of this particular patient. When he emerges from the room and lets the attending physician know that the patient refused his exam, she simply instructs him to wait for the next patient.

Community Capacity Building for HIV and Addiction Service Integration: An Intervention Trial in Vietnam

“…At the end of the study, female CHW in the intervention group achieved a significantly higher confidence level than the females in the control group; yet it still fell below the male intervention providers’ confidence level. Future CHW capacity-building interventions should incorporate a specially designed component to empower providers to handle embarrassment, discomfort, distrust, or misconceptions that may occur due to provider-patient gender discordance [ 30 ].…”

Responding to patient requests for women obstetrician-gynecologists

“…Trainees, clerkship directors, and attending teaching physicians should be made aware of this potential issue early in training and should be educated on how to manage patient requests for gender-concordant trainee involvement in their care. 37,38 Any educational deficit experienced by a trainee as a result of patient refusal of care should be addressed and appropriately rectified.…”