Patient gender preferences for medical care

Patients’ gender preferences for medical care are a factor that we all know exists yet most physicians prefer to ignore it in daily practice hoping that modern medicine is gender neutral.  Forty plus years ago when I started in medicine this wasn’t a consideration.  Nearly all physicians were men and nurses were women.  Patients simply had no choice.  Male physicians felt entitled to see all comers and present day women physicians feel the same.  We are of course all trained to treat both men and women and hope patients feel the same.

But is it really true?

The clearest example of preferences is in obstetrics and gynecology.  Now that women are 90% of residents in training women have adequate choice in most localities and they do indeed express themselves.  Women prefer female intimate care by percentages that vary from study to study from 50% to 70% with most of the rest having no preferences.  Only 10-15% prefer care by males in one study.  Variables include the age of the patient with young women preferring same gender care in higher numbers than older women who have generally become accustomed to care by males.

Men are often thought to be more accepting of opposite gender care.  It is a poorly studied area.  Over 90% of practicing urologists are men and the relatively few women often specialize in female urologic care.  The numbers of female urologists in training are increasing but don’t come close to matching the increase in female Ob-Gyns.  There does not appear to be an equivalent demand for female urologists as compared to Ob-Gyn; few men appear to be requesting female urologists.  Routine male genital exams are much less intrusive then women’s exams, yet there is still evidence that 30-50% of men prefer males for this exam.  The majority of the rest state no preferences with fewer preferring women.  Once again age is a consideration with adolescents preferring same gender care in greater numbers than adults.   Although girls are frequently given a choice of gender for gynecologic care, this is offered to boys much less for intimate exams.  Other factors that effect patient choice are less significant including religious beliefs, a history of sexual assault and homophobia.

The subject is less studied when it comes to general care.  However the widespread presence and success of women’s clinics who offer general care suggest that a significant percentage of women prefer same gender care for all their needs.  Men’s clinics are almost nonexistent though it is easy for a man to find a male general practitioner.

Gender preferences for ancillary care also exist but are rarely acknowledged, at least for men.   As 90% of nurses, technicians and assistants are women, men have little choice here.  There was a time when male urinary catheterizations were routinely done by physicians or orderlies.  They are now routinely done by nurses.  A choice is rarely offered to men even when the procedure is not urgent, male nurses are available, and the patient is clearly embarrassed.  In contrast male nurses often ask a woman if she’d prefer a female to do the catheterization.  Some avoid doing them all together for multiple reasons.  A similar situation exists for testicular ultrasound usually performed by female technicians.  Though urologists are over 90% men, their office assistants are usually women.  My urologist recognizes that his patients are frequently embarrassed when female assistants aid him on procedures.  Yet the office makes no concerted effort to employ men, who are more difficult to obtain.  Indeed a man may have to sign in at the front desk telling the secretary about his erectile dysfunction.  It is astounding how little consideration can be given to men’s preferences.  It is not rare to find prostate screening offered by a clinical team consisting of all female nurses.  One can’t even imagine the converse, an all male mammography laboratory. Is it any wonder that men avoid medical care in much greater numbers than women? Cross gender embarrassment is clearly an important factor.

In short, though modern medicine claims to be gender neutral, we are all aware that patients, including many physicians, are not.  The issue has been mostly resolved for women with the entry of large numbers of women into medicine.  But large numbers of men still avoid medical care because of embarrassment.  Statistics on this are difficult to obtain as men are loathe to admit that the presence of women may embarrass them. Study questionnaires on this topic have to be filled out in private; frank answers will not be obtained if questions are asked by women.  Hospitals routinely make no effort at all to respect gender preferences.   I have never seen a hospital patient bill of rights which mentioned choice of gender.  Institutions are in a partial bind when it comes to hiring as gender is a protected federal class and equal employment laws need to be followed.   Yet legal exemptions for issues of bodily privacy are routine (bona fide occupational qualifications).  Unlike the case with racial preferences, it is legal to grant patients their gender preferences when intimate exposure is required.   Hospitals try to avoid this issue because of greater staffing needs and increased costs. Admittedly this is not the biggest problem we face in terms of access to medical care.  Yet it remains a factor that is poorly recognized and largely unstudied.

Joel Sherman is a cardiologist who blogs at Patient Modesty & Privacy Concerns.

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  • http://bioethicsdiscussion.blogspot.com Maurice Bernstein, M.D.

    I think one of the misconceptions that doctors and other medical care providers has held over the years, including myself until recently years, was that all patients believed that their need for diagnosis, treatment and cure, by professionals, readily trumped physical modesty issues.. This error in thinking on the part of the medical profession was particularly applied to male patients but certainly in serious and emergent situations also to women.

    I strongly encourage a change in that professional assumption. ..Maurice.

  • Alan

    As a male patient I couldn’t agree more with the article. For years I suffered with several medical issues because they were intimate in nature and I just could not bring myself to present them to, and be exposed to female providers. I dealt with the pain, discomfort, and the risk that it was something more serious. I didn’t address the modesty issues as I just assumed that the concern would be met with ridicule and resistance by providers, especially the females in the profession, I assumed I would be labeled sexist as I “should” be willing to submit to this or I was just wierd. After reading several of the blogs running on the subject I asked and was surprised by the willingness to accomodate. As a male the gender embalance causes issues in getting same gender care for intimate care, While it is a valid claim for providers, the question is what are you doing about it. The answer is very little, the focus is more to getting the patient to accept the current situation than addressing it. I have no real problem with the fact that providers see themselves as gender nuetral, the problem is we your patients do not. It’s hard telling how many men have died from embarassment rather than seek help they percieve as being unsympathetic to modesty issues. While the full reason men avoid medical care more than women may never be known, I have absolutely no doubt the precieved lack of concern for modesty plays at least a role in it, I know for me it did. Now I have started to attempt to get accomodation rather than avoid…but how many just don’t try and don’t seek help

  • minutemoon

    To get an idea of how neglected and private this
    topic is within the medical community, look at
    the very end of this article under Similar Posts
    and see if you can find anything like this on this
    blog. Some may see this issue as a small, petty,
    irrelevant, insignificant item considering all the
    problems facing health care today — but, rather,
    it goes to the fundamentals of medical practice –
    respecting the individuality and dignity of each
    patient, and understanding that the values of a
    medical culture may not match the values of the
    underlying society or individual patients. Many
    hospitals have idealistic core values and/or
    mission states. Almost all have something vague
    to say about respecting patient values, privacy,
    dignity. Little time has been spent delving into,
    not only the definition of those words — but also how,
    specifically, the hospital culture can implement
    these goals on the ground level on a day to day
    basis. You’ll find (almost?) no written standards
    or policy statements about patient gender
    selection or opposite gender chaperones, or
    patient modesty from any American hospital.
    You’ll find (almost) no American hospital web sites
    that even address this issue. It’s one of the great
    elephants in the room of American health care. And
    I applaud doctors like Sherman and Bernstein who
    are willing to advocate for patients in this area. Few in the medical community seem interested enough to go public
    with a discussion of patient modesty.

  • BG

    I liked this article as well as the comments. It is great to hear from great professionals like Dr Sherman and Dr Bernstein. I haven’t seen many doctors with good reputations that have the courage to discuss issues such as patient modesty so I hope other healthcare professionals that may be reading this can look up to them as great examples and begin to advocate for the patients.

    Many many men avoid medical care completely (myself included) because we know that it’s not very likely that our morality, modesty and dignity will be respected. Undressing for an exam is humiliating enough without unnecessary female nurses or assistants gawking at our nudity. Any kind of abdominal surgery is completely out of the question.

    I wonder how many men would still be alive today if they thought they would be treated respectfully, and sought out medical help.

  • minutemoon

    Granted, there are many articles on KevinMD and some get only a few comments. People are busy. But the lack of response to this piece may indicate several things:
    1. Readers don’t consider the topic relevant.
    2. Readers do consider the topic silly.
    3. Readers don’t consider the topic silly and do consider it relevant, but don’t consider it a problem. People who complain are few in number and cranks.
    4. Readers resent the implications of the article.
    5. Readers know it’s a problem and just don’t know what to say about it.
    6. Readers don’t feel comfortable taking about this issue.
    I’m sure there are other reasons. But it would be interesting to hear some thoughtful response from medical providers about this issue, one way or the other.

  • Charlotte

    The topic is very important as it has to do with patient autonomy and human dignity. Women are showing by their actions that they care a great deal about who is allowed to exam them and treat them. I grew up and gave birth to children when there were few female physicians and women had to accept this. Although I had both good and bad experiences, I will always advice young women to seek out a woman because the bad experiences were exceedingly traumatic, I think the field of ob/by is now “getting it.” It is interesting to read older online posts (dated in the early 2000s) by male medical students wondering about going into gynecology. Other posters always seem to encourage them as they state that some women will never care and simply want a good doctor etc. etc. That may have been true as there were those of us who did not have a choice and the option of same sex care was not available. And, yes, we all do want a good doctor. However, given the opportunity for same sex care, I know of very, very few women who don’t choose it. There are women my age (older 50s) who have a certain allegiance to their male ob gyn because he may have been kind and delivered their babies but they are all advising their daughters to go to women. We don’t talk about it, we simply don’t want them to have to deal with the embarrassment, humiliation, lack of “say” and inability to discuss our physical problems that we had to deal with. It is simply understood. So, women are voting with their actions even though they may say otherwise.
    People do consider the topic relevant but until you are in a medical situation where your modesty and dignity are violated, you don’t really think about it. Although I am married to a surgeon, I had not had to have any real medical care since the birth of my children until recently. I had a horrific experience that completely traumatized me. So, yes, now I am paying attention. Many folks are NOT comfortable talking about this but it is relevant and not silly. Most folks just don’t think about it until it happens to them.

  • minetochoose

    This subject is part of the “medical mystique” that those (most) in the field prefer not to talk about. What sort of chaos would ensue if patients started questioning the gender of medical personel? In short, if patients just continue to believe that gender does not matter then there is less opening for ethical questions of modesty.
    Medicine is practically the only business where people will accept that gender does not matter, but it took years of conditioning to get to that point.
    I hope it does not take years to create ethical options.

  • Linda

    I am female and prefer a female physician, driving to a nearby town for care because there are only male PCP’s covered by our insurance in my town. My husband refused to go to an appointment that was made for him with a female NP and waited an additional 5 weeks to see one of the male MD’s. When he had to have someone demonstrate care after a urological procedure, he requested a male nurse to explain. We both understand that physicians and other health care providers may be comfortable with a person of either gender, but WE are more comfortable with someone of the same sex examining us. Both my children are in their 20′s and were horrified at the thought of seeing someone of the opposite sex for an examination as were the younger co-workers I asked. Older females were used to having men for MD’s so they seemed to worry about the distinction less although several commented that they’d prefer a female if they had the choice. All the male co-workers see male MD’s.

  • Kay

    I would never see male doctor. The theee I tried touched me inappropate. Knowing I was married, ask me to meet him. I did not tell my husband. There is no telling what he may have done.After the physican died I did tell me husband. He is still angry about what went on. It happens more than you think. They just talk their way out of it.

  • gzuckier

    I actually tend to prefer female physicians, for much the same reason I tend to prefer NPs and PAs (who, of course, are more likely female); they tend to talk down to me less and are more likely to see the interaction as at least somewhat peer to peer.
    Fun fact: study we did years ago, most significant factor linked with women not getting mammograms: they had a male PCP, and had not made an OBGYN visit that year. These women tended to be older than those with female PCPs, probably no surprise.

  • http://patientprivacyreview.blogspot.com/ Doug Capra

    There seems to be a trend, a thread in these discussions
    that sometimes emerges. “Studies show,” people say — that female doctors are more compassionate, better communicators, spend more time with patients, are more empathetic, etc. There is some truth to that — of course studies also show that male doctors tend to spend more time with their male patients than with females, and female doctors spend more time with their female patients than with their male patients. Gender seems to be an issue. It doesn’t surprise me that one gender may show more empathy toward their own gender.I think it’s important not to stereotype male and female doctors. Patients have very personal reasons for preferring one gender over another. It certainly doesn’t have anything to do with ability with most patients. It’s good to see more female doctors in the field. But we need to avoid the pretense that one gender is objectively better than the other gender. Patients have preferences. Patients are individuals and needed to be treated as such. But doctors are individuals, too, and need to be judged that way.

  • PT

    Having worked in healthcare for many years I can certainly
    say that female nurses have made many a derogratory
    comment about their male patients genitals without any
    sense of impunity.
    The notion that to them its a right yet shunned other male employees,their position being that all male healthcare
    workers are perverts.Hopefully this problem can finally
    come out so that people can see the truth.

    PT

  • Suzy Furno-Maricle

    I didn’t think the point of the article was to turn doctors into villians. Really the point is to say that a significant amount of people want gender choice to be an accepted view in healthcare. That is a fairly simple concept.
    Doctors may indeed say that they can’t believe a person would reject needed proceedures based on gender. According to their beliefs I can see their point. However, we are beyond whether it should matter….and need to move on to the fact that for many it does. People often avoid needed medical care based on their gender beliefs, and those beliefs do not change because the term “medical” is used. For some, no gender option means no possibility of medical care. I can’t see how we can continue to accept that as ethically (and humanely) satisfactory.
    The reasons for gender preferences are vast and varied. But where we are today is that everyone deserves care that they believe is dignified and respectful.
    We know that it not impossible to balance gender options. What we do know is that it may take some time and thought.
    We should be is asking doctors to look at what it may take for everyone to accept and receive respectful care and how can we work for solutions to make it happen. We need to move away from the fact that it hasn’t happened yet and move forward to make it happen now.

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