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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