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

Sónia F Bernardes,Margarida Costa,Helena Carvalho

doi:10.1016/j.jpain.2013.03.004

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 physician 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 effects of patient (distressed) pain behaviors and diagnostic evidence of pathology (EP) on treatment prescriptions and referrals for chronic low-back pain, and to explore the mediating role of pain credibility judgments and psychological attributions on these effects. A total of 310 general practitioners (GPs; 72.6% women) participated in a between-subjects design, 2 (patient pain behaviors) × 2 (EP) × 2 (GP sex) × 2 (patient sex). GPs were presented with vignettes depicting a fe(male) chronic low-back pain patient, with(out) distress and with(out) EP (eg, 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. PerspectiveThis 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.

Highlights

There are sex-related differences in communication styles and primary-care preventive practices
Our goal was to explore whether physician sex moderates the: a) effects of patient’s 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 x 2 (EP) x 2 (GP sex) x 2
This study aimed to explore whether physician sex moderates: [1] the effects of patients’ pain behaviors and EP on prescriptions and referrals for chronic low-back pain patients (CLBP), and [2] the mediating role of pain credibility judgments and psychological attributions on these effects

Summary

Introduction

There are sex-related differences in communication styles and primary-care preventive practices. The effect of physician sex on dimensions of medical care such as treatment prescriptions and referrals has been less explored 7,11,12,49, especially in pain management contexts. Studies looking for sex-related differences in pain management practices (PMP). Some authors have not found significant differences in analgesic administration practices 43, some have shown that female/male doctors prescribe more analgesics or opioids to female/male patients, respectively. This pattern emerges both in vignettes studies depicting chronic low-back pain patients (CLBP) 53,54 and in a prospective observational study of physicians’

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