Abstract
BackgroundChest pain is a common complaint and reason for consultation in primary care. Few data exist from a primary care setting whether male patients are treated differently than female patients. We examined whether there are gender differences in general physicians' (GPs) initial assessment and subsequent management of patients with chest pain, and how these differences can be explainedMethodsWe conducted a prospective study with 1212 consecutive chest pain patients. The study was conducted in 74 primary care offices in Germany from October 2005 to July 2006. After a follow up period of 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient and decided about the etiology of chest pain at the time of patient recruitment (delayed type-reference standard). We adjusted gender differences of six process indicators for different models.ResultsGPs tended to assume that CHD is the cause of chest pain more often in male patients and referred more men for an exercise test (women 4.1%, men 7.3%, p = 0.02) and to the hospital (women 2.9%, men 6.6%, p < 0.01). These differences remained when adjusting for age and cardiac risk factors but ceased to exist after adjusting for the typicality of chest pain.ConclusionsWhile observed gender differences can not be explained by differences in age, CHD prevalence, and underlying risk factors, the less typical symptom presentation in women might be an underlying factor. However this does not seem to result in suboptimal management in women but rather in overuse of services for men. We consider our conclusions rather hypothesis generating and larger studies will be necessary to prove our proposed model.
Highlights
Chest pain is a common complaint and reason for consultation in primary care
We examined whether there are gender differences in general physicians’ (GPs)’ initial assessment and subsequent management of patients with chest pain, how these differences can be explained, and what underlying mechanisms might be at work
GPs and patients characteristics Practices located in urban areas were 63.5%, and 67% of the participating 74 GPs were male with a mean age of 49 years
Summary
Chest pain is a common complaint and reason for consultation in primary care. Few data exist from a primary care setting whether male patients are treated differently than female patients. Chest pain is a common reason for consultation in primary care and incidence varies according to setting, country, and inclusion criteria [1,2,3]. Since the late 1980s there has been a rising concern that in patients, as far as CHD is concerned, women might be treated and managed differently than men. In the following years many reports seemed to support the observation that men are often treated earlier, and more aggressively, than women when presenting with similar symptoms [11,12,13]. Results of other authors did not support what was termed as “gender bias” in the management of CHD [14,15,16]
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