How physicians treat mentally distressed men and women

Abstract

There is speculation that women receive different medical care than men because physicians have stereotyped views about women's symptoms and treatment preferences. This paper asks if men and women who visit physicians for mental distress receive comparable medical care and, if not, whether medical considerations or psychosocial ones explain the differences. Data are from a large national survey of ambulatory care visits in the United States. We find that women and men are equally likely to report mental distress as their main problem to physicians. Physicians determine that distressed men have mental disorders more often than distressed women. On the whole, distressed men and women receive similar numbers of diagnostic services, therapeutic services and dispositions for follow-up care. The kinds of services and dispositions differ a little: women tend to receive limited examinations, blood pressure checks and drug prescriptions more often; men are more likely to have general examinations, medical counseling or no service at all. Women are retained for follow-up care with the same physician more often; men tend to be sent elsewhere for additional care or no follow-up plans at all are made for them. Sex differences in care are statistically small (only 6% of the many comparisons are significant at P <0.05). But the significant differences highlight two points: when differential care occurs, it is in non psychiatrists' offices and it usually shows women receiving more of a given service or disposition. Differential care for women and men can be due to medical factors (such as patient age, prior visit status, seriousness of problem) or psychosocial ones (such as patient requests, patient emotionality, physician sex bias). When we control for several medical factors, the significant sex differences persist. This suggests that the extra care distressed women sometimes receive from nonpsychiatrists is due to patient behavior or physician attitudes.