Does patient or parent gender affect your encounter?

[GetMeOuttaThisMess]

As described in title, does the gender of your patient (adult), or the parent of a pediatric patient, affect your encounter, possibly even before the direct interaction?  Another way to ask, is one gender in general easier to deal with?  This has been a topic of discussion in our setting.  If so, I’d be curious as to the provider gender and the gender of the interactive party. This is not meant as a gender beatdown so let’s be civil.

 

[mgriffiths]

I am a 29yo male - I would not say that gender effects my encounter except getting women to complete intimate exams - and not even with me - getting them to schedule these at all with anyone.  Our clinic just started tracking some of these types of data for billing purposes and all of our female providers are at least 75%+ completion, while the male providers are between 40-50% (some much lower).  When I heard what items would be tracked I immediately knew I would do pretty terrible in that category.

[sas5814]

Not really. It is a mixed bag as to who will be more problematic vs practical. Men can be as big a PIA as women and visa versa. I shape my visit to the mood and behavior of the patient.

[rev ronin]

All protected class differentiations are used as a starting point to build community and rapport. Sometimes it helps, occasionally it doesn't.  I try to candidly address things in an evidence-based manner (e.g. "Because you're black, I do NOT want to mess around treating hypertension; studies show that African-Americans do much worse with respect to stroke and heart attack than others, and I don't want you to become a statistic")

The one combo I've learned to be wary of is adult female patient with father present.  It seems to mean "abuse survivor" without any exceptions that I can think of. I got a patient complaint for even bringing up the 'needs a Pap' Epic alert once, when the patient was complaining of asthma--All I did was what I was instructed to do by the EMR.

When it comes to paps/pelvics or breast exams, I ALWAYS start the patient clothed, do all the other parts of the exam, agree as to what happens next, leave the room for the patient to change into a gown, and return with chaperone to complete the rest of the exam.  It just seems an excusably less efficient way to get the job done while respecting patient feelings.

[mgriffiths]

1 hour ago, rev ronin said:

When it comes to paps/pelvics or breast exams, I ALWAYS start the patient clothed, do all the other parts of the exam, agree as to what happens next, leave the room for the patient to change into a gown, and return with chaperone to complete the rest of the exam.  It just seems an excusably less efficient way to get the job done while respecting patient feelings.

this is how I used to do it, but for the first 6 months of my practice I had exactly zero women agree to this part of the exam.  I agree it's probably a more sensitive approach, but in my practice it does not make sure patient's get the care they need.  So, I now have my MA mention it and if patient is amenable start the exam with any intimate exams and then I leave for the patient to get dressed and return to finish everything else.  I now have around a 40-50% agreement rate.

[rev ronin]

2 minutes ago, mgriffiths said:

this is how I used to do it, but for the first 6 months of my practice I had exactly zero women agree to this part of the exam.  I agree it's probably a more sensitive approach, but in my practice it does not make sure patient's get the care they need.  So, I now have my MA mention it and if patient is amenable start the exam with any intimate exams and then I leave for the patient to get dressed and return to finish everything else.  I now have around a 40-50% agreement rate.

I could honestly care less about agreement rates.  The patient's emotional well being is more important than "getting" a pap or breast exam.  My MAs (all of whom were female, go figure) did mention paps and other outstanding preventative care, but also knew that I wanted to do the clothed bit first.

To the extent that we're using psychological tricks to get women to consent to intimate exams when they otherwise would not--and I'm not saying that you are doing this, just talking in general--that feels like 'seduction culture'.  Are we going to start out with the 'neg'?  "Oh, some women don't want a male provider doing a pap.  I suppose you might be one of them, right?"

Thankfully, paps are going away.  Pretty soon, Gardasil-immunized women will be excluded from routine screening, and so we don't have to train another generation of women to tolerate paps as a part of routine care.  Can't come soon enough, as far as I'm concerned.  Part of evidence-based medicine is looking at the cost/reward ratio, and with Gardasil 9 out there and cervical cancer rates falling, I'm less interested in what the number crunchers think and more interested in doing the right things for my patients.

[sas5814]

I'm with you Rev. I quit a job where the bean counters were counting our "success rate" in getting people to do tests like Pap smears because we had a grant. The grant made up its own medical standards that often deviated from current standards but we had to follow the grant....because it's the grant. Things like annual pap smears for women with serial normal exams and HPV negative. DREs for men every year after a certain age even if they were asymptomatic with normal PSA (which we also had to do even in cases where it wasn't indicated).

I also read that HPV testing is soon going to supplant the Pap smear. Not perfect but better.

 

This thread hijack has now concluded..... back to your regular programming.

[GetMeOuttaThisMess]

The one reason why I bring this up is that our setting is somewhat unique in that we aren't the PCP so you aren't required to come see us; it is your option to.  Secondly, we don't offer any services that would/should make either gender uncomfortable.  No gyn, breast exams, male genitalia examinations (aside from hernia checks in males for athletic physicals), or DRE's.  The observation in our setting is that one gender specifically is noticeably more difficult to deal with, regardless of gender of provider (we have one of each).  Granted, we are talking about individuals here, and no one plays nice for the most part when feeling ill, but the degree of difficulty in getting one to buy what we are selling is noticeable.