Goals

  • Recognize the prevalence of gender disparities in medicine.
  • Understand how different practice patterns as well as patient and health professional characteristics may contribute to health inequities.
  • Learn about factors that contribute to the development and persistence of gender disparities in the healthcare environment.
  • Develop the knowledge, language, and skills to advocate for reduction of gender disparities in healthcare outcomes within your own practice.

Objectives

  1. Define the terms ‘health disparity’ and ‘health inequity’ and recognize areas in medicine where gender disparities have been identified.
  2. Explore how the practice of excluding women from clinical research has contributed to the gender data gap and directly impacted health outcomes for women.
  3. Understand how the concepts of the “reference man” and “bikini medicine” have impacted development of pharmaceutical therapies and evidence-based treatment strategies for women.
  4. Discuss how the gender identity of patients and healthcare professionals, as well as diversity within the healthcare workplace, can impact delivery of effective, timely, equitable healthcare for both men and women, cisgender and transgender.
  5. Recognize and consider implementing communication strategies and clinical practice patterns to help reduce gender disparities in care.

Module Content

Title
Author
Time

Healthy People 2020: Disparities

Objective: q
Office of Disease Prevention and Health Promotion: Healthy People 2020
6 minutes

Healthy People 2020 provides definitions of "social determinants of health", "health disparity", and "health inequity," which aims to assess and work to eliminate health disparities over the next decade.

Alyson McGregor | TEDxProvidence | Why medicine often has dangerous side effects for women

Objective: 2
Alyson McGregor, MD, MA, FACEP
15 minutes

In this TED Talk, Dr. Alyson McGregor discusses how the exclusion of women in clinical research has led to adverse outcomes for women, and how including women in clinical trials could help identify sex-specific adverse effects before drugs are released to the market. Read more from her on why incorporating sex and gender into medicine is so critical in this article from the Annals of Emergency Medicine.

Vulnerability of Female Drivers Involved in Motor Vehicle Crashes: An Analysis of US Population at Risk

Objective: 2
Dipan Bose, Maria Segui-Gomez, Jeff R. Crandall
15 minutes

This important retrospective cohort study on crash data from 1998-2008 found that the odds for a belt-restrained female driver to sustain severe injuries were 47% higher than those for a belt-restrained male driver involved in a comparable crash, largely because the seatbelt was designed and tested only on male subjects.

Why women get overlooked in healthcare - with Serena Williams

Objective: 3
Rachel Thomas, Serena Williams, Esther Choo, MD, Janine Clayton, MD
40 minutes

In this podcast, Serena Williams talks about post-partum complications after the birth of her daughter, Olympia, in this podcast episode. She is joined by Dr. Janine Clayton, Director of the Office of Research on Women's Health at NIH, and Dr. Esther Choo, EM Physician, who discuss the lack of representation in clinical research and evidence-based therapies for women.

Women suffer needless pain because almost everything is designed for men

Objective: 3
Sigal Samuel
10 minutes

This article highlights how the gender data gap has created gender disparities in multiple areas from pharmaceutical research to automobile design. The failure to include individuals different than the typical "reference man" and to disaggregate gender data when women are included in studies, contributes to a world that is more hazardous for and less accomodating to women.

Younger Women Hesitate To Say They're Having A Heart Attack

Objective: 4
Maanvi Singh
5 minutes

Dr. Judith Lichtman discusses her study with NPR which found that young women were hesitant to present their symptoms of a heart attack to their healthcare providers, worrying they would be seen as hypochondriacs. Dr. Nisha Parikh, a UCSF cardiologist, also comments offering her own clinical anectodal experience consistent with these findings.

FemInEVERYTHING? Can We Say That Women Doctors are Just Better for Everyone?

Objective: 4
Dara Kass, MD
5 minutes

Dr. Dara Kass discusses the landmark article by Yusuke Tsugawa that found that female internists had lower mortality rates and lower readmission rates when compared to their male internist counterparts.

A Key To Black Infant Survival? Black Doctors

Objective: 4
This episode was produced by Brit Hanson, fact-checked by Ariela Zebede and edited by Viet Le
12 minutes

In the US, black infant mortality continues to be much higher than white infant mortality. Research shows that the race of the physician impacts black maternal and infant outcomes. This episode explores potential solutions to persistent racial and gender inequities.

Patient-physician gender concordance and increased mortality among female heart attack patients

Objective: 4
Brad N Greenwood, Seth Carnahan, Laura Huang
15 minutes

Based on a retrospective study of ED admission in Florida hospitals, this article posits that gender concordance between the patient and physician increases likelihood of survival after heart attacks. Specifically, there was increased mortality when male physicians treated female patients with acute myocardial infarction.

Sex & Why Podcast: EPISODE 13, PART 2: LGTBQI HEALTH-RELATED ISSUES

Objective: 4
Jeannette Wolfe, MD
30 minutes

Discussion with Dr Elizabeth Samuels and Dr Michelle Forcier highlighting some of the unique challenges that transgender individuals may face in seeking healthcare, as well as some suggested best practices for how to effectively and respectfully communicate with transgender patients.

Should You Choose a Female Doctor?

Objective: 5
Tara Parker-Pope
10 minutes

This newspaper article discusses a series of peer-reviewed studies that suggest female physicians have better outcomes than male physicians, and interview several of the study authors to discuss possible reasons behind these differences. The author hypothesizes that the differences in communication styles between men and women may partially explain their differences in outcomes. This is also notable due to skill in shared decision making, also noted in this Feminem article: https://feminem.org/2016/08/22/female-decision-making/

Effect of physicians’ gender on communication and consultation length: a systematic review and meta-analysis

Objective: 5
Laura Jefferson, et al
25 minutes

This meta-analysis looks at gender differences in communication practices with patients, finding that women tended to engage in more positive talk, ask more psychosocial questions, discuss emotions, and demonstrate more partnership building behaviors.

Physician Gender Differences in General and Cancer-Specific Prevention Attitudes and Practices

Objective: 5
Amelie G Ramirez, et al
20 minutes

In this cross-sectional study of physician survey data looking at male versus female physician prevention practices, female physicians were more likely to dicuss physical activity, sexual behavior, violence, and use of substances other than alcohol with their patients than their male counterparts.

Talking Points and Discussion Questions

  1. In your own experience as a patient, have you noticed certain practices, whether from male or female healthcare professionals, which made you feel more listened to or more likely to continue engaging with that healthcare system? Reflect on these experiences.

  2. Reflect on your own practice patterns and institutional policies. Are there areas in which you could plan to implement more evidence-based practices through sex and gender based medicine?

  3. Consider the gender inequities in pay and leadership representation within the context of this module – how do we still have a system in which women are undercompensated despite evidence that suggests female healthcare professionals have better patient outcomes than male healthcare professionals? How can we advocate for institutional and organizational changes to reduce these inequities?

Dive Deeper

  1. Explore the NIH Office of Research on Women’s Health Website to learn more about topics such as telescoping, a phenomenon in which women are more likely to experience addiction to pain medications and alcohol at lower doses than men, as well as other ongoing research on women’s health.
  2. Consider participating in this online NIH Course to explore a systems-based approach to lsex and gender differences in pathology. Discuss the anatomic and physiologic differences between treating female and male patients with colleagues to refine your knowledge and apply these principles to your own practice.
  3. Engage further in the conversation around Sex and Gender Based Medicine through the Sex and Gender Health Collaborative and Dr. Jeaannette Wolfe’s website, which provides resources to integrate sex and gender knowledge into medical education and practice. 

 

Module Authors and Reviewers

Amanda Lu

Amanda Lu