Where’s the ‘real’ doctor? Dealing with gender bias from patients

Near the beginning of the COVID-19 pandemic, Trisha Pasricha, MD, found herself at a loss for words with a male patient. After thoroughly explaining what he should expect with regard to the endoscopic procedure Pasricha would perform on him, the patient said what too many female physicians hear at some point in their career: “Well, before we do anything, I’m going to need to discuss it with the doctor.”

Pasricha, the man’s gastroenterologist, could only wonder why the patient didn’t recognize her credentials; that she was the doctor. This moment shines a spotlight on what Pasricha considers a “classic” experience for women physicians: gender bias from patients, a topic she has written about and discussed on public radio. And, of course, male HCPs can also be the target of gender bias, too.

Recognizing gender bias

Like Pasricha, many women in healthcare are subjected to gender bias and discrimination. More than 70% of women physicians reported instances of discrimination based on gender, according to a paper published by the National Academy of Medicine.

When left unaddressed, gender bias and discrimination can contribute to feelings of disenfranchisement, marginalization, and low self-confidence among those who experience it.

The many sources of gender bias

Gender bias is prevalent in medicine. According to an article published by the American Medical Association, a female physician’s salary is, on average, 27.7% lower than that of her male counterparts. The lingering paternalistic attitudes that deem female physicians less hard-working than male physicians only contributes to that disparity, and the American Medical Association is taking action as a result.

But medical institutions and those who work in healthcare aren’t the sole source of gender bias in exam rooms. In many cases, doctors are subject to gender-based discrimination from patients. 

One article published by the New England Journal of Medicine looked at a national survey detailing the causes and conditions for burnout and suicidal thoughts in general surgery residents. Each participant disclosed their gender.

The most common source of gender discrimination for men was attending surgeons (28.5%). Meanwhile, nearly half of the women surveyed identified patients or patients’ families as the source of gender discrimination. The remaining 50.8% were divided between two other sources: nurses or staff (23.6%), and attending surgeons (17.6%). 

When discrimination affects the unexpected

While women physicians face gender discrimination with more regularity, gender bias also affects male physicians, too—especially OB-GYNs.

In a study published by the Southern Medical Association, researchers gathered data regarding discrimination based on sex in modern obstetrics and gynecology. The survey assessed OB-GYNs’ perceived discrimination from patients, as well as patients’ ideas about gender in obstetrics and gynecology. 

The patient survey found that while some patients may express the importance of their OB-GYN’s gender, most patients choose their doctors based on ratings.

These results make room for the varying degrees of gender bias experienced by both men and women in obstetrics and gynecology, opening the door to a more nuanced understanding of how discrimination operates.

How to address gender bias from patients

Many physicians who are burned out due to gender bias and discrimination in the workplace are unfortunately hesitant to speak out. According to the National Academy of Medicine, this is likely due to the belief that biased behaviors are a result of a larger work culture, and addressing them may be a fruitless effort.

The New England Journal of Medicine, on the other hand, recognizes the importance of interventions in employee training designed to mitigate gender bias in staff and colleagues. Patients won’t necessarily be involved in these interventions, so the Journal suggests implementing a training module that teaches residents how to respond to gender bias in patients as it comes up.

For Pasricha, addressing gender biases led her to write a commentary for The Atlantic, which details the numerous times she’s come face-to-face with gender discrimination at work. While she did receive push-back after publishing the piece, she was also met with solidarity for sharing her message.

“Just sort of acknowledging that there is probably some implicit bias that you're carrying,” Pasricha says, “and taking whatever 10 steps you can take to address that will help the women physicians in your life.”

Sources

1. Farkus, M. Sexism Against Women Doctors Exacerbated By The Pandemic, Boston Physician Says. Boston Public Radio. 2021.

2. Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, abuse, harassment, and burnout in surgical residency training. New England Journal of Medicine. 2019;381(18):1741-1752.

3. McAneny, B. Challenging gender bias in the house of medicine. American Medical Association. 2018.

4. Templeton K, Bernstein CA, et al. Gender-Based Differences in Burnout: Issues Faced by Women Physicians. National Academy of Medicine. 2019.

5. Turrentine M, Ramirez M, et al. Role of Physician Gender in the Modern Practice of Obstetrics and Gynecology: Do Obstetrician-Gynecologists Perceive Discrimination from their Sex?. Southern Medical Association. 2019.