GENDER DIFFERENCES IN MEDICAL-TREATMENT - THE CASE OF PHYSICIAN-PRESCRIBED ACTIVITY RESTRICTIONS

A growing scientific literature highlights concern about the influence of social bias in medical care. Differential treatment of male and fe male patients has been among the documented concerns. Yet, little is k nown about the extent to which differential treatment of male and fema le patients reflects the influence of social bias or of more acceptabl e factors, such as different patient preferences or different anticipa ted outcomes of care. This paper attempts to ascertain the underlying basis for an observed differential in physicians' tendency to advise a ctivity restrictions for male and female patients. We explore the exte nt to which the gender-based treatment differential is attributable to : (1) patients' health profile, (2) patients' role responsibilities, ( 3) patients' illness behaviors, and (4) physician characteristics. The se four categories of variables correspond to four prominent social sc ience hypotheses concerning gender differences in health and health ca re utilization (i.e. biological basis hypothesis, fixed role hypothesi s, socialization hypothesis, physician bias hypothesis). Data are draw n from the Medical Outcomes Study (MOS), a longitudinal observational study of 1546 patients of 349 physicians practicing in three U.S. citi es. Multivariate logistic regression is used to evaluate the likelihoo d of physician-prescribed activity restrictions for male and female pa tients, and to explore the absolute and relative influence of patient and physician factors on the observed treatment differential. Results reveal that the odds of prescribed activity restrictions are 3.6 times higher for female patients than for males with equivalent characteris tics. The observed differential is not explained by differences in mal e and female patients' health or role responsibilities. Gender differe nces in illness behavior and physician gender biases both appear to co ntribute to the observed differential. Female patients exhibit more il lness behavior than males, and these behaviors increase physicians' te ndency to prescribe activity restrictions. After accounting for illnes s behavior differences and all other factors, the odds of prescribed a ctivity restrictions among female patients of male physicians is four times that of equivalent male patients of those physicians. Medical pr actice, education, and research must strive to identify and remove the likely unconscious role of social bias in medical decision making. (C ) 1997 Elsevier Science Ltd.