Do gender and race affect decisions about pain management?

OBJECTIVE: To determine if patient gender and race affect decisions about p ain management. DESIGN, SETTING, AND PARTICIPANTS: Experimental design using medical vignet tes to evaluate treatment decisions. A convenience sample of 111 primary ca re physicians (61 men, 50 women) in the Northeast was asked to treat 3 hypo thetical patients with pain (kidney stone, back pain) or a control conditio n (sinusitis), Symptom presentation and severity were held constant, but pa tient gender and race were varied. MEASUREMENTS AND MAIN RESULTS: The maximum permitted doses of narcotic anal gesics (hydrocodone) prescribed at initial and return visits were calculate d by multiplying mg per pill x number of pills per day x number of days x n umber of refills. No overall differences with respect to patient gender or race were found in decisions to treat or in the maximum permitted doses, Ho wever, for renal colic, male physicians prescribed higher doses of hydrocod one to white versus black patients (426 mg vs 238 mg), while female physici ans prescribed higher doses to blacks (335 mg vs 161 mg: F-1.85 = 9.65, P = .003). This pattern was repeated for persistent kidney stone pain, For per sistent back pain, male physicians prescribed higher doses of hydrocodone t o males versus females (406 mg vs 201 mg), but female physicians prescribed higher doses to females (327 mg vs 163 mg; F-128 = 5.50, P = .03). CONCLUSION: When treating pain, gender and racial differences were evident only when the role of physician gender was examined, suggesting that male a nd female physicians may react differently to gender and/or racial cues.