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

By Jules Murtha
Published January 25, 2022

Key Takeaways

  • Nearly half of the women surveyed identified patients or patients’ families as the source of gender discrimination.

  • When left unaddressed, gender bias and discrimination can contribute to feelings of disenfranchisment, marginalization, and low self-confidence.

  • Many physicians who are burned out due to gender bias and discrimination in the workplace are hesitant to speak out.

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.

What is discrimination?

"Discrimination" is a term that encompasses disparaging or disrespectful treatment, lack of career promotion, disparities in financial and administrative resources among physicians. It can also show up in rude comments and remarks made to physicians—particularly mothers and women of color—and could be initiated by senior staff, administrators, colleagues, allied health professionals, and patients.

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

Related: Medicine has a problem with female doctors, survey shows

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 results of the survey speak volumes: Of the 7,409 residents who participated, 31.9% reported gender discrimination in residency. Rates of all measures were higher among women, with 65.1% reporting gender discrimination compared with 10% of men.

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 results showed that 60% of male OB-GYNs felt that their practice was negatively affected by their gender. No female OB-GYNs reported feeling that their gender hurt their volume of patients. However, 46% of women did report feeling discriminated against due to lower compensation compared with the salaries of male OB-GYNs.

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.

Related: A closer look at the biggest pay gaps in physician pay

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.

While further research centering doctors’ role in addressing gender bias from patients is needed, institutional efforts to address casual gender bias may include the implementation of:

  • Reporting mechanisms specific to gender bias

  • Gender-targeted interventions

  • Mindfulness training

  • Stress management programs

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.”

What this means for you

The effects of gender discrimination reach far and wide in the field of medicine. As clinicians experience frequent exposure to discrimination, in addition to sexual harassment and abuse in the workplace, they report higher levels of burnout—a syndrome that can lead to depression, alcoholism, poor health, and suicide. Acknowledging and confronting gender bias in all forms is crucial. Some clinicians may need to adjust their worldview to uproot the norms that enable gender bias. To that end, physicians must support each other in efforts to identify and call out attitudes that may enforce harmful gender stereotypes in the workplace.

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.

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