Dr. Pink and Dr. Blue: How Gender Indirectly Influences Prescribing Habits

Objective:

Participants:

One hundred ninety-one physicians responded: male (n=97), female (n=94). Medical specialty was not indicated. Seventy-five percent of male respondents (73) indicated they had been practicing medicine for 16 or more years, whereas 60% of female physicians (57) indicated 16 or more years of practicing medicine.

Results:

Overall, there was a high level of agreement between male and female participants. Ten out of 17 questions (59%) displayed little to no difference. The remaining 7 questions differed by at least 5 percentage points between male and female participants. The majority of those questions (5) pertained to how respondents search for medical information about a therapeutic that they currently prescribe or are thinking of prescribing. The remaining 2 questions pertained to the thought process behind prescribing one medication over another.

Conclusions:

Attitudinal differences based on gender may translate into divergent prescribing habits among physicians. It seems that gender might indirectly influence the medication physicians prescribe, as well as the media from which they gather relevant medical information. There were several limitations to this study. First, the population was small. Second, self-assessments are imperfect in nature. However, we believe that this area of research merits further study.

From an early age, our personalities and self-perceptions are closely associated with our genders. In general, we attribute particular behaviors and attitudes to one gender or another. Gender differences have become a cultural obsession. These obsessions, in part, might have helped propel such books as Men Are from Mars, Women Are from Venus, and have given rise to gender-orientated talk shows, with hosts such as Howard Stern and Oprah. Comedians can make good livings telling jokes that are based on stereotypical gender biases. In corporate America, it has been suggested that gender biases are the reason why women earn less than their male counterparts. And in politics, gender biases based on stereotypes can lead to serious discussions or can be used as tongue-in-cheek disqualifiers for women, a point exemplified by a 2008 interview with author Marc Rudov on The O’Reilly Factor. Bill O’Reilly was discussing “the downside” of having a female president and Rudov’s response was, “You mean besides the PMS and the mood swings, right?” Then again, in February 2014, they had another serious discussion about “the downside” of having a female president, but with a different cast of characters.

Whether there were nefarious undertones or it was purely a ratings booster, the discussions on The O’Reilly Factor epitomize the pervasiveness of gender differences and biases in our culture. There have been entire volumes of research dedicated to differences in attitudes and behaviors based on gender, often with conflicting conclusions. And even in an age of heightened awareness, gender stereotypes persist and in some instances flourish. Authors of a review of gender differences and personality attempted to determine if there were true differences in personality traits based on gender. Participants were asked to complete a personality assessment based on the Big Five Personality Dimensions: neuroticism, conscientiousness, agreeableness, openness, and extraversion. Based on implicit and explicit measures, they determined that there was little to no difference between males and females, with one exception. Extroversion was self-reported slightly more often by male participants in the study.

With regard to divergent attitudes and behaviors, some researchers have looked to biology for answers, while others explore social constructs and gender modeling. In 1990, Pomerleau et al examined how parents and environment might influence a child’s play by providing stereotypical gender-appropriate toys and reinforcing gender-specific behavior. What can be gleaned from this conformational “pink vs blue” study is that even before children can differentiate themselves through play, parents and others in the children’s environment influence their behaviors. Opponents of this idea have a counterargument. They assert that biology and hormone levels are the major factors in determining gender identity, while environment has only secondary effects at best. A similar argument might be made regarding self-perceptions. Causality is difficult to determine due to a variety of environmental and biological influences. However, we can gain invaluable insights into gender-specific behaviors by exploring divergent behavior patterns and disregarding their impetus. Of course, advertisers and marketers have known this for years.

Does Gender Influence Physician Behavior?

Several studies have explored divergent physician behavior based on gender. Gender does seem to be linked to interpersonal variations within medical practices. One area of interest has been the doctor-patient relationship. In general, female physicians tend to use more partnership-building statements and shared control models in their practices. Essentially, female health care professionals fostered more active participation through a variety of verbal and nonverbal cues. A meta-analysis of primary care physicians confirms as much. It also indicates that women spend about 10% more time with their patients than their male counterparts. Female physicians are also more likely to deliver preventive services. There is little difference with regard to information quality, social pleasantries, general medical information, or patient compliance. In general, quality of care was similar, although how that care was delivered differed.

The Medical Bag Original Research

There are numerous reasons why physicians might prescribe a particular medication over another. One common motivation is that a medication might be considered the standard of care. However, in cases where 2 or more medications are equally efficacious and have similar safety profiles, subtle differences have an influence on physician preference. Based on previous literature, we attempted to determine if gender had any effect on how physicians obtained relevant medical information and what considerations might influence their prescribing habits.

We invited registered physicians (N=191) by email to participate in a survey about individual attitudes and prescribing considerations. Early responders were predominately male (n=97). For reasons unknown, female responders (n=94) took additional invitations to participate in this survey. We screened participants based on gender and years practicing medicine. Seventy-five percent of male participants indicated 16 or more years practicing medicine, compared with 60% of female participants. The differences in years of practicing medicine might be due to random occurrence, but it might also be attributed to changing educational demographics. According to a 2010 Pew Research Center poll, a higher percentage of women (ages 25-29) are receiving bachelor degrees than their male counterparts: 36% to 28%, respectfully. More women are attending and graduating from medical school, and more women are becoming faculty members in medical schools. If this current trend is sustained, women should represent 50% of all medical faculty members by 2030.

The survey consisted of 5 separate questions: 2 broad questions had multiple yes/no check boxes from which to choose (each set had 7 yes/no check boxes). The remaining 3 questions were individual level-of-agreement questions about quality of care or level of care. The level-of-agreement answer choices included the following: very rarely, rarely, occasionally, often, and almost always; or: rarely, occasionally, often, and very often. Similar to existing literature, we found virtually no gender difference in responses to the level-of-agreement questions. Few participants answered the open-field questions. However, their responses did not differ significantly.

Level-of-Agreement Questions:

• How likely are you to recommend an alternative therapy (such as counseling, diet and exercise, physical therapy, homeopathic remedies, etc) before prescribing a medication?
• How likely are you to prescribe a new or innovative treatment plan if you believe the solution could help your patient?
• How often do you discover that patients presenting symptoms of one disease are also suffering from additional medical issues that they are less comfortable discussing?

In the 2 broad questions that contained a total of 14 answer sets, we found divergent attitudes and behaviors. To identify whether gender might play a role in the participants’ answers, we set a minimum variance threshold of 5 percentage points between male and female answers. We identified 7 areas that warrant more research. Each corresponding question below indicates the number of yes answers and the number of total responses for each gender. The figures represent percentage of divergence in participants’ answers to the 2 large question sets. Note that there were 2 participants who did not answer all the questions in the survey.

Question Set 1:

When looking for information about a specific product that you currently prescribe or are considering prescribing, what steps do you take?

Answers:

1. Visit a general medical website and/or forum? (M=59/97) (F=68/93)

2. Contact a pharmaceutical sales representative? (M=39/97) (F=22/93)

3. Utilize a smartphone or tablet app? (M=37/97) (F=40/93)

4. Read medical journals? (M=62/97) (F=52/93)

5. Visit a pharmaceutical website? (M=48/97) (F=52/93)

Question Set 2:

What are the main factors that prompt you to prescribe one product over another?

Answers:

1. Patient requests? (M=13/96) (F=5/92)

2. Side effect considerations? (M=70/96) (F=73/92)

Discussion

To our knowledge, this is the first study to explore whether gender might have an indirect influence on physician prescribing habits. There were limitations to this study, including sample size and inherent shortcomings associated with self-assessments. Self-assessments typically measure an individual’s self-views and only reflect a modest relationship with their actual behavior or performance. Therefore, we decided to supply only raw numbers and not a statistical analysis. However, based on the results, we believe that gender might indirectly influence a physician’s prescribing habits. Furthermore, we believe that this study highlights an area of research that is untapped.

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