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Cited by 116Sex and Gender in HealthcareClinical Reasoning and Diagnostic SkillsDiversity and Career in Medicine

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

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Maserejian, Nancy N., Link, Carol L., Lutfey, Karen L., Marceau, Lisa D., McKinlay, John B.·2009·Journal of Women's Health
DOI 10.1089/jwh.2008.1007PMC PMC2825679
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Abstract

Background: Previous studies have documented the underdiagnosis of coronary heart disease (CHD) in women, but less is known about which alternate diagnoses take precedence and whether additional patient factors modify possible gender bias. Objective: To measure gender variation in clinical decision making, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD. Methods: This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. Results: Physicians ( n = 128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age ( p = 0.006), but only among middle-aged women were they significantly less certain of the CHD diagnosis ( p < 0.001). Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts ( p = 0.03). An interaction effect showed that females with high SES were most likely to receive a mental health diagnosis as the most certain ( p = 0.006). Conclusions: Middle-aged female patients were diagnosed with the least confidence, whether for CHD or non-CHD conditions, indicating that their gender and age combination misled physicians, particularly toward mental health alternative diagnoses. Physicians should be aware of the potential for psychological symptoms to erroneously take a central role in the diagnosis of younger women.

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  • Eight articles appeared to refer to the same data collected in a single cross-country comparison study, and a further two articles analysed the same data.

    “eight articles appeared to refer to the same data collected in a single cross-country comparison study [27–32, 34, 35] and a further two articles analysed the same data [45, 47].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [34]

    The Materials and Methods (page unavailable) describe this article's analysis of 128 Massachusetts physicians and say the vignette methodology was published previously, citing a cross-country factorial experiment. Our copy does not establish that this article analysed the same data as that experiment or substantiate the cited counts of eight and two articles. (LLM, conf=0.72)

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  • Many assumption studies attempted to make their vignettes as realistic as possible by having them validated by clinicians and by having participants view/read the vignettes as part of a normal day at work.

    “many of the assumption studies attempted to make their vignettes as realistic as possible by having them validated by clinicians [25–41] and also by having participants view/read the vignettes as part of a normal day at work [27–36, 39, 41].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [34]

  • Physicians in one study were less certain of the diagnosis of coronary heart disease for middle-aged women, who were thus twice as likely to receive a mental health diagnosis than their male counterparts.

    “physicians in one study were less certain of the diagnosis of coronary heart disease for middle-aged women, who were thus twice as likely to receive a mental health diagnosis than their male counterparts [34].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [34]

  • In cardiology, heart attacks are frequently misdiagnosed in women.

    “A notable example can be seen in cardiology [57], where heart attacks are frequently misdiagnosed in women.”

    From Ethical Framework for Harnessing the Power of AI in Healthcare and Beyond (2024) · cites this paper as [57]

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Research works printed but not linked: 6

  1. [2]Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press; 2003. [PubMed] [Google Scholar]
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  6. [37]Lutfey KE. Link CL. Grant RW. Marceau LD. McKinlay JB. Is certainty more important than diagnosis for understanding race and gender disparities? An experiment using coronary heart disease and depression case vignettes. Health Policy. 2008. [DOI] [PMC free article] [PubMed]

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Authors
Maserejian, N. N., Link, C. L., Lutfey, K. L., Marceau, L. D., & McKinlay, J. B.
Affiliations
New England Research Institutes (US)
ORCID
Marceau, Lisa D.
Venue
Journal of Women's Health
Publisher
SAGE Publications
Published
2009-10
Volume
18
Issue
10
Pages
1661-1667
ISSN
  • 1059-7115 (ISSN-L)
  • 1540-9996
  • 1931-843X
DOI
10.1089/jwh.2008.1007
PMC
PMC2825679
OpenAlex
W2064691740
Cited by
116
References
35
Citations by year
2026: 10 · 2025: 23 · 2024: 25 · 2023: 10 · 2022: 7 · 2021: 10 · 2020: 4 · 2019: 4 · 2018: 8 · 2017: 4 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 3
FWCI
2.01
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Women s Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute on Aging (AG 16747, R01AG016747)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Social Sciences › Gender Studies › Diversity and Career in Medicine
Keywords
gender bias in diagnosis, coronary artery disease, underdiagnosis in women, alternative diagnoses, socioeconomic status, race, physician experience, middle-aged women, clinical decision-making
MeSH terms
Adult, Aged, Attitude of Health Personnel, Coronary Disease, Diagnosis, Differential, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Physician-Patient Relations, Practice Patterns, Physicians', Videotape Recording, Outcome Assessment, Health Care, Sex Distribution, Patient-Centered Care

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