Gender bias in assessing chest pain among general medical trainees and general practitioners in western of Brittany, France

Alice Clement, Antoine Dany, Marie Barais

Keywords: Gender, chest pain, Implicit bias, gender bias, general practice

Background:

Implicit biases are cognitive biases and interfere with medical reasoning. They are suspected of causing inequalities in care. For example, myocardial infarction (MI) is less well diagnosed on average in women than in men.

Research questions:

The hypothesis of this study was that implicit gender bias influences general practitioners (GPs) when faced with chest pain (CP), encouraging them to evoke an organic cause less often in women than in men. The main aim of the study was to estimate this gender bias.

Method:

The study was observational and cross-sectional. The study's population comprised GPs and GP interns from Finistère, blinded to the real purpose of the study. Participants were asked to estimate the risk of MI and functional chest pain (FCP) in the face of clinical vignettes of patients presenting with CP, with random assignment of the sex of the patient. The primary endpoint was the mean difference in scores according to patient gender. Secondary endpoints were an intra-individual comparison of scores and a subgroup analysis. The study included 291 participants.

Results:

Multivariate analysis revealed a statistically significant difference for MI and FCP for the primary and secondary endpoints, with a stronger bias in GPs and university training supervisors. The sex of the respondent did not affect the responses.

Conclusions:

This study confirmed the existence of an implicit gender bias influencing the assessment of chest pain by a sample of interns and GPs. This bias can have a negative impact on women's health, and raising awareness among GPs is therefore a public health issue.

Points for discussion:

We have to deal with semiologic differences between male and female presentation in primary care.

How to deal with it during trainee education?

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