Women less likely to receive a disease diagnosis than men
In the Netherlands, diagnostic interventions in the primary care setting were less likely to lead to a disease diagnosis in women than men, according to a recent analysis.
“Recent studies show that differences between women and men in primary care diagnostic trajectories for somatic symptoms are not uncommon,” Aranka V. Ballering, MSc, a PhD student at the University Medical Center of Groningen in the Netherlands, and colleagues wrote. “It has not yet been studied whether women and men receive disease diagnoses in an equal frequency after diagnostic interventions have been performed in general practice.”
Ballering and colleagues analyzed data from 34,268 episodes of care, which lasted from a patient’s first encounter with a general practitioner for a health problem to the last encounter for the same health problem. Of the episodes of care, a common somatic symptom was identified in 10,541 women (mean age, 43.4 years) and 7,915 men (mean age, 42.3 years). These common symptoms included headache, dizziness, heart pain, back pain, nausea, muscle pain, shortness of breath or dyspnea, chills, tingling of extremities and/or feet, swallowing or throat difficulties, weakness or general tiredness and arm or leg symptoms.
Of the diagnostic interventions that were included in the study — physical exams, diagnostic imaging, laboratory diagnostics or referrals to a specialist — the researchers found that only laboratory diagnostics were performed more frequently in women. The odds of receiving a disease diagnosis were significantly higher in the episodes of care when a physical exam took place (OR = 2.32; 95% CI, 2.17-2.49) or when the general practitioner requested a referral to a specialist (OR = 1.38; 95% CI, 1.27-1.49). Conversely, a request for laboratory diagnostics increased the odds for a symptom diagnosis (OR = 0.5; 95% CI, 0.47-0.54).
Ballering and colleagues identified a significant interaction between both sex and laboratory diagnostics (OR = 0.82; 95% CI, 0.73-0.93) and sex-by-specialist referral (OR = 0.84; 95% CI, 0.72-0.97).
“These estimates indicate that if a general practitioner requests laboratory diagnostics or a specialist referral, the odds of receiving a disease diagnosis are significantly lower for female patients than for male patients,” the researchers wrote. “For example, in (lower) back pain, it was found that all diagnostic interventions, except for imaging, are associated with a disease diagnosis.”
In these episodes of care for back pain, Ballering and colleagues found a significant interaction between patients’ sex and physical exams (OR = 0.51; 95% CI, 0.34-0.78), imaging (OR = 0.64; 95% CI, 0.43-0.96) and a specialist referral (OR = 0.46; 95% CI, 0.29-0.72). According to the researchers, this suggests that women received significantly fewer disease diagnoses after undergoing one of the diagnostic interventions than men.
In addition, there were several other significant interactions between patients’ sex and laboratory diagnostics, including tingling sensations in the extremities (OR = 0.32, 95% CI, 0.13-0.81), tiredness (OR = 0.72; 95% CI, 0.53-0.96) and arm or leg symptoms OR = 0.56; 95% CI, 0.37-0.86).
The researchers were unaware of the full medical history, socioeconomic status and race of the patients in the study. They also were unaware of the sex of the general practitioners involved in the episodes of care and limited their data adjustments for comorbidities to asthma, COPD, CVD and cancers. The researchers wrote that although these and the other study limitations may hinder the generalizability of the findings, the results are consistent with previous studies.
“Unfortunately, our study does not lead to clinical implications that directly result in changes in patient care,” Ballering and colleagues wrote. “The current study should be complemented with studies that assess the aforementioned help seeking for somatic symptoms and sex-specific diagnostic accuracy for diagnostic interventions in detail.”
Studies that “focus on gender-sensitive medicine from the patient’s perspective” would also be helpful, according to the researchers.
Perspective
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This study showed that differences between women and men are present in the association between diagnostic interventions and disease diagnosis: female patients receive fewer disease diagnoses than male patients after a diagnostic intervention is conducted.
I think the results would be similar if the same study was conducted here in the United States. I believe this is because, just like in the study, women seek help earlier in the disease process than men and oftentimes present with more atypical complaints, which are difficult to diagnose.
Generally, women are usually more inclined to schedule and go to a doctor’s appointment than men; and when men do come in, it is usually after a waiting period where they were hoping symptoms would resolve on their own. In my practice, the refrain I have heard many times is, “I am here because my wife made the appointment,” or “I am here because my significant other advised me to get checked out.”
The findings in this study are fueled by the gender differences in help-seeking behavior for common somatic symptoms. This is not a good or bad thing, but as discussed in the study, this is something that calls for further evaluation into additional research that focuses on gender-sensitive medicine from the patient’s perspective.
As we see in this study, and as confirmed in my practice, women are more likely to access the medical system earlier and more often with concerns and complaints versus men. Some things that may “level the playing field” could be educating patients about symptoms (when to be concerned and when things can wait), increasing access to care, which I believe telemedicine has helped greatly in this area, and lastly, and more difficultly, ensuring a good relationship between patient and provider.
Assistant clinical professor, Rowan School of Medicine
Perspective
Back to TopI worry that the results of Ballering and colleagues’ study may be the same if it was conducted in the United States. All too often, somatic or vague symptoms in women are dismissed or go uninvestigated. Women often present with less typical presentations. This is sometimes due to presenting early in the disease process or describing symptoms differently. It is important to remember that researchers have only been required to include women in their studies in the past 30 years.
Many studies done before that time only took into account the male presentation of disease. It is essential to take into account that this study was done using a database of information. Although it can provide valuable data, it is not a substitute for evaluating patient care. As the authors state, “disease diagnosis is not a direct indicator of improved patient care.” However, it does highlight differences based on sex. Further investigation and bringing these issues into focus can improve overall patient care.
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