Journal of the American Medical Women's Association (1972)最新文献

Objective: To determine whether lesbian and heterosexual female physicians differ on health, professional, and demographic characteristics.

Methods: The Women Physicians' Health Study (WPHS), a mailed questionnaire sample survey, was completed by 4501 women physicians (59% response rate), of whom 115 were identified as lesbians and 4177 were identified as heterosexuals. Lesbian and heterosexual were defined by response to items about self-identification and sexual behavior. Dependent variables are self-reported health status and behavior and professional characteristics.

Results: Lesbians weighed more and were more likely to report histories of depression or sexual abuse, family histories of alcoholism, and orientation-related workplace harassment (all p = .01). On the other hand, they were more likely to comply with mammogram screening (p < .01).

Conclusions: Many health status and behavior differences found in other studies of lesbian and heterosexual women were less pronounced here. This may be because the population of female physicians is more homogeneous, but perhaps also because the size of our lesbian sample was limited (n = 115). However, even with the buffer of high socioeconomic status and medical education, lesbian physicians seem to have a somewhat higher cumulative risk of disease compared to their heterosexual female colleagues.

A century ago, psychiatrists understood women's susceptibility to mental illness in terms of their unique biology. Although contemporary physicians certainly do not share late 19th-century psychiatrists' biases about women and the social order, the similarities between today's emphasis on women's biology and earlier explanations of the relationship between women's biology and mental illness bear investigation. This paper reviews the history of medical ideas about the connection between women's reproductive organs and their mental health and questions modern assumptions about that connection.

Hyperlipidemia is a risk factor for coronary heart disease (CHD) in both men and women, although the association between total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and CHD risk differs in men and women. Although several clinical trials of lipid lowering for both primary and secondary prevention of CHD have been conducted, women have not always been included, have been included in small numbers, or have not had their results analyzed separately. CHD risk assessment is an important component of decision making about screening and treatment of hyperlipidemia. This article presents guidelines for screening and treatment of hyperlipidemia in women with CHD, in healthy women, and in women at risk for CHD.

Objective: To assess the extent of bone-health treatment and to test for racial differences in that treatment among black and white women with documented low bone mass.

Methods: All women who underwent central dual-energy X-ray absorptiometry testing at the Washington, DC Veterans Affairs Medical Center (VAMC) from January 1, 1998 through October 15, 2001 were identified via the VAMC's computerized patient record system. Self-administered questionnaires measuring patient demographics, fracture history, and presence of appropriate bone-health treatments were mailed to those with T scores < or = -1.0 (n=110).

Results: Seventy-five women (68%) completed the survey (mean 61 years old, 55% white and 35% black). There were no statistically significant differences between black and white women in smoking (71% nonsmokers), avoiding excess alcohol (95%), or exercising regularly (68%). Eighty-one percent reported taking calcium supplements, 71% vitamin D supplements, and 56% antiresorptive medications; whites were significantly more likely than blacks to be taking calcium supplements (90% v 69%, p=.048) and antiresorptive drugs (71% v 35%, p=.004). The racial difference in antiresorptive medication use remained significant after adjusting for bone loss severity and prior fractures (odds ratio 3.71; 95% confidence interval 1.24, 11.0).

Conclusion: Women with low bone mass treated at the Washington, DC VAMC reported high rates of bone-building behaviors and the use of calcium and vitamin D supplements and somewhat lower rates of antiresorptive drug use. Whites were more likely than blacks to be taking calcium supplements and antiresorptive drugs. The causes of these disparities should be identified in future studies.

Objectives: To estimate how many Californians know a victim of domestic violence, to examine their knowledge of certain characteristics of the violence, and to estimate and examine such knowledge among specific demographic groups.

Method: A total of 3713 California adults (similar numbers of whites, blacks, Hispanics, Korean Americans, Vietnamese Americans, and other Asian Americans) completed a random-digit-dial interview. Respondents were asked whether a friend, relative, or coworker had been threatened or harmed by an intimate partner. Weights were applied to the cross-sectional sample to obtain estimates for the general population. Descriptive statistics and multivariate regressions were used with the full sample.

Results: Nearly half (45.5%) of the adult general population of California knows a victim of domestic violence (DV); 40.5% know a woman and 5.0% know a man. More than one-third of the population (35.7%) knew the victim while the abuse was happening. Although 86.5% of those who reported knowing a DV victim indicated that the victim incurred physical harm, only 18.3% of the injured victims were reported to have sought medical care. Gender was the most consistent respondent predictor: Men were less likely to know someone who was a victim of DV and to have specific information about the violence. Ethnic differences were fewer, but distinctions among groups were documented.

Conclusions: Knowing a victim of DV is common among California adults. Implications for medical practice are discussed in terms of the ethnicity, gender, and work force status of the population served and geographic location of the medical practice.

Objectives: To measure the impact of physician gender on patient satisfaction, controlling for confounding patient variables, and to examine the extent to which differences in satisfaction with male and female physicians can be explained by physician practice styles.

Method: New adult patients (n=509) were randomized to see male and female primary care physicians at a university medical center outpatient facility. Patient sociodemographics and self-reported health status (using the Medical Outcomes Study Short Form-36) were measured before the initial visit, and satisfaction with the physician was measured immediately following the visit. The entire medical encounter was videotaped and physician practice style was later analyzed using the Davis Observation Code.

Results: Female physicians spent a significantly greater proportion of the visit on preventive services and counseling than male physicians did, and male physicians devoted more time to technical practice behaviors and discussions of substance abuse. Visit length was not significantly different for male and female physicians. Patients of female physicians were more satisfied than were those of male physicians, even after adjusting for patient characteristics, visit length, and physician practice style behaviors.

Conclusion: Patient satisfaction with primary care physicians appears to be influenced not only by patient characteristics and physician behaviors, but also by the gender of the provider. Possible explanations for this may be that psychosocial aspects of the physician-patient interaction are different for male and female physicians. Patients may also bring expectations about female physicians to the encounter, presuming them to be more empathetic, nurturing, and responsive.

Women physicians have made great strides not only in gaining acceptance but also in excelling in the medical profession. A large minority of physicians today are women. Success in the dual roles of mother and physician really is possible, and the experience offers a uniquely rich and complex life. Our hope is that the practical suggestions offered here will prove useful to the next generation of women physicians and that each subsequent generation will become ever more successful in filling these roles.