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STD care: variations in clinical care associated with provider
sex, patient sex, patients' self-reported symptoms or high-risk behaviors,
partner STD history.
Social Science & Medicine 2004;59(5):1011-1018.
St. Lawrence JS, Kuo WH, Hogben M, Mantano DE, Kasprzy D, Phillips WR.
Abstract
Sexually transmitted diseases in the United States are frequently diagnosed
by private, as well as public, physicians. However, we know little about
the decision processes that physicians employ when faced with people who
may or may not be infected. To address this gap, we compared physicians'
responses to different patient vignettes to assess how variations in patients'
presentations affect physicians' clinical behavior. We systematically varied
reported symptoms, behavioral risk, partner STD, and sex of patients in 16
different vignettes, with one vignette randomly presented to each physician
in a national survey. Physicians rated the likelihood of 12 clinical management
actions they might take with the patient vignette presented. Responses varied
with self-reported symptoms, high-risk behavior, and report of an STD infected
partner such that female physicians were more attentive to sexual health,
and all physicians were more likely to treat female patients aggressively,
relative to their male patients. Overall behavior was broadly congruent with
sound medical practice, although we discuss several caveats to this general
statement.