Journal of General Internal Medicine

, Volume 10, Issue 3, pp 119–125 | Cite as

Are patients of women physicians screened more aggressively?

A prospective study of physician gender and screening
  • Matthew W. KreuterEmail author
  • Victor J. Strecher
  • Russell Harris
  • Sarah C. Kobrin
  • Celette Sugg Skinner
Original Articles


OBJECTIVE: To determine the effects of physician gender on rates of Pap testing, mammography, and cholesterol testing when identifying and adjusting for demographic, psycho-social, and other patient variables known to influence screening rates.

DESIGN: A prospective design with baseline and six-month follow-up assessments of patients’ screening status.

SETTING: Twelve community-based group family practice medicine offices in North Carolina.

PARTICIPANTS: 1,850 adult patients, aged 18–75 years (six-month response rate, 83%), each of whom identified one of 37 physicians as being his or her regular care provider.

MAIN RESULTS: Where screening was indicated at baseline, the patients of the women physicians were 47% more likely to get a Pap test [odds ratio (OR)=1.47, 95% confidence interval (CI)=1.05, 2.04] and 56% more likely to get a cholesterol test (OR=1.56, 95% CI=1.08, 2.24) during the study period than were the patients of the men physicians. For mammography, the younger patients (aged 35–39 years) of the women physicians were screened at a much higher rate than were the younger patients of the men physicians (OR=2.69, 95% CI=0.98, 7.34); however, at older ages, the patients of the women and the men physicians had similar rates of screening.

CONCLUSIONS: In general, the patients of the women physicians were screened at a higher rate than were the patients of the men physicians, even after adjusting for important patient variables. These findings were not limited to gender-specific screening activities (e.g.. Pap testing), as in some previous studies. However, the patients of the women physicians were aggressively screened for breast cancer at the youngest ages, where there is little evidence of benefit from mammography. Larger studies are needed to determine whether this pattern of effects reflects a broader phenomenon in primary care.

Key words

preventive medicine mass screening family practice physician gender Pap testing mammography cholesterol testing 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hayward RA, Shapiro MF, Freeman HE. Corey CR. Who gets screened for cervical and breast cancer? Results from a new national survey. Arch Intern Med. 1988;148:1177–81.PubMedCrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control. Use of mammography-United States, 1990. MMWR. 1990;39:621–9.Google Scholar
  3. 3.
    Makuc DM. Freid VM. Kleinman JC. National trends in the use of preventive health care by women. Am J Public Health. 1989;79:21–6.PubMedGoogle Scholar
  4. 4.
    Harlan LC, Bernstein AB. Kessler LG. Cervical cancer screening: who is not screened and why? Am J Public Health. 1991;81:885–90.PubMedGoogle Scholar
  5. 5.
    Lewis CE. Disease prevention and health promotion practices of primary care practices in the United States. Am J Prev Med. 1986;4(suppl):9–16.Google Scholar
  6. 6.
    Woolhandler S, Himmelstein DU. Reverse targeting of preventive care due to lack of health insurance. JAMA. 1988;259:2872–4.PubMedCrossRefGoogle Scholar
  7. 7.
    The NCI Breast Cancer Screening Consortium. Screening mammography: a missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey studies. JAMA. 1990;264:54–8.CrossRefGoogle Scholar
  8. 8.
    Vogel VG. Graves DS, Vernon SW. Lord JA, Winn RJ, Peters GN. Mammographic screening of women with increased risk of breast cancer. Cancer. 1990;66:1613–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Rakowski W, Jube CE, Marcus BH, Prochaska JO, Velicer WF, Abrams DB. Assessing elements of women’s decisions about mammography. Health Psychol. 1992;11:111–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Rakowski W, Fulton JP, Feldman JP. Women’s decision making about mammography: a replication of the relationship between stages of adoption and decisional balance. Health Psychol. 1993;12:209–14.PubMedCrossRefGoogle Scholar
  11. 11.
    Kruse J. Phillips CM. Factors influencing women’s decisions to undergo mammography. Obstet Gynecol. 1987;70:744–8.PubMedGoogle Scholar
  12. 12.
    Glockner SM, Holden MG, Hilton SVW, Norcross WA. Women’s attitudes towards screening mammography. Am J Prev Med. 1992;8:69–77.PubMedGoogle Scholar
  13. 13.
    Champion VL. Compliance with guidelines for mammography screening. Cancer Detect Prev. 1992;16:253–8.PubMedGoogle Scholar
  14. 14.
    Lurie N, Slater J, McGovern P, Ekstrum J, Quam L, Margolis K. Preventive care for women: does the sex of the physician matter? N Engl J Med. 1993;329:478–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Osborn EH, Bird JA. McPhee SJ, Rodnick JE, Fordham D. Cancer screening by primary care physicians: can we explain the differences? J Fam Pract. 1991;32:465–71.PubMedGoogle Scholar
  16. 16.
    Hall JA, Palmer RH, Orav EJ, Hargraves JL, Wright EA, Louis TA. Performance quality, gender, and professional role: a study of physicians and nonphysicians in 16 ambulatory care practices. Med Care. 1990;28:489–501.PubMedCrossRefGoogle Scholar
  17. 17.
    Becker MH (ed). The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324–473.Google Scholar
  18. 18.
    Fishbein M, Ajzen I. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley, 1975.Google Scholar
  19. 19.
    Weinstein ND. The precaution adoption process. Health Psychol. 1988;7:355–86.PubMedCrossRefGoogle Scholar
  20. 20.
    Prochaska JO, DiClemente CC. Stages and processes of self-change for smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Prochaska JO, DiClemente CC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47:1102–14.PubMedCrossRefGoogle Scholar
  22. 22.
    Velicer WF, DiClemente CC. Prochaska JO, Brandenburg N. Decisional balance measure for assessing and predicting smoking status. J Pers Soc Psychol. 1985;48:1279–89.PubMedCrossRefGoogle Scholar
  23. 23.
    Burack RC, Liang J. The early detection of cancer In the primary care setting: factors associated with the acceptance and completion of recommended procedures. Prev Med. 1987;16:739–51.PubMedCrossRefGoogle Scholar
  24. 24.
    American Cancer Society. Summary of current guidelines for the cancer-related check-up: recommendations. New York: American Cancer Society, 1988.Google Scholar
  25. 25.
    Report of the National Cholesterol Education Program Expert Panel on Detection. Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med. 1988;148:36–69.Google Scholar
  26. 26.
    Mandelblatt J. Cervical cancer screening in primary care: issues and recommendations. Prim Care. 1989;16:133–55.PubMedGoogle Scholar
  27. 27.
    Eddy DM. Screening for cervical cancer. Ann Intern Med. 1990;113:214–26.PubMedGoogle Scholar
  28. 28.
    Fletcher SW, Black W. Harris R, Rimer BK, Shapiro S. Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst. 1993;85:1644–56.PubMedCrossRefGoogle Scholar
  29. 29.
    Maheux B. Dufort F, Beland F, Jacques A, Levesque A. Female medical practitioners: more preventive and patient-oriented? Med Care. 1988;28:87–92.CrossRefGoogle Scholar
  30. 30.
    Roter D. Lipkin M. Korsgaard A. Sex differences in patients’ and physicians’ communication during primary care medical visits. Med Care. 1991;29:1083–93.PubMedCrossRefGoogle Scholar
  31. 31.
    Fennema K. Meyer DL, Owen N. Sex of physician: patients’ preferences and stereotypes. J Fam Pract. 1990;30:441–6.PubMedGoogle Scholar
  32. 32.
    Bowman JA, Redman S, Dickinson JA, Gibberd R, Sanson-Fisher RW. The accuracy of Pap smear utilization self-report: a methodological consideration in cervical screening research. Health Serv Res. 1991;26:97–107.PubMedGoogle Scholar
  33. 33.
    McKenna MT, Speers M, Mallin K, Warnecke R. Agreement between patient self-reports and medical records for Pap smear histories. Am J Prev Med. 1992;8:287–91.PubMedGoogle Scholar
  34. 34.
    Sawyer JA, Earp J, Fletcher RH, Daye FF, Wynn TM. Accuracy of women’s self-report of their last Pap smear. Am J Public Health. 1989;79:1036–7.PubMedGoogle Scholar
  35. 35.
    King ES. Rimer BK. Trock B, Balsham A, Engstrom P. How valid are mammography self reports? Am J Public Health. 1990;80:1386–8.PubMedGoogle Scholar
  36. 36.
    Etzi S, Lane DS, Grimson R. The use of mammography vans by low-income women: the accuracy of self-reports. Am J Public Health. 1994;84:107–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1995

Authors and Affiliations

  • Matthew W. Kreuter
    • 1
    Email author
  • Victor J. Strecher
    • 2
  • Russell Harris
    • 3
  • Sarah C. Kobrin
    • 2
  • Celette Sugg Skinner
    • 4
  1. 1.the Department of Community Health, Division of Behavioral Science and Health EducationSchool of Public Health, Saint Louis UniversitySt. Louis
  2. 2.the Health Communications Research Laboratory, Department of Health Behavior and Health EducationSchool of Public HealthUSA
  3. 3.the Department of Medicine, Division of General Medicine and Clinical EpidemiologySchool of Medicine, University of North Carolina at Chapel HillChapel Hill
  4. 4.the Division of Radiology Research, Malinckrodt Institute of RadiologyWashington University Medical School (CSS)St. Louis

Personalised recommendations