Journal of General Internal Medicine

, Volume 16, Issue 4, pp 211–217 | Cite as

Do gender and race affect decisions about pain management?

  • Carol S. WeisseEmail author
  • Paul C. Sorum
  • Kafi N. Sanders
  • Beth L. Syat
Original Articles


OBJECTIVE: To determine if patient gender and race affect decisions about pain management.

DESIGN, SETTING, AND PARTICIPANTS: Experimental design using medical vignettes to evaluate treatment decisions. A convenience sample of 111 primary care physicians (61 men, 50 women) in the Northeast was asked to treat 3 hypothetical patients with pain (kidney stone, back pain) or a control condition (sinusitis). Symptom presentation and severity were held constant, but patient gender and race were varied.

MEASUREMENTS AND MAIN RESULTS: The maximum permitted doses of narcotic analgesics (hydrocodone) prescribed at initial and return visits were calculated by multiplying mg per pill × number of pills per day × number of days × number of refills. No overall differences with respect to patient gender or race were found in decisions to treat or in the maximum permitted doses. However, for renal colic, male physicians prescribed higher doses of hydrocodone to white versus black patients (426 mg vs 238 mg), while female physicians prescribed higher doses to blacks (335 mg vs 161 mg; F1,85=9.65, P=.003). This pattern was repeated for persistent kidney stone pain. For persistent back pain, male physicians prescribed higher doses of hydrocodone to males versus females (406 mg vs 201 mg), but female physicians prescribed higher doses to females (327 mg vs 163 mg; F1,28=5.50, P=.03).

CONCLUSION: When treating pain, gender and racial differences were evident only when the role of physician gender was examined, suggesting that male and female physicians may react differently to gender and/or racial cues.

Key Words

gender race pain treatment 


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  1. 1.
    Calderone JL. The influence of gender on the frequency of pain and sedative medication administered to postoperative patients. Sex Roles. 1990;23:713–25.CrossRefGoogle Scholar
  2. 2.
    Cleeland CS, Gronin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330:592–6.PubMedCrossRefGoogle Scholar
  3. 3.
    McDonald DD. Gender and ethnic stereotyping and analgesic administration. Res Nurs Health. 1994;17:5–49.CrossRefGoogle Scholar
  4. 4.
    Knox H, Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;296:1537–9.Google Scholar
  5. 5.
    Ng B, Dimsdale JE, Rollnik JD, Shapiro H. The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain. Pain. 1996;66:9–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Ng B, Dimsdale JE, Shragg GP, Deutsch R. Ethnic differences in analgesic consumption for postoperative pain. Psychosom Med. 1996;58:125–9.PubMedGoogle Scholar
  7. 7.
    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
  8. 8.
    Poses RM, Smith WR, Schmitt BP, Alexander-Forti D, Cebul RD, Wigton RS. Do women and men receive different care for sore throats? Motiv Res. 1995;19:193–203.CrossRefGoogle Scholar
  9. 9.
    Burns RB, McCarthy EP, Freund KM, et al. Black women receive less mammography even with similar use of primary care. Ann Intern Med. 1996;125:173–82.PubMedGoogle Scholar
  10. 10.
    Sleath B, Svarstad B, Roter D. Patient race and psychotropic prescribing during medical encounters. Patient Educ Couns. 1998;34:227–38.PubMedCrossRefGoogle Scholar
  11. 11.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.PubMedCrossRefGoogle Scholar
  12. 12.
    Elderkin-Thompson V, Waitzkin H. Differences in clinical communication by gender. J Gen Intern Med. 1999;14:112–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74:1464–80.PubMedCrossRefGoogle Scholar
  14. 14.
    McDonald DD, Bridge GR. Gender stereotyping and nursing care. Res Nurs Health. 1991;14:373–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Schwartz LM, Woloshin S, Welch HG. Misunderstandings about the effects of race and sex on physicians’ referrals for cardiac catheterization. N Engl J Med. 1999;341:279–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Kalichman SC, Kelly JA, Hunter TL, Murphy DA, Tyler R. Culturally tailored HIV-AIDS risk-reduction messages targeted to African-American urban women: impact on risk sensitization and risk reduction. J Consulting Clin Psychol. 1993;61:291–5.CrossRefGoogle Scholar

Copyright information

© Blackwell Science Inc 2001

Authors and Affiliations

  • Carol S. Weisse
    • 4
    Email author
  • Paul C. Sorum
    • 1
  • Kafi N. Sanders
    • 2
  • Beth L. Syat
    • 3
  1. 1.Departments of Medicine and PediatricsAlbany Medical CenterAlbany
  2. 2.Department of Public HealthYale UniversityNew Haven
  3. 3.Center for Educational OutcomesDartmouth CollegeDurham
  4. 4.Department of PsychologyUnion CollegeSchenectady

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