Gender differences in time spent during direct observation of doctor-patient encounters.
BACKGROUND
Despite increasing recognition of women's health needs, little is known about how primary care physicians spend time with women. Therefore, we examined differences in time use and preventive service delivery during outpatient visits by male and female patients.


METHODS
As part of a multimethod study of 138 family physicians, 3384 outpatient visits by adults were directly observed, medical records were reviewed, and patient surveys were performed. Time use was assessed by the Davis Observation Code, which classifies every 15 seconds into 20 behavioral categories. Receipt of health habit counseling recommended by the U.S. Preventive Services Task Force was assessed by direct observation, and eligibility was determined by chart review. Logistic regression and multivariate analysis of variance (ANOVA) were used to compare time use and preventive service delivery in visits by women vs. men.


RESULTS
Sixty-four percent of adult visits were from women. Women reported poorer physical health, had higher rates of anxiety (12.5% vs. 7.4% in men), and depression (21.9% vs. 8.4% in men), a higher percent of visits for well care (10.2% vs. 8.8% in men), and more drugs prescribed (64.8% vs. 61% in men) and raised more emotional issues than men (14.7% vs. 7.5%). After controlling for visit and patients characteristics, visits by women had a higher percent of time spent on physical examination, structuring the intervention, patient questions, screening, and emotional counseling. Visits by men involved a higher percent of time spent on procedures and health behavior counseling. More eligible men than women received exercise, diet, and substance abuse counseling. Patients of female physicians exhibited gender differences in only one category of how time was spent (substance abuse), whereas among patients of male physicians, gender differences were noted in 10 of the 20 categories.


CONCLUSIONS
Outpatient visits by women differ from those of men in ways that reflect women's unique healthcare needs but also raise concern about unequal delivery of health habit counseling for diet and exercise.
Tabenkin
Hava
H
Department of Family Medicine, H'a Emek Medical Center, Afula, Israel.
Goodwin
Meredith A
MA
Zyzanski
Stephen J
SJ
Stange
Kurt C
KC
Medalie
Jack H
JH
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003376:Counseling / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D009820:Ohio; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010822:Physicians, Women / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors