title: STD care: variations in clinical care associated with provider sex, patient sex, patients' self-reported symptoms or high-risk behaviors, partner STD history.
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.
authors.affiliation: Behavioral Interventions and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-E44, Atlanta, GA 30333, USA. nzs4@cdc.gov
authors.forename: Janet S
authors.initials: JS
authors.lastname: St  Lawrence
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Kuo
authors.forename: Matthew
authors.initials: M
authors.lastname: Hogben
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Montaño
authors.forename: Danuta
authors.initials: D
authors.lastname: Kasprzyk
authors.forename: William R
authors.initials: WR
authors.lastname: Phillips
mesh_terms: D003657:Decision Making; D005260:Female; D015438:Health Behavior; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012008:Recurrence; D012309:Risk-Taking; D012737:Sex Factors; D012749:Sexually Transmitted Diseases / Q000628:therapy*