title: Gender bias in diagnosing fibromyalgia.
abstract: BACKGROUND
  Both patient- and physician-centered characteristics may influence disease classification c fibromyalgia (FM).
  
  
  OBJECTIVE
  This study assessed the diagnostic criteria for FM and how rheumatologists use these criter in clinical practice.
  
  
  METHODS
  Practicing rheumatologists were surveyed. Participants were asked to read a brief case description of a patient with FM and then to select those criteria most important to them for confirming tt diagnosis. Case studies of either male or female patients were randomly assigned. Data were analyzed using a random forests classification analysis to abstract the strongest variables for distinguishing disease classification--in this assessment, stratified by gender of the case study.
  
  
  RESULTS
  A total of 61 surveys were analyzed. Four rheumatologists (6.6%) chose the 2 (and only the 2 criteria for FM classification (tender points and widespread pain) proposed by the American College of Rheumatology (ACR). The candidate diagnostic criteria discriminating between rheumatologists (when stratified by gender of the case study) consisted of (1) tender points, (2) normal erythrocyte sedimentatio rate, (3) normal thyroid tests, (4) fatigue, and (5) poor quality of sleep. Of these, the criterion of tender points was chosen by rheumatologists statistically more frequently for male patients (P = 0.047).
  
  
  CONCLUSIONS
  This study provides insight into the diagnostic thought processes of rheumatologists. minority of practitioners relied solely on the published ACR classification criteria for the diagnosis of FM. We also report gender bias with regard to disease classification, because rheumatologists were more likely to require a physical finding to support a diagnostic conclusion in male patients.
authors.affiliation: Division of Rheumatology, The George Washington University, Washington, DC 20037, USA. jkatz@mfa.gwu.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Katz
authors.forename: Gulnara
authors.initials: G
authors.lastname: Mamyrova
authors.forename: Olena
authors.initials: O
authors.lastname: Guzhva
authors.forename: Lena
authors.initials: L
authors.lastname: Furmark
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D003937:Diagnosis, Differential; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis*; D006801:Humans; D008297:Male; D011287:Prejudice; D012219:Rheumatology; D012720:Severity of Illness Index