SAUSALITO, CA (ASRN.ORG) – Early on in my residency, a fellow surgeon-in-training revealed that she was switching fields. Her real love was not general surgery, she explained, but urology.

As she recounted the steps leading to her decision to focus on diseases of the urinary tract, I couldn’t help wondering about her future practice. She might see an occasional woman or child; but most of her patients would be men.

I shared these thoughts with her, and she laughed. “Male patients have different expectations than female patients,” she said. “Somehow, I think I’m a better fit as a doctor for men.”

It wasn’t the first time a colleague had made a sweeping generalization about patient care, but what struck me was how boldly she had emphasized differences between men and women. As medical students we were taught to care for all patients equally, and as young practicing doctors, most of us assumed that at least as far as gender was concerned, that meant treating everyone the same.

It turns out that my colleague was onto something.

In a study published this year, researchers analyzed the results of a survey that asked nearly two million patients how they felt about their hospitalization. Known as the Hospital Consumer Assessment of Healthcare Providers and Systems, or Hcahps (pronounced “H-caps”), and administered to patients within six weeks of discharge, the survey consists of 27 questions about topics ranging from communication with nurses and doctors and responsiveness of hospital staff to general cleanliness and noise levels.

When the researchers divided the questionnaire results by the patients’ sex, they discovered that men tended to be more positive over all about their hospital experiences. Women were less satisfied with staff responsiveness, their discussions with nurses, communication about medications and discharge plans and the general conditions of the hospital. Among men and women who were older or felt sicker, these differences were even more pronounced.

“What patients require when they are ill and feeling vulnerable is not the same,” said Marc N. Elliott, the study’s lead author and a senior statistician at the RAND Corporation in Santa Monica, Calif. “What’s becoming clear is that we are not meeting the needs of female patients.”

In some cases the extent to which male and female patients differed in their satisfaction levels was substantial, surprising even the researchers. “There was a fairly consistent gender gap,” Dr. Elliott said. “But some of the differences were on the same magnitude as what you might see among patients from different ethnic groups or widely disparate socioeconomic backgrounds.”

One of the more marked differences was the amount of information about medications or discharge plans that patients needed to feel sufficiently informed. Women generally wanted more information than they received, while men were satisfied with what they were told. There were also considerable disparities between men and women regarding cleanliness, with women inclined to be less satisfied with the hygiene of hospital surroundings.

The findings from this study underscore how complex addressing quality and patient experience can be. Currently, most health care improvement efforts tend to treat patients as a monolithic group. It’s an oversight that can be attributed, at least in part, to the relative paucity of research and data on the patient experience.

That situation may change, as the Hcahps survey becomes linked to reimbursement and more hospitals begin administering the questionnaire to their patients. While some hospital administrators and clinicians are concerned about this prospect, Dr. Elliott and his colleagues believe their study is an indication of what this survey could help to do. By offering patients an opportunity to express their opinions, Hcahps might uncover issues that have gone unnoticed.

“Patients are hesitant to tell us what they are feeling because they don’t want to be seen as confrontational,” Dr. Elliott said. “To make substantial improvements, we need to get at that information.”

He added: “Real quality improvement is not one-size-fits-all.”

 

By Pauline Chen, MD

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