Key result
Stress context reduces CHD diagnoses and cardiology referrals for symptomatic women versus men.
RCT
2x2 factorial (male vs. female and stress vs. no stress)
Two competing hypotheses explaining gender bias in cardiac care were tested. The first posits that women's coronary heart disease (CHD) symptoms are simply misinterpreted or discounted. The second posits that women's CHD symptoms are misinterpreted when presented in the context of stress. In two studies, medical students and residents randomized to 2 (male vs. female) x 2 (stress vs. nostress) experiments read vignettes of patients with CHD symptoms and indicated their diagnosis, treatment, and symptom origin interpretation. Both studies disconfirmed the first hypothesis and strongly supported the second. Only when stress was added did women receive significantly lower CHD diagnoses and cardiologist referrals than men and did the origin interpretation of women's CHD symptoms (e.g., chest pain) shift from organic to psychogenic. Neither participants' gender nor their attitude toward women influenced assessments.
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Chiaramonte et al. (2006) conducted an RCT in Coronary heart disease symptoms. Clinical vignettes with female gender and stress context vs. Clinical vignettes with male gender or no stress context was evaluated on CHD diagnosis, cardiologist referral, and symptom origin interpretation. Presenting female patients with CHD symptoms in a stress context led to significantly lower CHD diagnoses and cardiologist referrals compared to men, shifting interpretations to psychogenic causes.
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