Avoiding gender bias in consultations

Ms Sinead Lay, Case Manager at Medical Protection, discusses gender-neutral healthcare and how to avoid unintentional upset

Both the medical profession and the patient community are increasingly diverse. Whilst gender should not be a barrier to providing high-quality care, it’s essential for healthcare providers to be aware of the unique considerations when treating patients of a different gender, and patients who may be transitioning gender.

One crucial aspect of delivering equitable care is avoiding gender bias which can manifest in subtle and unintentional ways and this can lead to unintended upset and complaints of poor clinical care. In this article, we will explore some helpful tips to avoid gender bias and ensure respectful and effective interactions.

Gender bias in healthcare occurs when preconceived notions, stereotypes, or societal expectations influence the care provided to individuals based on their gender. This bias can lead to disparities in diagnosis, treatment, and patient experience. To ensure gender-neutral healthcare, doctors must be aware of their potential biases and actively work to overcome them.

When treating a patient of a different gender, who might naturally feel less comfortable than if they were attending a doctor of the same gender, it is imperative to establish a foundation of trust and respect from the very beginning of the doctor-patient relationship and doctors should strive to establish a welcoming and non-judgmental atmosphere where patients feel comfortable discussing sensitive topics. To achieve this, it is helpful if the doctor starts the conversation by introducing themselves and addressing the patient by their preferred title and last name, unless they specify otherwise.

It is important to actively listen to patients’ concerns and questions without interrupting, as this demonstrates respect for their perspective. Utilising open-ended questions allows patients to express their concerns and reassures them that their privacy is a top priority for their doctor and fosters a sense of trust. Furthermore, asking open-ended questions when addressing sensitive matters also helps to avoid gender bias; for example, if asking about a patient’s sexual health, it may be helpful to use gender-neutral terms and inclusive language. This may ensure that all patients feel valued and respected, while avoiding assumptions about a patient’s sexual orientation or gender identity.

In the 9th edition of the Medical Council’s guide, it emphasises the responsibility of doctors to maintain their competence.

2.1 You must practise and promote a positive culture of patient safety. This includes:

• Providing a good standard of practice and care, maintaining your professional competence, keeping your knowledge and skills up-to-date, reflecting on your practice and working within your sphere of competence.

The above guidance also applies to procedural skills and examinations. For example, an internal medicine doctor or a general surgeon may not regularly perform gender-specific examinations such as breast examinations or prostate examinations if their primary practice focuses on other areas. Despite this, these doctors should maintain competence in these types of examinations to ensure comprehensive and safe patient care.

In relation to informed consent for treatment, the Medical Council also advises that patients must “be sufficiently informed about the treatment options and the nature, risks and benefits of such treatment options”. Doctors must possess the relevant background knowledge to be able to counsel patients and address any questions or concerns they may have.

Other important considerations when treating patients are being mindful of physical contact and taking the time to explain any necessary physical or intimate examinations before proceeding. Furthermore, it is essential to offer the patient a chaperone, such as a nurse or another staff member, during intimate exams. This practice ensures patient comfort but also safeguards the interests of both parties involved and can help to protect a doctor against false allegations of improper conduct during intimate examinations.

At Medical Protection, we occasionally receive requests to assist doctors with local or regulatory complaints where there are allegations of poor professional conduct in relation to physical and intimate examinations. The case study below, brought before the Medical Council, relates to a formal complaint lodged by a female patient against a male doctor. The complaint alleged that the doctor had been “too close” during a medical consultation, raising concerns about his conduct. However, as the investigation unfolded, it became evident that this case was marked by a significant misunderstanding, with the doctor ultimately found innocent of any wrongdoing.

It is important to actively listen to patients’ concerns and questions without interrupting, as this demonstrates respect for their perspective

Case study

Ms Y, a 28-year-old woman, had visited Dr X, a respected general practitioner, for a follow-up appointment regarding a recent minor surgery. Ms Y was not offered a chaperone. During the consultation, Ms Y felt uncomfortable and believed that Dr X was invading her personal space:

•                Perceived invasiveness: Ms Y claimed that Dr X stood too close to her during the consultation, making her feel uneasy and encroached upon. She believed he was invading her personal space.

•                Inadequate explanation: She felt that Dr X did not adequately explain the purpose of his physical proximity, which exacerbated her discomfort.

•                Failure to address concerns: When Ms Y expressed her discomfort and requested more space, she felt that Dr X did not take her concerns seriously and continued with the examination.

Following the consultation, Ms Y decided to file a formal complaint with the Medical Council and provided a detailed account of her experience, including the date and location of the incident. The Medical Council initiated an investigation into Ms Y’s complaint. An investigator was appointed to collect evidence, including Ms Y’s testimony, any relevant medical records, and statements from potential witnesses. Dr X was informed of the complaint and given an opportunity to respond to the allegations. He provided a detailed account of the consultation, tried to rectify any misunderstandings, and apologised for any upset caused to Ms Y. Dr X’s conduct during the examination was assessed against the Council’s code of conduct and ethics to determine whether any ethical violations had occurred.

Thankfully for Dr X, as the investigation progressed, it became clear his actions were not motivated by any inappropriate behaviour but rather by his commitment to carry out a thorough assessment. He had not intended to invade her personal space. The Medical Council was satisfied that Dr X’s professional practice had met the appropriate standard and concluded the investigation with no further action.

Dr X was very grateful for the help provided by Medical Protection in responding to the complaint and providing medicolegal advice and support. He reflected on this situation and became more aware of the importance of clear communication with patients, his proximity to patients during assessments and the importance of offering a chaperone during intimate examinations.

Conclusion

To provide the best possible care for patients, it is essential that doctors adopt an inclusive approach, remain updated on the latest research and guidelines, continuously self-reflect, and maintain their competence in gender-specific health problems. From a medicolegal perspective, it is also important to be mindful of body language and physical proximity to patients during assessments, and to remember to offer a chaperone to a patient if performing an intimate examination.