Patient gender and psychotropic prescribing during the physician-patient interaction

The primary goal of this study was to examine how patient gender differences in the physician-patient interaction may influence differences in the prescribing of psychotropic medications to male and female patients in ambulatory care settings.;A secondary data analysis of an existing data set of 508 audio-tapes of physician-patient interactions and interviews with each patient and physician from 11 different ambulatory care settings was conducted. The data set used in this project was originally collected between 1985 and 1986 to examine physician-patient communication.;All patient somatic complaints, emotional complaints, and social problems expressed during the physician-patient interaction as well as whether the patient asked for or the physician suggested a psychotropic medication were coded from transcriptions of the audio-tapes. Patient and physician demographic information were obtained from physician and patient interview data. Physician perception of patient emotional health and social problems were obtained from physician interview data.;Multiple linear regression techniques were used to examine: (1) whether female patients expressed more somatic complaints, emotional complaints, and social problems than male patients and (2) whether physicians perceived female patients' emotional health and social problems as more severe than male patients' after controlling for expression of complaints. Female patients were significantly more likely to express somatic complaints than male patients. Physicians were not more likely to perceive female patients as having worse emotional health and social problems than male patients.;Logistic regression techniques were used to examine what influenced physician prescribing of psychotropic medications. Male patients, patients who expressed more emotional complaints, and patients who physicians perceived as being in worse emotional health were significantly more likely to receive a prescription for a psychotropic medication.;Logistic regression techniques were used to examine whether physicians or patients initiated psychotropic prescribing for those 88 patients who received psychotropic prescriptions. Patient income, patient expression of social problems, physician rating of emotional problems, and whether a psychotropic medication was new or continued all significantly influenced whether physicians or patients initiated psychotropic prescribing. Physicians were not more likely to suggest psychotropic medications to female patients and female patients were not more likely to ask for psychotropic medications.