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Women report more numerous, more severe and more frequent somatic symptoms than men. Women’s symptoms more often remain medically unexplained, and they are less satisfied with the provided care. It is unknown what drives these perceptions and differences. Sex-associated biological differences might cause a men-women gap in the physical generation of somatic symptoms. Gender-associated socio-cultural factors are considered determinants of risk, outcomes and healthcare seeking for these symptoms. These differences do not only exert their effects on the level of the patient, but also on the level of health care professionals. Doctors perform fewer diagnostic interventions and are more likely to search for psychological origins of somatic symptoms in women.

 

Current studies thus suggest gender inequalities in medical trajectories, but are typically focussed on quantitative differences between men and women, thereby ignoring intersex conditions and gender-associated factors. This overly simple conceptualization also implies that in-depth analyses of the mechanisms contributing to sex and gender inequalities are lacking.

 

The aim of the current study is to investigate sex and gender inequalities in medical trajectories associated with common somatic symptoms, and their determinants at the level of the patient and the doctor. Medical trajectories are initiated by patients’ decisions to seek help, followed by doctor-patient interactions during consultations, resulting in doctors' decisions about diagnostic procedures, referrals and treatment strategies. The current study encompasses all aspects of such medical trajectories, from the macro level of healthcare seeking behaviour in the population to the micro level of communication in the consultation room. Since the medical decisions shaping the trajectory associated with common somatic symptoms are particularly made during consultations in general practice, these form the core of the current proposal.

 

The project will consist of four complementary subprojects focusing on different stages in medical trajectories associated with common somatic symptoms. Subproject 1 is focused on the level of the patient, and studies sex and gender differences in the prevalence of and healthcare seeking for common somatic symptoms. This subproject is based on existing data from the general population cohort LifeLines, in which biological sex is defined by genetic data, and psychosocial gender by a gender score that will be calculated using a large set of available gender-associated variables. Subproject 2 is centred around doctor-patient interactions, and will analyse sex and gender differences in communication patterns and language use in existing videotaped consultations between GPs and patients. This subproject also includes a controlled experimental study in which the effects of communication patterns on men and women will be studied. Subproject 3 focuses on the level of the doctor, and analyses objective indications for sex and gender inequalities in diagnostic procedures, referrals and treatment strategies for patients presenting common somatic symptoms. This subproject is based on existing data extracted from electronic patient records, collected in the context of routine clinical practice by general practitioners. Subproject 4 provides in depth insight into the patient perspective by supplementing these data with interviews in which patients with various sex and gender identities are asked to reflect on all stages in their medical trajectories in relation to their expectations and needs.

 

This unique multidisciplinary project combines epidemiological studies with observational analysis of clinical practice, qualitative research towards the patient perspective and a controlled experimental design in which the effects of communication patterns will be studied. The innovative project combines the extensive experiences of multiple experts from different fields (common somatic symptoms, gender, communication, patient experience) and types of organizations (university, general practice). A graphical summary is provided in the figure in the appendix.

 

Impact is ascertained by the involvement of patients, health care professionals, and university teachers in the project. Concrete tools developed for knowledge transfer include the enrichment of existing databases with sophisticated sex and gender-variables, development of an evidence-based online educational module for health care professionals, development of a gender-sensitive consultation intervention for primary care, patient-empowerment guidelines and online patient stories.

 

The project will develop and transfer new knowledge on sex and gender-relevant issues in medical trajectories that is both generalizable and in-depth, and incorporate the patient perspective. The added value of the project goes beyond common somatic symptoms: gender inequalities in diagnostic and treatment decisions are also relevant for recognized medical diseases.

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