Provider gender and moral reasoning: The politics of an “ethics of care”

Women constitute 35% of providers in genetics at the doctoral level. A survey of 682 geneticists in 19 nations showed that gender was the single most important determinant of ethical decision making. Women were less directive and more observant of patient autonomy than men. In the United States, women were twice as likely as men to accede to patient requests for prenatal diagnosis for sex selection. Women now constitute 30% of all medical students, about half of all obstetrical residents, and 94% of master's-level genetic counselors. Evidence that women providers respond differently to some ethical problems suggests that in the future, as more women enter the field, provider-patient relationships may become more egalitarian.     

A Genetic Counselor’s Journey from Provider to Patient: A Mother’s Story

As genetic counselors, we frequently offer support and information while shielding ourselves emotionally from the heartbreaking situations faced by our patients. To experience such circumstances firsthand changes our perspective on the world, ourselves, our relationships, and, inevitably, our role as genetic counselors. No one asks to be in the position of having to make a decision about one’s pregnancy, but such experiences may help us, as a profession, reflect on and improve our counseling. It is my hope that this personal account will provide other counselors with a real-life example they may draw upon when supporting patients in crisis. Here is my story.     

Predictors of Satisfaction with Obstetric Care in High-risk Pregnancy: The Importance of Patient–Provider Relationship

The study set out to examine the predictive effects of patients’ emotional distress and their relationships with their health care providers on satisfaction with obstetric services in high-risk pregnancies. Participants were 104 pregnant women with a history of recurrent losses, fetal demise, previous or current fetal genetic abnormality, advanced maternal age, or obstetric or medical complications of the present pregnancy. Self-report measures of emotional distress and the quality of their relationships with their medical provider were administered. Hierarchical multiple regression analyses were conducted to assess the predictive effect of these variables on satisfaction with services. Provision of information, constructive communication, and good relationships predicted elevated satisfaction with health services. Provision of information also buffered against the adverse effect of emotional distress on satisfaction with health services. These findings elucidate the central role of provider–patient interaction, particularly as it is related to provision of information, in high-risk pregnancy.     

Should My Provider Pray with Me? Perspectives of Urban Adolescents with Asthma on Addressing Religious and Spiritual Issues in Hypothetical Clinical Settings

This qualitative study examined the preferences of urban adolescents with asthma for including religious/spiritual (R/S) inquiry in a variety of hypothetical clinical encounters. Twenty-one urban adolescents (M _age = 15.6 years, 52 % female, 81 % African American) with asthma participated in a semi-structured interview. Interviews were transcribed and underwent a thematic analysis. R/S preferences were contextual rather than personal, driven by: (1) acuity of the hypothetical clinical context; (2) nature of the patient–provider relationship; and (3) level of R/S intervention/inquiry. Most adolescents welcomed prayer if near death, but did not see the relevance of R/S in a routine office visit.     

Patient–Provider Communication About Sexual Health: The Relationship with Gender, Age, Gender-Stereotypical Beliefs, and Perceptions of Communication Inappropriateness

This investigation examined patient–provider communication about sexual health related to gender and age. Data were collected from 277 individuals, aged 18–60, via convenience and snowball sampling at a large university in southwestern United States. Results indicate women are more proactive about their sexual health than men and tested for STDs more frequently. Women, more than men, initiate discussions with their healthcare provider about sexual health matters and healthcare providers are more likely to initiate communication about such matters with women than men. Men hold stronger gender-stereotypical beliefs than women, are less likely to initiate conversations about sexual issues with their provider, and believe sexual discussions with their partner are inappropriate. Age relates to sexual activity initiation and perceived STD risk.