J Am Board Fam Med
-
Recently it was shown that the relative lack of diagnostic interventions conducted in women mediated the negative association between female sex and diagnosed disease. However, it remains unknown whether women and men receive disease diagnoses in an equal frequency after diagnostic interventions have been performed in general practice. ⋯ We used generalized linear mixed-effect models to assess the association between diagnostic interventions and disease diagnoses when patients presented with common somatic symptoms and studied whether the association differed between female and male patients. RESULTS: In 34,268 episodes of care (61.4% female) physical examinations and specialist referrals were associated with more disease diagnoses (OR = 2.32; 95% CI = 2.17-2.49 and OR = 1.38; 95% CI = 1.27-1.49, respectively), whereas laboratory diagnostics were associated with fewer disease diagnoses (OR = 0.50; 95% CI = 0.47-0.54). Significant interaction terms showed that women presenting with back pain, tiredness, arm and/or leg symptoms and tingling extremities were provided with fewer disease diagnoses after diagnostic interventions were performed than men. We found no significant interaction term that indicated that men were provided with fewer disease diagnoses after a diagnostic intervention than women. CONCLUSION: Especially when patients present with the mentioned symptoms, general practitioners should be aware that diagnostic interventions yield fewer disease diagnoses in female patients than in men. Yet, performing fewer diagnostic interventions in women with these symptoms will further exacerbate sex differences in disease diagnoses.
-
Income inequality has been associated with multiple adverse health outcomes including diabetes and obesity, with this relationship potentially mediated by limited access to primary care. We explore the association between county-level economic inequality and the primary care physician (PCP) workforce in North Carolina. ⋯ Local increases in economic inequality are associated with local decreases in PCP workforce (per capita), particularly in family medicine. Although further research is needed to identify specific reasons for the decrease, medical schools in areas with high economic inequality should consider prioritizing training of physicians in family medicine and other primary care specialties to better serve community health care needs.
-
Differential item functioning (DIF) procedures flag examination questions in which examinees from different subpopulations who are of equal ability do not have the same probability of answering it correctly. Few medical certification boards employ DIF procedures because they do not collect the needed data on the examinee's race or ethnicity. This article summarizes the American Board of Family Medicine's (ABFM) combined use of DIF procedures and an expert panel to review certification questions for bias. ⋯ Using DIF procedures and panel review can improve the quality of the board certification questions and demonstrate the organization's commitment to avoid racial or ethnic bias.
-
The proportion of family physicians reporting provision of patient care in Spanish changed little between 2013 to 2020 but rose substantially for care delivered in other non-English languages. Physician-patient language concordance is associated with better clinical outcomes and higher patient satisfaction, serves as a proxy indicator for workforce diversity, and should be monitored and encouraged as the US population continues to diversify.
-
One major issue facing the health care system in the United States is the disparity in health care management of diseases that affect minority patient populations. Pseudofolliculitis barbae (PFB) is very common in Black men. It presents as skin-colored to erythematous, follicular or perifollicular papules and pustules predominantly on the neck and chin. ⋯ For those who are able to obtain medical waivers, there is significant time and costs associated with this, especially if they must wait to receive this waiver from a dermatologist. If primary care providers are able to identify the disease and spread awareness of its legitimacy, it may be easier for patients to receive the necessary waivers and may encourage employers to reflect on the ethnic equity of this practice. Our professional support can help reduce stigma and lead to improvements in the physical and psychological health of this historically mistreated population.