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Gender Bias in the Diagnosis of a Geriatric Standardized Patient: A Potential Confounding Variable

Received May 17, 2005; revised January 10, 2006; accepted February 1, 2006. Dr. Lewis is Geriatrics Fellow, University of California, Los Angeles Neuropsychiatric Institute and Hospital, Los Angeles, California. Dr. Lamdan is affiliated with the Department of Psychiatry and Behavioral Science, Temple University, School of Medicine, Philadelphia, Pennsylvania. Dr. Wald is affiliated with the Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. Mr. Curtis is Director, Standardized Patient Program, Temple University School of Medicine, Philadelphia, Pennsylvania. Address correspondence to Dr. Lamdan, TUH-Episcopal Campus, 100 E. Lehigh Avenue, Philadelphia, PA 19125; rlamdan{at}temple.edu (E-mail). Copyright © 2006 Academic Psychiatry.

Background: Gender bias has been reported in the diagnosis and treatment of patients with a variety of illnesses. In the context of our 10-station fourth year Objective Structured Clinical Evaluation, we queried whether this could influence diagnosis in a geriatric case. Case writers hypothesized that, due to this bias, the female standardized patient may be diagnosed with depression more often than the male. METHOD: A male or female geriatric standardized patient protrayed a dysphoric widow with mild cognitive impairment. Students examined the patient and documented the clinical encounter and their differential diagnosis. RESULTS: Major depression was diagnosed in 93/107 female standardized patient encounters compared with 58/78 male exams, with the female students contributing most to this difference. DISCUSSION: The potential for gender bias in medical care and in education remains a concern. We need to be mindful of this when designing clinical skills assessments.

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