Gender differences in consulting a general practitioner for common symptoms of minor illness
Introduction
Much of the research which has investigated the social patterning of consulting behaviour has focused on predicting or explaining variations in health service use, and in particular on understanding reasons for gender differences in consulting (Williams et al., 1986). These studies, based on community or general practice morbidity surveys, all start with the observation that women have higher consulting rates than men (Clearly et al., 1982; Williams et al., 1986; Kandrack et al., 1991; Gijsber van Wijk et al., 1992; Gijsber van Wijk et al., 1995; Verhaak, 1995; Fylkesnes, 1992; Sayer and Britt, 1996). For example, the third national study of morbidity statistics in British general practice (McCormick et al., 1995) showed that in the 16–44 age group, men had about half the contact rate with general practitioners of women, and in the 45–64 age group they had about three quarters that of women. General Household Survey data confirm this finding; in 1993, almost one fifth (19%) of women had consulted a general practitioner in the 14 days prior to interview, compared to 14% of men (Office of Population Censuses and Surveys, 1995).
A number of explanations have been posited for gender differences in consultation rates (Mechanic, 1978). The most widely accepted explanation is that once symptoms are recognised, women may have a higher propensity to consult because they may be more willing to admit illness and seek help, or they may have greater access to consult a general practitioner for a number of reasons including employment commitments and other role responsibilities (such as caring for children). Other explanations suggest that women may be more likely to perceive symptoms of illness than men (they may be more aware of their bodies), or they may actually have higher rates of symptoms (women and men may be equally likely to perceive symptoms, but women simply have more).
There is conflicting research evidence for and against these explanations. Evidence which supports women's greater propensity to consult comes from analyses of general practice based morbidity surveys which find that gender differences in rates of consulting are greatest for those conditions labelled as “minor” or “intermediate”, whilst rates are similar for those labelled “serious” (Sayer and Britt, 1996; McCormick et al., 1995). Further support for this explanation is provided by studies which found an excess of female consulting persisted when health status has been taken into account (Verhaak, 1995), and which found that “psychological predisposition” to consult was an important predictor of consultation for women but not for men (Briscoe, 1987). However, other studies support the explanation that differences in consulting are due to real differences in experience of symptoms rather than in the propensity to consult. One study found that the female excess of consulting in morbidity data is largely due to consulting for gynaecological or obstetrical problems, or for prevention and diagnostics, whereas consulting for vague, medically undefined, symptoms was not important in explaining variations (Gijsber van Wijk et al., 1992, Gijsber van Wijk et al., 1995). Further studies suggest that once symptoms are experienced and recognised, there are no gender differences in the tendency towards help seeking from general practitioners or other physicians (Hibbard and Pope, 1983, Hibbard and Pope, 1986; Verbrugge, 1985; Williams et al., 1986; Greenley et al., 1987; Verbrugge and Ascione, 1987).
All of the studies cited above use either general practice morbidity data (which provide information only about gender differences in consulting rather than in rates of reporting or experiencing symptoms) (Gijsber van Wijk et al., 1992, Gijsber van Wijk et al., 1995; McCormick et al., 1995; Sayer and Britt, 1996) or they use community survey data, but seek to explain variations in rates of consulting over a period of time without knowing the symptoms or illness which prompted each consultation (Clearly et al., 1982; Hibbard and Pope, 1983, Hibbard and Pope, 1986; Williams et al., 1986; Greenley et al., 1987; Kandrack et al., 1991; Verhaak, 1995; Fylkesnes, 1992; Office of Population Censuses and Surveys, 1995). Few studies have examined consulting rates among men and women known to have comparable morbidity. One study conducted in Detroit in the late 1970's used health diaries to examine experience of, and response to, symptoms of illness (Verbrugge, 1985; Verbrugge and Ascione, 1987). This found that despite higher daily rates of symptoms “there is great commonality in how men and women ... react to common bothersome symptoms” (Verbrugge and Ascione, 1987, p. 561).
In this paper we present data from a study of the social patterning of health and illness in the community; here we focus on gender differences in reported consultation behaviour in response to a checklist of 33 relatively common, “minor” symptoms. The aim of the analysis was to examine whether, in response to reports of the same symptoms of minor illness, women reported a greater propensity to consult a general practitioner than men. Understanding the differences in consulting for symptoms of minor illness is important because this is where gender differences in morbidity seem to be most commonly seen (Macintyre et al., 1996).
Section snippets
Methods
Data are presented from the West of Scotland Twenty-07 study, a longitudinal study of three age cohorts, aged 15, 35, and 55 when first studied in 1987/88. All respondents were resident in the Central Clydeside Conurbation, a socially varied but mainly urban area centred on Glasgow in the West of Scotland. The initial sample sizes were around 1000 per cohort, but data are presented here from the second round of face to face interviews with the two older cohorts, aged 39 and 58 in 1991 (852 aged
Results
The percentages of respondents who reported having experienced each symptom in the last month, and consulting a doctor with the symptom in the last month, are presented by gender in Table 1 (39 cohort) and Table 2 (58 cohort). The tables also present 95% confidence intervals on the odds ratios of reporting or consulting for each symptom of women compared to men.
In the younger cohort (Table 1), women were significantly more likely to report having experienced at least one symptom of minor
Discussion
This paper has explored gender differences in consulting behaviour for symptoms of minor illness in two age cohorts of respondents in early and late middle age in the West of Scotland. Although we observed that women in the younger cohort were significantly more likely to have consulted a general practitioner for any of the symptoms reported in the last month, and for a few individual symptoms in both cohorts, when only those who had reported a symptom in the last month were included, there
Acknowledgements
We would like to thank the study respondents and interviewers. We are very grateful to Rob Elton for statistical advice and help with data analysis. Sally Macintyre, Karen Fairhurst and Jane Hopton gave helpful comments on the paper. The West of Scotland Twenty-07 study is funded by the UK Medical Research Council.
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