THE EFFECT OF GENDER AND EDUCATION ON OBSTETRIC PRACTITIONERS' ATTITUDES TOWARD PSYCHOSOCIAL ASPECTS OF PATIENT CARE AND PATIENT SELF-DETERMINATION.

Description

Women currently fill 47% of obstetrics/gynecology residency positions, up from 3% in 1972. This study explored the attitudes and clinical practices of women obstetricians toward psychosocial aspects of care and patient self-determination. To investigate the effects of gender and education, the attitudes of female obstetricians were compared to those of male obstetricians and female nurse-midwives. Data were obtained from 285 subjects (77 female and 71 male obstetricians, and 137 midwives) returning a questionnaire mailed to a random sample of 200 of each group certified since 1980. Attitudes were measured by the Maheux Attitude and Practice Scales, the Levinson House Staff Attitude Scale, and an investigator-designed instrument, the Obstetric Autonomy Support Scale (OASS). Group differences were determined by analysis of variance and Scheffe pairwise group comparisons. The female and male obstetricians differed on only one measure: the women held more positive attitudes toward social components of health care (P $<$.05). The female obstetricians held less positive attitudes than the midwives toward social components (P $<$.05), and multidisciplinarity (P $<$.05), and were more likely to involve patients in care than the midwives (P $<$.05). On the OASS, the midwives were more autonomy-supporting, less manipulating, and less controlling than physicians of either gender (ANOVA P $<$.0001, Scheffe P $<$.05). The midwives differed significantly from the male obstetricians on eight of 11 measures, with the midwives being more psychosocially oriented. The discrepancy between the midwives' support of patient autonomy and their decreased likelihood of involving patients in care was further analyzed. The difference may have been attributable to the larger percentage of midwife subjects (49%) working in the public sector, than physicians of either gender (male = 9%, female = 8.4%). A t-test was utilized to compare midwife scores on this subscale. The private sector midwives were more likely to report involving patients in care than those in the public sector (t = 2.99, 112.2 df, p $<$.01). Educational preparation appears to exert a stronger effect on psychosocial attitudes than gender of the provider. Despite a positive orientation toward patient autonomy, practice in the public sector may deter the provider from involving the obstetric patient in decision-making.

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