Responding to patient requests for women obstetrician-gynecologists

Patients may request care from a woman obstetrician-gynecologist for various reasons, including privacy concerns, religious or cultural reasons, and in some cases, a history of abuse. They should be given the opportunity to voice their reasons for requesting a woman obstetrician-gynecologist but should not be compelled to do so. Respect for patient autonomy is a compelling reason to consider honoring a patient’s gender-based request. When a patient requests a woman obstetrician-gynecologist, efforts should be made to accommodate the request if possible. However, medical professionals and institutions are not ethically obligated to have a woman obstetrician-gynecologist on call or to make one available at all times. If it is not feasible for a woman obstetrician-gynecologist to provide care because of staffing or other system constraints or patient safety concerns, accommodation is not required, and physicians do not have an overriding responsibility to ensure that patients receive gender-concordant care. Patients have the right to decline care and may choose to seek care elsewhere if their requested healthcare provider type is not available. Institutions and medical clinics should have policies and procedures in place for managing patient requests for women obstetrician-gynecologists, and patients should be made aware of these policies preemptively. These policies and procedures should include information about whom to contact for assistance and how to document the encounter. They should also be accessible and familiar to physicians and trainees. Care should be taken to ensure that adequate educational opportunities in obstetrics and gynecology are available for all medical trainees, regardless of gender.

Introduction

Patients may request care from women obstetrician-gynecologists for various reasons, including privacy concerns, religious or cultural reasons, and in some cases, a history of abuse.¹ Whatever the underlying reason is, these types of requests raise ethical, professional, and educational issues related to gender discrimination and conflicting duties to patients, physician colleagues, and trainees in obstetrics and gynecology. There is a lack of professional guidance regarding physicians’ rights and responsibilities when faced with such gender-based requests for, or refusals of, care. Given the frequency of patient requests for women obstetrician-gynecologists, we review the key ethical considerations regarding the patients’ preferences for women obstetrician-gynecologists, with particular emphasis on their right to protect their bodily integrity, which is a critical aspect of patient autonomy. We explore the patient, physician, and educational considerations that may conflict when responding to gender-based requests. On the basis of the primacy of the responsibility to promote patients’ well-being, we then suggest a process for handling such requests in a manner that maintains respect for patient autonomy, ensures patient safety and optimal medical care, considers staffing constraints, and supports physician colleagues and trainees.

Although we focus exclusively on gender-based preferences for provider type, patients sometimes request or refuse care from physicians on the basis of other personal characteristics such as race, religion, or sexual orientation.² Responding to these types of refusals or requests involves additional ethical considerations regarding discrimination that are described elsewhere.3, 4, 5, 6, 7, 8, 9 Importantly, we use the term "woman obstetrician-gynecologist" rather than "female obstetrician-gynecologist" in recognition that gender is likely to motivate patients’ requests, rather than biologic sex.