Gender bias in clinical decision making emerges when patients with coronary heart disease symptoms also have psychological symptoms

Background: Delayed treatment may contribute to women's relatively higher morbidity and mortality from coronary heart disease (CHD). We tested whether disparities in treatment may be due to bias in diagnosis and treatment recommendations for women with psychological symptoms. Methods: Fourth year medical students (N = 225) from 13 U.S. medical schools were randomly assigned to make clinical decisions (CHD risk judgments, diagnosis, treatment recommendations) about one of four experimental vignette patients (male or female; with symptoms of depression and anxiety or without). Vignettes were presented as text via an online survey platform. Results: The female patient with psychological symptoms was perceived to be at lowest risk for CHD. Perceptions of risk partly mediated lower likelihood of recommending the female patient with psychological symptoms be seen in an emergency department, take medication, or receive nutrition or exercise advice relative to the male patient with psychological symptoms. Conclusions: There was a gender bias in CHD clinical decision-making when patients had concurrent psychological symptoms.