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1. Gender Differences in Medical Evaluations: Evidence from Randomly Assigned Doctors

   https://doi.org/10.1257/aer.20220349  

   Cabral, Marika; Dillender, Marcus (February 2024, American Economic Review)

   Little is known about what drives gender disparities in health care and related social insurance benefits. Using data and variation from the Texas workers’ compensation program, we study the impact of gender match between doctors and patients on medical evaluations and associated disability benefits. Compared to differences among their male patient counterparts, female patients randomly assigned a female doctor rather than a male doctor are 5.2 percent more likely to be evaluated as disabled and receive 8.6 percent more subsequent cash benefits on average. There is no analogous gender-match effect for male patients. Our estimates indicate that increasing the share of female patients evaluated by female doctors may substantially shrink gender gaps in medical evaluations and associated outcomes. (JEL H75, I11, I12, J14, J16, J28) 

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2. Perceived Penalties for Sharing Patient Beliefs with Health Care Providers

   https://doi.org/10.1177/0272989X241262241  

   Marsh, Jessecae_K; Asan, Onur; Kleinberg, Samantha (August 2024, Medical Decision Making)

   BackgroundHealth care interactions may require patients to share with a physician information they believe but is incorrect. While a key piece of physicians’ work is educating their patients, people’s concerns of being seen as uninformed or incompetent by physicians may lead them to think that sharing incorrect health beliefs comes with a penalty. We tested people’s perceptions of patients who share incorrect information and how these perceptions vary by the reasonableness of the belief and its centrality to the patient’s disease. DesignWe recruited 399 United States Prolific.co workers (357 retained after exclusions), 200 Prolific.co workers who reported having diabetes (139 after exclusions), and 244 primary care physicians (207 after exclusions). Participants read vignettes describing patients with type 2 diabetes sharing health beliefs that were central or peripheral to the management of diabetes. Beliefs included true and incorrect statements that were reasonable or unreasonable to believe. Participants rated how a doctor would perceive the patient, the patient’s ability to manage their disease, and the patient’s trust in doctors. ResultsParticipants rated patients who shared more unreasonable beliefs more negatively. There was an extra penalty for incorrect statements central to the patient’s diabetes management (sample 1). These results replicated for participants with type 2 diabetes (sample 2) and physician participants (sample 3). ConclusionsParticipants believed that patients who share incorrect information with their physicians will be penalized for their honesty. Physicians need to be educated on patients’ concerns so they can help patients disclose what may be most important for education. HighlightsUnderstanding how people think they will be perceived in a health care setting can help us understand what they may be wary to share with their physicians. People think that patients who share incorrect beliefs will be viewed negatively. Helping patients share incorrect beliefs can improve care. 

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3. Laypeople’s Use of and Attitudes Toward Large Language Models and Search Engines for Health Queries: Survey Study

   https://doi.org/10.2196/64290  

   Mendel, Tamir; Singh, Nina; Mann, Devin M; Wiesenfeld, Batia; Nov, Oded (January 2025, Journal of Medical Internet Research)

   BackgroundLaypeople have easy access to health information through large language models (LLMs), such as ChatGPT, and search engines, such as Google. Search engines transformed health information access, and LLMs offer a new avenue for answering laypeople’s questions. ObjectiveWe aimed to compare the frequency of use and attitudes toward LLMs and search engines as well as their comparative relevance, usefulness, ease of use, and trustworthiness in responding to health queries. MethodsWe conducted a screening survey to compare the demographics of LLM users and nonusers seeking health information, analyzing results with logistic regression. LLM users from the screening survey were invited to a follow-up survey to report the types of health information they sought. We compared the frequency of use of LLMs and search engines using ANOVA and Tukey post hoc tests. Lastly, paired-sample Wilcoxon tests compared LLMs and search engines on perceived usefulness, ease of use, trustworthiness, feelings, bias, and anthropomorphism. ResultsIn total, 2002 US participants recruited on Prolific participated in the screening survey about the use of LLMs and search engines. Of them, 52% (n=1045) of the participants were female, with a mean age of 39 (SD 13) years. Participants were 9.7% (n=194) Asian, 12.1% (n=242) Black, 73.3% (n=1467) White, 1.1% (n=22) Hispanic, and 3.8% (n=77) were of other races and ethnicities. Further, 1913 (95.6%) used search engines to look up health queries versus 642 (32.6%) for LLMs. Men had higher odds (odds ratio [OR] 1.63, 95% CI 1.34-1.99; P<.001) of using LLMs for health questions than women. Black (OR 1.90, 95% CI 1.42-2.54; P<.001) and Asian (OR 1.66, 95% CI 1.19-2.30; P<.01) individuals had higher odds than White individuals. Those with excellent perceived health (OR 1.46, 95% CI 1.1-1.93; P=.01) were more likely to use LLMs than those with good health. Higher technical proficiency increased the likelihood of LLM use (OR 1.26, 95% CI 1.14-1.39; P<.001). In a follow-up survey of 281 LLM users for health, most participants used search engines first (n=174, 62%) to answer health questions, but the second most common first source consulted was LLMs (n=39, 14%). LLMs were perceived as less useful (P<.01) and less relevant (P=.07), but elicited fewer negative feelings (P<.001), appeared more human (LLM: n=160, vs search: n=32), and were seen as less biased (P<.001). Trust (P=.56) and ease of use (P=.27) showed no differences. ConclusionsSearch engines are the primary source of health information; yet, positive perceptions of LLMs suggest growing use. Future work could explore whether LLM trust and usefulness are enhanced by supplementing answers with external references and limiting persuasive language to curb overreliance. Collaboration with health organizations can help improve the quality of LLMs’ health output. 

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4. Physicians’ electronic inbox work patterns and factors associated with high inbox work duration

   https://doi.org/10.1093/jamia/ocaa229  

   Akbar, Fatema; Mark, Gloria; Warton, E. Margaret; Reed, Mary E; Prausnitz, Stephanie; East, Jeffrey A; Moeller, Mark F; Lieu, Tracy A (October 2020, Journal of the American Medical Informatics Association)

   null (Ed.)

   Abstract Objectives Electronic health record systems are increasingly used to send messages to physicians, but research on physicians’ inbox use patterns is limited. This study’s aims were to (1) quantify the time primary care physicians (PCPs) spend managing inboxes; (2) describe daily patterns of inbox use; (3) investigate which types of messages consume the most time; and (4) identify factors associated with inbox work duration. Materials and Methods We analyzed 1 month of electronic inbox data for 1275 PCPs in a large medical group and linked these data with physicians’ demographic data. Results PCPs spent an average of 52 minutes on inbox management on workdays, including 19 minutes (37%) outside work hours. Temporal patterns of electronic inbox use differed from other EHR functions such as charting. Patient-initiated messages (28%) and results (29%) accounted for the most inbox work time. PCPs with higher inbox work duration were more likely to be female (P < .001), have more patient encounters (P < .001), have older patients (P < .001), spend proportionally more time on patient messages (P < .001), and spend more time per message (P < .001). Compared with PCPs with the lowest duration of time on inbox work, PCPs with the highest duration had more message views per workday (200 vs 109; P < .001) and spent more time on the inbox outside work hours (30 minutes vs 9.7 minutes; P < .001). Conclusions Electronic inbox work by PCPs requires roughly an hour per workday, much of which occurs outside scheduled work hours. Interventions to assist PCPs in handling patient-initiated messages and results may help alleviate inbox workload. 

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5. Hospital-Physician Integration and Cardiac Rehabilitation Following Major Cardiovascular Events

   https://doi.org/10.1001/jamanetworkopen.2024.62580  

   Thai, Ngoc H; Post, Brady; Young, Gary J; Noor-E-Alam, Md (March 2025, JAMA Network Open)

   Cardiac rehabilitation (CR) is a medically supervised program designed to improve heart health after a cardiac event. Despite its demonstrated clinical benefits, CR participation among eligible patients remains poor due to low referral rates and individual barriers to care. To evaluate CR participation by patients who receive care from hospital-integrated physicians compared with independent physicians, and subsequently, to examine CR and recurrent cardiac hospitalizations. This retrospective cohort study evaluated Medicare Part A and Part B claims data from calendar years 2016 to 2019. All analyses were conducted between January 1 and April 30, 2024. Patients were included if they had a qualifying event for CR between 2017 and 2018, and qualifying events were identified using diagnosis codes on inpatient claims and procedure codes on outpatient and carrier claims. Eligible patients also had to continuously enroll in fee-for-service Medicare for 12 months or more before and after the index event. Physicians’ integration status and patients’ CR participation were determined during the 12-month follow-up period. The study covariates were ascertained during the 12 months before the index event. ExposureHospital-integration status of the treating physician during follow-up. Main Outcomes and MeasuresPostindex CR participation was determined by qualifying procedure codes on outpatient and carrier claims. ResultsThe study consisted of 28 596 Medicare patients eligible for CR. Their mean (SD) age was 74.0 (9.6) years; 16 839 (58.9%) were male. A total of 9037 patients (31.6%) were treated by a hospital-integrated physician, of which 2995 (33.1%) received CR during follow-up. Logistic regression via propensity score weighting showed that having a hospital-integrated physician was associated with an 11% increase in the odds of receiving CR (odds ratio [OR], 1.11; 95% CI, 1.05-1.18). Additionally, CR participation was associated with a 14% decrease in the odds of recurrent cardiovascular-related hospitalizations (OR, 0.86; 95% CI, 0.81-0.91). The findings of this cohort study suggest that hospital integration has the potential to facilitate greater CR participation and improve heart care. Several factors may help explain this positive association, including enhanced care coordination and value-based payment policies. Further research is needed to assess the association of integration with other appropriate high-quality care activities. 

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