2. Joffe MD, Loiselle J. Orthopedic emergencies, in Fleisher GR, Ludwig S, Henretig FM, et al (eds): Textbook of Pediatric Emergency Medicine. Philadelphia, PA, 2000, p 1601 3. Schutzman SA: Immobile arm, in Fleisher GR, Ludwig S, Hen- retig FM, et al (eds): Textbook of Pediatric Emergency Medicine. Philadelphia, PA, 2000, pp 317-320 4. Frumkin K: Nursemaid’s elbow: A radiographic demonstration. Ann Emerg Med 1985;14:690-693 PATIENT PREFERENCE FOR EMERGENCY PHYSICIAN AGE AND GENDER To the Editor:—Generally, the physician-patient relationship in the emergency department (ED) is a new one that requires time for the patient to feel confident about his or her provider. Patients’ attitudes and expectations influence the establishment of a produc- tive physician-patient interaction. 1 In the Emergency Medicine literature, the impact of emergency physicians’ dress and appear- ance on patient perceptions of the quality of care has been evalu- ated. 2 This study sought to determine if patients have a preference for a specific age or gender of their treating emergency physician. A prospective, convenience sampling of 204 ED patients was performed at an urban academic medical center which included a university, community and VA hospital with ED visits totaling 120,000 patients per year. Institutional Review Board (IRB) ap- proval was obtained at all institutions. Adult patients, age greater than 18 years, were voluntarily and anonymously surveyed after receiving medical care from faculty and resident physicians. A short list of questions followed asking patients to identify the gender and estimate the age of their treating physician. Patients were also asked to note if they held preferences for these variables and, if so, to identify them. Participant age and gender were gathered in each survey. Descriptive statistics are reported as proportions and 95% confidence intervals (CI). Survey forms were completed by 204 ED patients. Twenty percent (41/204) of surveys were collected from the university hospital, 30% (61/204) from the community hospital, and 50% (102/204) from the VA hospital. The male:female ratios of partic- ipants were 70:30 total population, with 23:17 at the university hospital, 22:39 at the community hospital and 97:5 at the VA hospital. Of the participants, 13% (26/204) were 30, 25% (50/ 204) were 30 to 40, 25% (51/204) were 41 to 50, and 37% (76/204) were 50 years of age. Eighty-one patients were found to have an age or gender pref- erence (40%, 95% CI 33%-47%). Only 20 patients held prefer- ences for both physician age and gender (10%, 95% CI 6%-15%). Forty-nine patients had an age preference (24%, 95% CI 18%- 31%) and, of these, the distribution was heterogeneous amongst the age groups. The age group 30 to 40 years was most popular (47%, 95% CI 32%-62%) and the age group including 41 to 50 years (32 %, 95% CI 20%-47%) was the next favored. By contrast, only 9% (95% CI 4%-18%) preferred ages greater than fifty and thirteen percent preferred ages less than 30 (95% CI 5%-26%). Thirty-two patients were found to have a gender preference (15.7%, 95% CI 11%-22%). Eighteen percent of women and 14.7% of men reported a gender preference. Interestingly, of those, women preferred male and female doctors equally whereas men preferred male physicians by a ratio of 4.26 to 1 (95% CI 1.6%- 10%). These data suggest that a large group of patients revealed preferences for age, gender or both. One-quarter of patients held a preference for physician age. Of those, 79% favored a physician between 30 and 50 years of age with a bias toward the 30 to 40 year age group. These findings compare with that seen in the family practice literature, where patients’ desire a balance between an experienced yet, up to date doctor. 3,4 There is a small but notable gender preference among survey participants. More female patients were noted to hold preferences for the sex of their treating physician without partiality towards either sex. Male patients also held preferences for their physician’s gender with a strong male preference. A majority of male patients who held male preferences were from the VA hospital (59%) and, of these, all respondents were greater than 41 years of age. Shapiro et al, identified several gender-based stereotypes that may persist, especially in veteran and elderly patients. 5 Their data revealed that female physicians were seen less as technical and instrumental. Several limitations to this study are noted by the authors includ- ing a selection bias. In this study, very ill patients were not approached. In addition, this was a nonrandomized study. Because the greatest percentage of patients came from the VA hospital, this affected the study secondary to the preponderance of male patients treated at this ED. It was impossible to determine in this limited study whether physician preferences were based on preconceived stereotypes, the milieu of each patient-physician encounter, or the perception of competence in the physician. The fact that this study took place in an academic medical center, it is a possibility that by virtue of resident training level, residents were perceived as less competent. In our study group, a substantial minority did have preferences for both age and gender. This information may be useful to build patient trust and confidence in a brief ED encounter. It may be important for physicians to know to overcome certain biased expectations on the parts of their patients. Further studies are needed to investigate why patients hold preferences. In addition, it would be valuable to determine if patient preferences affect med- ical compliance. GINA L. SCHINDELHEIM, MD Lenox Hill Hospital Emergency Services Department New York, NY DAVID A. JERRARD, MD Emergency Medicine Residency University of Maryland School of Medicine Baltimore Veterans Administration Hospital Baltimore, MD MICHAEL WITTING, MD University of Maryland Emergency Medicine Residency University of Maryland School of Medicine Mercy Medical Center Baltimore, MD References 1. Weisman CS, Teitelbaum MA: Physician gender and the phy- sician-patient relationship: recent evidence and relevant questions. Soc Sci Med 1985;20:1119-1127 2. Pronchik DJ, Sexton JD, Melanson SW, et al: Does wearing a necktie influence patient perceptions of emergency department care. J Emerg Med 1998;16:541-543 3. McNaughton-Filion L, Chen JSC, Norton PG: The Physician’s Appearance. Fam Med 1991;23:208-211 4. McKinstry B, Yang SY: Do patients care about the age of their general practitioner? A questionnaire survey in five practices. Br J Gen Pract 1994;44:349-351 5. Shapiro J, McGrath E, Anderson RC: Patients’, medical stu- dents’, and physicians’ perceptions of male and female physicians. Percept Motor Skills 1983;56:179-190 Presented at the American College of Emergency Physician’s Research Forum, Chicago, Illinois, Oct. 2001. © 2004 Elsevier Inc. All rights reserved. 0735-6757/04/2206-0025$30.00/0 doi:10.1016/j.ajem.2004.07.011 503 CORRESPONDENCE