Modern medicine is beginning to recognize the importance of the perspective of the patient in health care, emphasizing the importance of inter-relationships of health needs, satisfaction and quality of life. Many studies have been conducted on patient’s preference of their obstetrician/gynecologist, but the majority of them were conducted in modern western societies, establishing a need to explore other populations. The present study was performed in the Israeli Druze community which is composed of a unique population that practices centuries-old traditions. To the best of our knowledge, this is one of a very few studies that were conducted among them.
In general, two factors consisting of feminization among modern populations [3,4,13] and traditional beliefs among religious populations [6,7,11,12] have led to same-sex preference of obstetricians/gynecologists. Interestingly, contrary findings have been reported also among women in modern western societies [10,23]. Due to the conservative nature of the Druze community, it did not come as any surprise that most of our Druze religious and non-religious responders (63.8%) preferred a female obstetricians/gynecologists.
We found 3 parameters in responder’s characteristics that correlates to the preference of female obstetricians/gynecologists, among them religiousness of the responders, which is also predictive parameter for choosing female obstetricians/gynecologists. The results emphasize again the importance of the religiousness as a factor in the decision of the Druze women regarding their preference of their obstetricians’/gynecologists’ sex, similar to other religious and traditional populations [6-8,11,12].
Still, looking at the percentage of same sex preference among other Arab traditional-populations, the percentage of Druze responders who preferred female obstetricians/gynecologists were lower than in the United Arab Emirates [6], Israeli Muslim Arabs [11], and Iraqi responders [7]. This was unexpected due to the similar religious and tradition nature of the Druze population. The differences might result from the higher percentage of secularity among our Druze responders compared to the secularity percentage among other Arab religious populations like the Israeli Muslim Arabs [11], which probably influence the preferences.
We also found significant differences between the religious Druze fraction and the secular one, regarding obstetricians/gynecologists sex preference. In a similar manner, secular Jewish responders significantly differ from religious Jews regarding physician sex preference [12]. However comparison of the religious Druze to their Jewish counterpart found that only 68.6% of the religious Druze women preferred a same-sex physician compared to 92.9% of the religious Jewish responders [12]. This discrepancy might stem from differences in the status of religiousness; in the case of Jewish responders the religious were only ultra-orthodox while in the Druze responders the religious are composed of ultraorthodox, religious and traditional responders.
An additional parameter that was correlated to female preference and is a predictive parameter is age of the responders. Other papers demonstrated that age is important to sex preference, including Makam et al. [24], and Lafta et al. [7]. However the latter demonstrated an opposite association; as age increased there was a decrease in female preference. Their explanation was that the life experiences of the older responders help them to see other factors as more important [7]. For the past two decades, many young Druze women have been seeking higher education and have become more integrated into the western/modern society. The integration and education have led to less religious and tradition adherence among the young Druze women [19-22,25]. Since there is no association between Druze responders education or employment status to obstetricians/gynecologists sex preference, we believe that age is the important factor, since older Druze women tend to be more religious and adhere more to tradition therefore choosing female obstetricians/gynecologists [19-22,25].
A patient’s preference for same-sex physicians is more evident in more intrusive fields, such as obstetrics and gynecology, compared to family physician [8,11,12]. Indeed, as had been seen in other populations, the Druze women we queried exhibited same-sex physician preference for their obstetrician/gynecologist (63.8%) compared to their family physicians (18.9%). Similarly, Druze women also exhibited same-sex physician preference for other intimate procedures, such as colonoscopy [6,8,11,12,17,23-26].
Furthermore, the main reasons for preferring female obstetricians/gynecologists by Druze responders were feeling more comfortable and less embarrassed, and the notion that female obstetricians/gynecologists are more gentle during intimate procedures. Others studies conducted among Arab traditional and religious populations found that one of the main reasons for sex preference is feeling more comfortable and less embarrassed when being treated by female obstetricians/gynecologists [7,12], and specifically for intimate procedures [12].
The sex of the regular obstetricians/gynecologists of the responders is the third parameter correlated to female obstetricians/gynecologists preference. This finding is supported by Piper et al. [10] and Schmittdiel et al. [27] who both demonstrated that the sex of the regular obstetricians/gynecologists influence the decision of obstetricians/gynecologists sex. We assume that preference of same sex obstetricians/gynecologists is influenced from positive experience with the regular obstetricians/gynecologists (though we don’t have data). Indeed when you choose only the responders with positive experience from their regular male/female responders, you eliminate sex preference for female [28].
The top three characteristics chosen by our Druze study participants applied to the obstetrician’s/gynecologist’s professional skills (i.e., experience, knowledge, and ability). Importantly, despite the top-rankings of professional skills, we found that women who preferred a female obstetricians/gynecologists assigned a lesser weight to knowledge in choosing a gynecologist. Moreover, we found that women who attributed reduced weight to professional level of obstetricians/gynecologists can be predicted to prefer female obstetricians/gynecologists. Previous studies found that among modern and western communities physician’s professionalism were important and associated to obstetricians/gynecologists preference rather than sex [3,10], while among religious Muslim other factors were more important, specifically sex [6,7]. Druze responders, like other religious communities, display association to sex rather than professional skills. Still, even the fraction of Druze women who preferred female obstetricians/gynecologists ranked with high percentage the preference for professional skills (~80% and above), suggesting that their proximity and interaction with the Israeli secular western society have considerable influence on the way they choose their obstetricians/gynecologists. Notably, we do not have detailed information about the integration and influence of the Israeli modern society on the Druze- additional research is required to investigate this issue.
It should be noted that our study has several limitations. One limitation is our use of a new non-validated questionnaire since there was such a paucity of studies similar to ours. We developed a 36-item questionnaire that incorporated items from previously validated instruments to assess sex preference of an obstetrician/gynecologist. Another caveat is the fact that the questionnaire was in Hebrew and this could affect the ability of the responders, specifically those who are older and those who are less educated, to fully understand the questions. The third limitation is the fact that most of the regular obstetricians/gynecologists of the responders are female. We do not have much data regarding prior experience with their regular obstetricians/gynecologists. And, the high percentage of female obstetricians/gynecologists could contribute to the preference of female obstetricians/gynecologists. Another limitation is the fact that we did not gather information regarding other considerations that the woman might have when she chooses a particular physician (for example, family relationship with the physician, or the location of their physician inside or outside their village). The last limitation is our studying only Druze women within Israel’s borders and exposed to the Israeli modern western lifestyle. It would be interesting to explore additional Druze populations from other countries that we expect are less exposed to western influences.