Gender and patient satisfaction with primary care: tuning in to women in quality measurement.

This study analyzes the relationship between patient gender and satisfaction with primary care visits, using 1999 survey data on 1691 women and 760 men making primary care visits at multiple sites affiliated with a large academic health system designated as a National Center of Excellence in Women's Health (COE). The main findings are that in multivariate analyses controlling for patient and visit characteristics, different aspects of the content of primary care visits are important to women and men. Women's overall satisfaction with visits is more dependent than men's on informational content, continuity of care, and multidisciplinarity. Men's overall satisfaction is more dependent on the personal interest shown in them by providers. No differences in satisfaction are found between those seen in sites affiliated with the COE and other primary care sites within the health system that are not core sites of the COE. We conclude that quality improvement and research in women's primary care could benefit from gender analysis of patient satisfaction data and from more gender-sensitive patient satisfaction measures.

Interrupting the reenactment cycle: psychotherapy of a sexually traumatized boy.

This case study describes the course in psychotherapy of an eight-year-old boy who had been sexually traumatized at an early age by his biological father. He was seen for 35 individual sessions during a three-month hospitalization. Many of the problems evidenced at admission were conceptualized as ineffective attempts to reenact and master the original trauma. Hospitalization provided an environment in which acting-out behaviors could be controlled in a manner sufficient to allow anxiety to be utilized in psychodynamically oriented therapy. A key element in psychotherapeutic work was the recognition that the boy struggled with positive as well as negative feelings toward his abusing father. Individual therapy provided a context in which these ambivalent feelings could be expressed, which ultimately allowed for developmental progression.