Emergency Physician Gender and Last Menstrual Period Documentation: A Retrospective Cohort Study

Female physicians in non- emergency medicine (EM) specialties may elicit more detailed gynecologic histories than males, potentially improving diagnosis and management of reproductive conditions. We aimed to determine whether EM physician gender affects documentation of last menstrual period (LMP) among reproductive-aged females undergoing pelvic point-of-care ultrasound (PoCUS) in the emergency department.

This single-site, retrospective cohort included nonpregnant or first-trimester pregnant females aged 18–40 years who were evaluated by an EM attending and underwent pelvic PoCUS from January 1, 2020, to December 31, 2024. Patients with prior hysterectomy, bilateral oophorectomy, recent childbirth, or under reproductive endocrinology care were excluded. The gender of the attending and resident, along with whether LMP documentation occurred were obtained. Logistic regression models assessed differences in LMP documentation by attending and resident gender while adjusting for patient age and ethnicity, pregnancy, and abdominal pain.

Of 732 eligible patient encounters, 13 were excluded, leaving 719 for analysis. Mean age was 28.6±5.9 years; 276 (38.4%) were Hispanic, 545 (75.8%) presented with abdominal pain, and 377 (52.4%) were pregnant. There were 29 unique attendings (14 [48.3%] male, 15 [51.7%] female), responsible for 195/719 (27.1%) encounters staffed by males and 524/719 (72.9%) by females. Eighty-eight residents (50 [56.8%] male, 38 [43.2%] female) documented 264 encounters, with 155 (58.7%) by males and 109 (41.3%) by females. LMP was documented in 299/719 (41.6%) total encounters and did not differ by attending gender (male 79/195 [40.5%] vs female 220/524 [42.0%]; p = 0.722). Among resident encounters, LMP was documented in 125/264 (47.3%). Female residents had 56% lower odds of documenting LMP compared with males (39/109 [35.8%] vs 86/155 [55.5%]; OR 0.44; 95% CI 0.25–0.76; p = 0.002).

Attending physician gender was not associated with LMP documentation, but female residents were less likely than males to document an LMP. These findings suggest that clinician documentation practices may vary by role and gender, highlighting opportunities for targeted education or workflow standardization to improve reproductive history assessment in the EM.