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Health data show that there are differences in clinical management based on gender. One hypothesis is that these differences in management are not intentional discrimination but are the result of implicit and unconscious biases on the part of healthcare providers. These biases influence the clinical reasoning and practice of providers. This article, using clinical examples, illustrates how reflective practice is integrated into medical teaching in Lausanne to enable students to identify their biases, control them and ensure fair and relevant care. Students are also prompted to reflect on their social positionality, as thematising the power dynamics around knowledge and social interactions helps to better understand and prepare for medical practice., Competing Interests: Les autrices n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In this article, we report abstracts of eight interviews, showing how clinicians use their interest in gender in their everyday practice. Clinicians report that being acquainted with a person interested by the question of gender raises their own awareness about the subject. In practice, they notice biased acquisition of knowledge due to non-inclusion of gender in research on one hand, and influence of gender stereotypes on clinical care on the other hand. Gender also influenced carriers. Some interviewed clinicians expressed they wished for more training, to reduce inequalities attributable to gender., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Gender bias in medicine negatively interfere with the medical care of both men and women, which can lead to risks for patients as well as health inequalities. Unisanté has launched a pilot project to integrate reflexivity by students at the Medical School of the University of Lausanne on the influence of gender in clinical practice, using an electronic portfolio. The clinical vignettes presented and discussed in this article illustrate this reflective work and the main biases and stereotypes encountered: pain management, assessment of the psychosocial context, management of domestic violence, screening for chlamydia infection and discussion of a contraceptive method., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Groin hernia in women is an entity whose clinical manifestations can be quite subtle, and which therefore risks to go unnoticed. Imaging studies by ultrasound or dynamic CT/MRI is strongly recommended in case of a clinical doubt. Optimal treatment consists of laparoscopic surgery, even in oligosymptomatic patients, because the risk of incarceration, and subsequent morbidity and mortality is high especially in cases of femoral hernia, which are frequent and often overlooked in women. During pregnancy, the risk of developing a groin hernia is very low (around 0,1%) and a wait-and-see attitude is to be preferred as much as possible, except in the case of an acute complication (incarceration)., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

We have been studying multimorbidity in epidemiology and clinical practice since the 1970s. Growing experience shows that the concept of multimorbidity is helpful for epidemiologists to describe population-level changes, but of little use to patients and clinicians who 'diagnose' multimorbidity. Several large, rigorous clinical trials show that organizational changes in primary care can improve the care of these complex patients, but do not improve directly health-related quality of life. This article describes the history of multimorbidity and results of recent randomized trials to prompt a discussion of new approaches to improve the experience of people living with multiple chronic diseases., Competing Interests: Les auteur·e·s n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Since four decades epidemiological research has emphasised the necessity to consider social determinants and the social distribution of illnesses in the Swiss population, particularly by gender. Gender influences social position, living conditions as well as health behaviours over the life-course which all together influence health outcomes. Despite this evidence, national health policies and strategies tend to consider gender as a background factor, if not to omit its influence on health. The Health2020 policy and the recent specific national strategies are particularly illustrative. To exclude or reduce gender as a mere biological factor however hampers the implementation of specific interventions aiming at reducing health inequalities in the name of the social justice principle., Competing Interests: Les auteur-e-s n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Biological sex and social gender jointly influence health. Failure to take into account differences in health between women and men is an issue. What is more, undue differences based on stereotypes can also lead to biased care. This article illustrates the influence of sex and gender on health through clinical situations affecting various dimensions of medical care (diagnosis, investigations, treatments, prognosis). It also gives tools and introduces a project aimed at integrating the gender dimension into the pregraduate education of medical students at the University of Lausanne. The aim is to ensure equitable quality care between women and men, taking into account gender specificities based on unbiased scientific evidence., Competing Interests: Les auteur-e-s n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

Among the health strategies to respond to the aging of the population, initiatives for the screening and management of age-related health issues are implemented, including in family medicine. Preliminary results of a qualitative study suggest that elderly people are ambivalent about anticipating age-related issues, tend to trivialize them and to be reluctant to discuss them spontaneously with their doctors. However, they find relevant that their family doctor brings up the topic with specific questions, because that allows initiating a discussion about some of these sensitive issue. It appears that the awareness of the existing management of geriatric syndromes and functional decline possibilities is rather low. A screening initiative is therefore an opportunity to address these different issues and to inform patients about existing solutions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: Cutaneous squamous cell carcinoma is an invasive and destructive tumor, and may cause death by local extension or because of metastasis. We report the case of a patient with a giant squamous cell carcinoma of the nose and extension to the brain and discuss the main risk factors from this extension., Observation: Resection of a giant squamous cell carcinoma was performed of the nose in a 45 year-old man after debulking radiotherapy. Histological examination disclosed a well-differentiated tumor and perineural involvement, with at least a 6 mm margin. A first relapse occurred on the orbital edge of the initial resection, the lesion was removed revealing an involvement of the infra-orbital nerve. Whilst the patient was receiving chemotherapy, a second relapse occurred responsible for ophthalmoplegia and loss of vision, with involvement of the left orbital apex, cavernous sinus and temporal lobe. The patient died from grand mal seizures., Discussion: Brain extension of cutaneous squamous cell carcinoma of the head is rare. It develops along the anatomic pathways, especially perineural spread. Main risk factors for such a poor course are discussed, including the size of tumor, the anatomic site, the depth and perineural invasion.

The authors propose a simple method of aesthetic evaluation of breast reconstructions after cancer, based on a 20-point score. In the 76 patients included in this study and mainly reconstructed by implant, the following seven criteria were evaluated by a score: the reconstructed breast, the symmetrized breast, symmetry of the 2 breasts, the areola, the nipple, the areolo-nipple complex (ANC) and the overall reconstruction. The first score was established during the visit by the patient and independently by the same plastic surgeon. The score was then established during two sessions of projection of standardized photographs, by two groups, A and B, composed of 9 nurses and secretaries and 10 plastic surgeons, respectively. Statistical analysis of the results showed that the scores for these criteria were all correlated for all examiners. This study confirms the reliability of aesthetic evaluation of breast reconstruction after cancer, by a group composed of 2 men and 2 women, surgeons or non-surgeons, on photographs or on clinical examination, based on a 20-point score.