You are less likely to die if your doctor is female
Jena, Anupam Bapu
Jena at HCP.MED.HARVARD.EDU
Tue Dec 20 14:39:10 UTC 2016
Hi Mark, wonderful to hear from you! I’ll share my thoughts and Ashish should chime in.
First off, terrific question, but hard to say. The first issue we have/had to address is whether our findings are driven by something unmeasured about the patients male and female docs see. We don’t think that’s likely b/c we focus on hospitalist physicians who within the same hospital are plausibly ‘quasi-randomized’ to patients, i.e., patients don’t choose M vs F docs in that setting. We also observe that the characteristics of patients are similar, which is consistent with the randomization hope.
That begs the question, why? It’s not about spending intensity, LOS, or where patients are discharged. We look at those. So, we are left w/ two things, are there slightly more misdiagnosis, incorrect treatments, or a hybrid problem of prognosis (i.e., may not matching the best treatment to a given patient). If I had to guess, misdiagnosis would have to be an element b/c we are looking at mortality here. I think it’s more likely that a misdiagnosis may be made than the correct diagnosis made but the incorrect treatment offered. I say that b/c I think (w/o data) that doctors would be better at identifying the correct trx if they have the right diagnosis, but the right diagnosis may be elusive.
There are reasons to think that misdiagnosis may play a role. There may be differences in the ability to ‘extract’ important information, due to time spent, patient comfort w/ the doctor, etc. All this is plausible but hard to know if it could actually improve mortality. I would lay my money on differences in clinical decisionmaking, e.g., anchoring, premature closure of diagnosis; these are features of decisionmaking that are different on average between M and F in other settings (e.g., finance is where this has been shown I believe).
Those are my 2 cents!
Hope all is well, Bapu
Anupam B. Jena, MD, PhD
Ruth L. Newhouse Associate Professor
Harvard Medical School
From: Mark Graber [mailto:graber.mark at gmail.com]
Sent: Monday, December 19, 2016 12:51 PM
To: Listserv ImproveDx
Cc: Jha, Ashish; Jena, Anupam Bapu
Subject: You are less likely to die if your doctor is female
Patients of female hospitalists had lower 30 day mortality rates and readmissions - see article attached, or here: http://www.msn.com/en-us/health/medical/you%e2%80%99re-less-likely-to-die-if-your-doctor-is-female-according-to-a-new-study/ar-AAlKb6o?li=BBnb4R7<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.msn.com_en-2Dus_health_medical_you-25E2-2580-2599re-2Dless-2Dlikely-2Dto-2Ddie-2Dif-2Dyour-2Ddoctor-2Dis-2Dfemale-2Daccording-2Dto-2Da-2Dnew-2Dstudy_ar-2DAAlKb6o-3Fli-3DBBnb4R7&d=CwMFaQ&c=WO-RGvefibhHBZq3fL85hQ&r=Xq_etsANojVYFKQHAR8Zagjs9xmtdmxIs8TLN5U_xd4&m=68ElPU8pnAeaPazp_CS1XwQeoWWNNIpaw_i31Ex8pxE&s=SCe-wzgscmnZ7YLiXXpjUJt-xIMF2epKSMCbrRL7sEY&e=>
Two of the authors were on the IOM panel that drafted “Improving Diagnosis in Health Care”, copied on this message. Congratulations guys, and maybe you can help us: Does this difference relate to doing a better job with diagnosis, treatment, or both?
Mark L Graber MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook
President Society to Improve Diagnosis in Medicine (SIDM)
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