You are less likely to die if your doctor is female

Hess, Dr. Donald dhess at SUSQUEHANNAHEALTH.ORG
Wed Dec 21 16:49:39 UTC 2016


I have a question for anyone who actually read the article: How did the authors determine that a given patient was specifically treated by a female vs. male hospitalist? Because of rotating shifts and schedules, the majority of patients are treated by both male and female hospitalists.

Regards, Don

Dr. Donald Hess

From: Peggy Zuckerman [mailto:peggyzuckerman at GMAIL.COM]
Sent: Wednesday, December 21, 2016 1:31 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] You are less likely to die if your doctor is female

My example will be inadequate to explain some of the differences that may exist between the listening and social skills of men and women, but I must note that there are very successful salesmen.  Their listening skills and ability to draw out the needs of their customers and to respond to those needs makes them successful.  Those same skills are not typical of many men, but can be taught to them.   Wondering if there is not a lesson to be learned from this field.

Naturally, I have to take note that the female is often thought to have these necessary social (and dare I say, nurturing skills) more frequently.  However, there are vast differences in the female population as to that.  The less-nurturing female may seem somehow odd, cold, etc, while the more-nurturing male is thought to be odd, but in a more positive manner.

Assuming I have gotten myself in trouble with both the males and the females of the species...

Peggy



Peggy Zuckerman
www.peggyRCC.com<http://www.peggyRCC.com>

On Tue, Dec 20, 2016 at 3:52 PM, HM Epstein <hmepstein at gmail.com<mailto:hmepstein at gmail.com>> wrote:
So, Dr. Jena, where do you think gender plays a role in diagnostic accuracy? Patience in listening to patients?  I don't want to display gender bias but there are many studies that demonstrate that while our brains are very similar, stereotypical female brains process data differently than stereotypical male brains do. [See cartoon below ;-) ]

[Inline image 1]

Or perhaps we can identify it within Buster Benson's Cognitive Bias Cheat Sheet <https://betterhumans.coach.me/cognitive-bias-cheat-sheet-55a472476b18#.lmlyvgxp3> under Problem #3: Need to Act Fast such as "Illusory Superiority" or "Egocentric Bias"?

 "In order to act, we need to be confident in our ability to make an impact and to feel like what we do is important. In reality, most of this confidence can be classified as overconfidence, but without it we might not act at all."
See: Overconfidence effect, Egocentric bias, Optimism bias, Social desirability bias, Third-person effect, Forer effect, Barnum effect, Illusion of control, False consensus effect, Dunning-Kruger effect, Hard-easy effect, Illusory superiority, Lake Wobegone effect, Self-serving bias, Actor-observer bias, Fundamental attribution error, Defensive attribution hypothesis, Trait ascription bias, Effort justification, Risk compensation, Peltzman effect

​Regards,
Helene​


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On Tue, Dec 20, 2016 at 9:39 AM, Jena, Anupam Bapu <Jena at hcp.med.harvard.edu<mailto:Jena at hcp.med.harvard.edu>> wrote:
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<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

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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