You are less likely to die if your doctor is female

Tom Benzoni benzonit at GMAIL.COM
Wed Dec 21 20:47:20 UTC 2016


You asked why include Ioannidis?

I'm sure you're familiar with his seminal paper
"Why most published research findings are false"
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124

Likely a measure of prevailing bias.
If the opposite had been found, would it have been published?
"Men are better than women?"
Try it.

Likely seeing an anchoring bias in the conversation:
1. Research published which supports bias.
2. Search around for reasons why it must be so.

Croskerry would say
Search for reasons it is not so (cognitive debiasing.)

tom

On Wed, Dec 21, 2016 at 7:28 AM, Tom Benzoni <benzonit at gmail.com> wrote:

> Consider adding John Ioannidis' work to consideration.
> tom
>
> On Tue, Dec 20, 2016 at 5:52 PM, HM Epstein <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 ;-) ]
>>
>> [image: 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*​*
>>
>>
>> hmepstein.com
>> @hmepstein <https://twitter.com/hmepstein>
>> @DxErrors <https://twitter.com/DxErrors>
>> Diagnostic Errors on Facebook
>> <https://www.facebook.com/DiagnosticErrors/>
>>
>> On Tue, Dec 20, 2016 at 9:39 AM, Jena, Anupam Bapu <
>> 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]
>>> *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-do
>>> ctor-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)
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>> ------------------------------
>>>
>>>
>>> To unsubscribe from IMPROVEDX: click the following link:
>>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBE
>>> D1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST
>>> .IMPROVEDIAGNOSIS.ORG
>>>
>>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>>> Medicine
>>>
>>> To learn more about SIDM visit:
>>> http://www.improvediagnosis.org/
>>
>>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBE
>> D1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST
>> .IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>
>
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20161221/072073f0/attachment.html> ATTACHMENT:
Name: image.png Type: image/png Size: 238693 bytes Desc: not available URL: <../attachments/20161221/072073f0/attachment.png> ATTACHMENT:
Name: image001.png Type: image/png Size: 61111 bytes Desc: not available URL: <../attachments/20161221/072073f0/attachment-0001.png>


More information about the Test mailing list