You are less likely to die if your doctor is female

Tom Benzoni benzonit at GMAIL.COM
Thu Dec 22 20:02:22 UTC 2016


Their pay is the same.
This is another constant myth that, by repetition, is believed true.
There is no place on a bill for a physician or coder to mark: Female;
discount payment XX%.
(My wife is a physician. I've run a practice and currently work.)
tom

On Thu, Dec 22, 2016 at 1:05 PM, HM Epstein <hmepstein at gmail.com> wrote:

> This article is from the consumer press, namely *The Dallas Morning News*.
> Debunked is a column written by a physician, Dr. Seema Yasmin, in Dallas.
> While nothing was actually debunked in this article, especially not in the
> way Dr. Hess just did, it does cite other studies that support the study's
> conclusions that we've been discussing. The links will take you to those
> studies. However, it's her concluding paragraphs I wanted to share with the
> group about compensation. If female physicians have (the same or) better
> outcomes than male physicians do, shouldn't their pay be the same?
> http://www.dallasnews.com/news/debunked/2016/12/20/patients-
> cared-female-doctors-better
>
> Best,
> Helene
>
> hmepstein.com
> @hmepstein <https://twitter.com/hmepstein>
> @DxErrors <https://twitter.com/DxErrors>
> Diagnostic Errors on Facebook <https://www.facebook.com/DiagnosticErrors/>
>
> *Do patients cared for by female doctors do better?*
> December 21, 2016
>
> Elderly patients cared for by female doctors live longer and are less
> likely to return to the hospital, say the authors of a new study published
> this week in the *Journal of the American Medical Association
> <http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255?utm_source=Silverchair_Information_Systems&utm_campaign=FTM_12152016&utm_content=news_releases&cmp=1&utm_medium=email>*.
> Harvard researchers found that 32,000 lives would be saved if patients were
> cared for by female doctors.
>
> The study looked at more than 1.5 million Medicare patients hospitalized
> at some time during January 2011 to December 2014. Patients who were cared
> for by female doctors had a lower death rate - 11.07 percent compared to
> 11.49 percent for patients with a male doctor - and lower readmission rates
> - 15.02 percent compared to 15.57 percent.
>
> The study compared doctors within the same hospital and found that better
> patient outcomes persisted even when taking into account patients who were
> severely sick and when comparing patients with different illnesses.
> *Gender differences*
>
> This is the first large-scale study to look at the impact of gender on
> patient care but earlier studies have shown that men and women practice
> medicine differently and that female doctors outperform men in medical
> school exams <http://www.bmj.com/content/324/7343/952>.
>
> In separate studies looking at patients with diabetes and chronic heart
> failure, researchers found that female doctors were more likely to follow
> clinical protocols and to practice evidence-based medicine
> <http://onlinelibrary.wiley.com/doi/10.1093/eurjhf/hfn041/abstract>.
>
> Other studies have found that female doctors are more likely to order
> screening tests such as mammograms and Pap smears for their patients. These
> tests are designed to detect illnesses before they cause significant harm.
>
> In a study from 1993, researchers at the University of Rochester
> <https://www.ncbi.nlm.nih.gov/pubmed/8450679> found patients with female
> doctors were more likely to have screening for breast and cervical cancer
> although no difference was found in the rate of screening for high blood
> pressure.
>
> Outside of the hospital, Canadian researchers found that having a female
> primary care doctor
> <http://ovidsp.tx.ovid.com.libproxy.utdallas.edu/sp-3.23.1b/ovidweb.cgi?QS2=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> means
> you are less likely to wind up in the emergency room. They studied the
> patients of 4,195 primary care doctors and found that as well as doing a
> better job at cancer screening and managing diabetes, patients of female
> doctors were at lower risk of an emergency room visit or a hospital
> admission.
>
> The authors concluded that “The indicators assessed in this study point to
> a benefit for patients under the care of female physicians.” They suggested
> the difference could be a result of more referrals to specialists by female
> primary care doctors as well as a more patient-centered approach to
> medicine.
> Better work for less pay
>
> Despite providing better patient outcomes, female doctors earn around
> $20,000 less per year than their male counterparts. In a study of 24
> medical schools in 12 states, researchers found that female doctors earn 8
> percent less than male doctors.
>
> Other analyses of scientist salaries show that women are offered
> substantially smaller faculty start-up packages. Male faculty were
> offered a funding package that was 67.5 percent higher
> <http://jamanetwork.com/journals/jama/fullarticle/2441254> than the sum
> offered to women faculty members, according to a study published in JAMA
> last year.
>
> And even reaching the rank of full professor is more challenging for
> women. Male doctors are more than twice as likely as female doctors to
> reach the status of full professor.
>
> Judging from these studies, we could all do better to have more female
> doctors. But although around half of medical school students in the U.S.
> are women, only one in three practicing doctors is a woman. Obstacles such
> as lower salaries and discrimination in academia mean women miss out on
> fulfilling careers and patients miss out on stellar clinical care.
>
> Fighting sexism is a matter of life and death.
>
> *Debunked is your go-to site for demystifying science and medicine. Send
> your questions and conspiracy theories to syasmin at dallasnews.com
> <syasmin at dallasnews.com> or tweet me at @DoctorYasmin. I'm a medical writer
> at The Dallas Morning News and a professor at the University of Texas at
> Dallas. I worked as a medical doctor and disease detective before training
> as a journalist.*
>
>
> On Thu, Dec 22, 2016 at 8:05 AM, Hess, Dr. Donald <
> dhess at susquehannahealth.org> wrote:
>
>> Hi Tom:
>>
>>
>>
>> I am very familiar with the Ioannidis paper that you cited below, and the
>> article under discussion is a perfect example. Rather than depend on sound
>> bites & pre-digested news items, I decided to download the article and read
>> it for myself. Oh my goodness!  This paper demonstrated why observational
>> studies rank at the bottom of the credence scale. With regard to how cases
>> were assigned to gender: It was according to a percentage of the
>> physician’s Part B billing. How can an individual’s clinician’s billing
>> data possibly be related to the outcomes of care provided by an entire team
>> of clinicians? This is reductionistic thinking gone far astray. It only
>> reinforces the delusion that outcomes rest on one individual rather than a
>> clinical team and its local context.
>>
>>
>>
>> Dr. Prida (in a previous post) made another excellent point: Doing
>> multiple statistical comparisons is bound to reveal some significant
>> correlations no matter how faulty the data. The more comparisons you make,
>> the more likely you’ll find something significant.
>>
>>
>>
>> In light of all this, it seems to me that the authors didn’t make much
>> effort in their discussion to disprove their findings. This makes me
>> question their equipoise. Were the investigators truly unbiased?
>>
>>
>>
>> The most unfortunate thing is that the findings of this study have gone
>> viral…which points to a bias that both physicians and the public share:
>> Just because somebody publishes a paper in a peer-reviewed journal does not
>> mean that their conclusions are valid. Reading the last few lines of an
>> abstract is insufficient. Where’s the critical thinking in all of this?
>>
>>
>>
>> Regards, Don
>>
>>
>>
>> Dr. Donald Hess
>>
>>
>>
>> *From:* Tom Benzoni [mailto:benzonit at GMAIL.COM]
>> *Sent:* Wednesday, December 21, 2016 3:47 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] You are less likely to die if your doctor is
>> female
>>
>>
>>
>> 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-
>> 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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>>
>>
>>
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>> .IMPROVEDIAGNOSIS.ORG
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>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
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>> http://www.improvediagnosis.org/
>>
>>
>>
>>
>>
>>
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>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
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>>
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>> Medicine
>>
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>> http://www.improvediagnosis.org/
>
>
>
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>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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