You are less likely to die if your doctor is female

Edward Hoffer ehoffer at GMAIL.COM
Thu Dec 22 20:38:07 UTC 2016


I have a different perspective. The study looked at patients cared for by
hospitalists. At every institution with which I am familiar, the doctor
caring for the patient is nearly impossible to ascertain. One name may go
on the bill, but the care is communal. So, I suspect this whole study is
about as meaningful as saying that if the American League team wins the
World Series, the stock market will go up - a random association.
Ed
Edward P Hoffer MD, FACP, FACC

On Thu, Dec 22, 2016 at 3:02 PM, Tom Benzoni <benzonit at gmail.com> wrote:

> 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/jou
>>> rnal.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)
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>> ------------------------------
>>>
>>>
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>>>
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>>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>>> Medicine
>>>
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>>>
>>>
>>>
>>>
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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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>>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
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>> 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:
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> SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST@
> LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
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> http://www.improvediagnosis.org/
>






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


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