You are less likely to die if your doctor is female

HM Epstein hmepstein at GMAIL.COM
Thu Dec 22 22:32:25 UTC 2016


Thank you all for your comments. It is fascinating how difficult it is for
the consumer press to get it 100% right. I'm probably just as guilty
because no matter how much I think I know, there's always another angle. In
this case, a prestigious journal printed a study conducted by learned
colleagues from Harvard (a magic name) and the "sexy" inaccurate headlines
will be the only take-away by the readers, if they retain it at all. Now
the echo chambers will repeat it and in five years my son will only want to
see a woman doctor. However, my understanding is that this is just a first
step in reviewing the data. The correlations will have to be examined more
closely to see which, if any, hold up.

Wishing all on this listserv and your families Happy Holidays and New Year!

Best,
Helene

hmepstein.com
@hmepstein <https://twitter.com/hmepstein>
@DxErrors <https://twitter.com/DxErrors>
Diagnostic Errors on Facebook <https://www.facebook.com/DiagnosticErrors/>

On Thu, Dec 22, 2016 at 3:38 PM, Edward Hoffer <ehoffer at gmail.com> wrote:

> 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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>>>> 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:
>>>> http://www.improvediagnosis.org/
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> ------------------------------
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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:
>>>> http://www.improvediagnosis.org/
>>>>
>>>> ------------------------------
>>>>
>>>>
>>>> To unsubscribe from IMPROVEDX: click the following link:
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>>>> in Medicine
>>>>
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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/
>>>
>>
>>
>> ------------------------------
>>
>>
>> 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/
>>
>
>
> ------------------------------
>
>
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> 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


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