Article Notes
- Female patients treated in EDs with a higher percentage or a higher number of female physicians were more likely to survive. Although true of both care from a female or male physician, the beneficial survival effect of a greater female physician presence, was more marked when treated by a male doctor.
- Female patients treated by male physicians were also more likely to survive when the male physician had previously seen more female patients (0.02% increased survival for each female patient seen in the last quarter!).
What did they do?
Fascinating big-data study covering 12 years of the 20-most-common surgical procedures in Ontario, Canada. Wallis, Jerath & co. investigated how patient-surgeon sex discordance correlated to a composite for adverse postoperative outcomes. (A deeper investigation of the related Wallis 2017 study).
And they found?
While ~15% of all patients experienced an adverse post-operative outcome, female patients treated by a male surgeon experienced significantly higher odds of a composite of adverse events (OR 1.15 [1.10-1.20]), 30-day complications (OR 1.16 [1.11-1.22]), readmissions (OR 1.11 [1.04-1.19]), and death (OR 1.32 [1.14-1.54]) compared to when treated by female surgeons.
Yet male patients treated by female surgeons experienced either lower odds (death 0.87 [0.78-0.97]) or statistically-similar odds of complications (composite end-point, readmission or post-op complications).
The hot-take
Women once again receive the metaphorical short-end of the medical-stick. Whether societal or elsewhere in the health industry value-chain, long established gender inequity reveals itself in worse surgical outcomes for female patients.
Hang on a sec…
But this cannot just be written off as a consequence of existing social gender inequity, but rather a disquieting causal loop between this as a cause and the result then perpetuating further inequity.
If some part of a surgeon’s ’professional success’ is wrapped-up in the ability to achieve positive outcomes for patients while minimising the adverse, then male surgeons are failing their female patients when compared to either female surgeons, or to the care they provide their male patients.
And yet the same discordance cost is not true for female surgeons.
The take-away
If you are a male surgeon at all interested in successful patient outcomes (surely that’s every surgeon?), then this should make you very, very uncomfortable. At the very least it should make male surgeons stop and consider whether their female colleagues conduct any aspects of their practice differently – particularly when treating female patients.
Daniel Jolley
Very interesting study covering 20 years of Floridian ED patient admissions for myocardial infarct, looking specifically at the influence of gender-discordance between patient and doctor.
The headline finding was that female heart-attack patients experienced lower survival when treated by a male physician than when by a female physician. Baseline mortality across all patients was 11.9%, with a 1.5% absolute survival decrease when compared to male patients treated by female physicians.
Although on the surface this absolute effect size could be misinterpreted as small, it represents a 12% relative risk difference – quite meaningful when we are considering mortality from the leading cause of death in the U.S.
Could the researchers suggest a reason?
The authors identified two interesting points:
"These results suggest a reason why gender inequality in heart attack mortality persists: Most physicians are male, and male physicians appear to have trouble treating female patients." – Greenwood, 2018
Daniel Jolley