Better survival for patients of female than male drs

[tr]

https://www.theatlantic.com/health/archive/2016/12/female-doctors-superiority/511034/

Discuss.

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[ldiot]

There's just so many confounding variables it's hard to really draw much out of this. I found it strange that they float the idea that females spend more time counseling patients as a likely reason for their results yet the things that counseling would seemingly matter most (like CHF) have mortality and readmission rates that aren't even statistically significant meanwhile sepsis was significant... so at least in that portion I think they're talking out their ass

 

[tr]

There's just so many confounding variables it's hard to really draw much out of this. I found it strange that they float the idea that females spend more time counseling patients as a likely reason for their results yet the things that counseling would seemingly matter most (like CHF) have mortality and readmission rates that aren't even statistically significant meanwhile sepsis was significant... so at least in that portion I think they're talking out their ass

Counseling time isn't the only systematic difference between male and female physicians. Women are also more likely to adhere to evidence based algorithms, which could explain the big effect on sepsis.

What is the concern about confounding variables? You think there is some systematic difference between male and female physicians other than the way they practice that could account for this? What would that be? The authors controlled for patient severity, location, volume, use of care, years of physician experience, etc and none of that made a difference. What confounder are you concerned about?

 

[ldiot]

Counseling time isn't the only systematic difference between male and female physicians. Women are also more likely to adhere to evidence based algorithms, which could explain the big effect on sepsis.

What is the concern about confounding variables? You think there is some systematic difference between male and female physicians other than the way they practice that could account for this? What would that be? The authors controlled for patient severity, location, volume, use of care, years of physician experience, etc and none of that made a difference. What confounder are you concerned about?

Do I think there is some difference other than the way they practice that would account for a difference in outcomes? What? Not sure where you got that idea... what I'm saying that an unmeasured cofounder or even insufficient correction for a cofounder could obviously skew results, and the fact that they had to correct for so many cofounders makes this type of error more likely. Not trying to insult your intelligence but it's an elementary school concept that you want to minimize variables. How did they account for severity of illness? They said that they did but didn't give any detail, I'm lead to believe they are just looking at diagnosis codes to determine severity. How did they correct for hospital fixed effects? They used indicator variables to correct for differences in medical schools for the physicians; are the indicator variables reflective of the quality of education today or when the physician actually attended? Why are they even bothering to correct for education in the first place if they aren't going to correct for the quality of residency? Is household income a sufficient measure of socioeconomic status for the patients?

I could go on all day long but my point is simply that it's literally impossible to correct for all of these variables in a retrospective study. I could "correct" for these variables in any manner that I want in order to give me any result that I want.

It would be more useful to look at a study linking, for example, degree to which the physician follows current practice guidelines to patient outcomes and THEN look at the degree to which male and female physicians follow these guidelines. This would actually produce meaningful data which establishes a cause and effect relationship rather than an unexplained correlation.

 

[tr]

Do I think there is some difference other than the way they practice that would account for a difference in outcomes? What? Not sure where you got that idea...

Ahem. That is the definition of a confounder.

what I'm saying that an unmeasured cofounder or even insufficient correction for a cofounder could obviously skew results, and the fact that they had to correct for so many cofounders makes this type of error more likely. Not trying to insult your intelligence but it's an elementary school concept that you want to minimize variables. How did they account for severity of illness? They said that they did but didn't give any detail, I'm lead to believe they are just looking at diagnosis codes to determine severity. How did they correct for hospital fixed effects? They used indicator variables to correct for differences in medical schools for the physicians; are the indicator variables reflective of the quality of education today or when the physician actually attended? Why are they even bothering to correct for education in the first place if they aren't going to correct for the quality of residency? Is household income a sufficient measure of socioeconomic status for the patients?

I could go on all day long but my point is simply that it's literally impossible to correct for all of these variables in a retrospective study.

Nor is it necessary, unless there is reason to believe these factors would both differ systematically between men and women and explain the obtained result. You believe socioeconomic status of patients would differ systematically between male and female physicians, in a way not captured by household income, but in such a way as to make their outcomes appear to differ? That's a reach given these are hospitalists and patients were essentially randomly assigned to doctors based on who was on shift. You think male and female doctors differ systematically in quality of residency program? That would be, not impossible, but hard to defend. You'd have to posit that the top residencies are full of women, and the bottom ones full of men, and this educational difference explains the mortality effects. Even if that's the case it wouldn't even change the findings here, just suggest that the result is explained by women doing better in school.

Think about what you are saying.

I could "correct" for these variables in any manner that I want in order to give me any result that I want.

I'd be willing to bet you could not. Data massage is not as easy as you think and this finding replicates and extends previous work.

It would be more useful to look at a study linking, for example, degree to which the physician follows current practice guidelines to patient outcomes and THEN look at the degree to which male and female physicians follow these guidelines. This would actually produce meaningful data which establishes a cause and effect relationship rather than an unexplained correlation.

Right, so that's been done in their ref no 3, although that study did not look at a mortality outcome. Different studies address different aspects of this question, for sure, and as with any study you have to judge it in the context of other results in the field. This study adds information about mortality effects to numerous existing studies (which they cite) that document differences in practice patterns between men and women.

 

[DrCommonSense]

https://www.theatlantic.com/health/archive/2016/12/female-doctors-superiority/511034/

Discuss.

Do you actually believe the PC police would ever allow a study to be published that stated "men are better physicians than women"?

There would be feminist cries out the wazoo about "sexism".

Ergo, this "conclusion" was only PC one available.

You can make these "stats" show anything you want with enough fuzzy statistically manipulation and confounding variables.

Feminism 101

 

[DrCommonSense]

https://www.theatlantic.com/health/archive/2016/12/female-doctors-superiority/511034/

Discuss.

How many patients admitted to the hospital have only one physician taking care of them? There are usually TEAMS of physicians with consulting services involved in the patient care.

How do you tell which level of "contribution" the TEAMS of physicians? Just because a hospitalist put their name on the admission orders for a patient doesn't mean they took care of the patient fully.

Trying to stratify these numbers to show a "4% readmission benefit" is nonsensical when considering the "team" orientation of modern medicine in the hospital and the many consulting services for each patient.

Also, this is a RETROSPECTIVE study that is open to sampling bias. We could easily run the numbers again for a different sample and find the opposite effect.


I can PROMISE I can perform a study to show the opposite results but it would NEVER get published due to the PC police.

 

[tr]

How many patients admitted to the hospital have only one physician taking care of them? There are usually TEAMS of physicians with consulting services involved in the patient care.

Assigned physician was considered as the one who was responsible for the largest proportion of Medicare Part B spending for that patient

Trying to stratify these numbers to show a "4% readmission benefit" is nonsensical when considering the "team" orientation of modern medicine in the hospital and the many consulting services for each patient.

Fair enough, but the attending of record generally has a major role in determining the involvement of any consultants as well.

Also, this is a RETROSPECTIVE study that is open to sampling bias. We could easily run the numbers again for a different sample and find the opposite effect.

Sampling bias is determined by your sampling approach, not by when your data were collected. What kind of sampling bias are you concerned about?

 

[DrCommonSense]

Assigned physician was considered as the one who was responsible for the largest proportion of Medicare Part B spending for that patient



Fair enough, but the attending of record generally has a major role in determining the involvement of any consultants as well.



Sampling bias is determined by your sampling approach, not by when your data were collected. What kind of sampling bias are you concerned about?

1) Assigned physician doesn't take into account the confounding variables such as use of other consulting services. Maybe the female physician used consulting services far more often to "decrease readmission rates by 4%" but the overall costs increased dramatically? We can't tell from this "study".

2) Yes they do but if the female physicians use them at a far higher level than the male physicians, the cost to the system could be significantly higher, making the cost/benefit ratio untenable over the longer term.

It would also be important to know the cost of ancillary services ordered by the female vs male physicians to determine the overall cost to "decrease readmission by 4%". Did they order far more CT scans, MRIs, lab work, Xrays, etc? Too little information is being given on the cost side of the equation.

3) Sample bias can occur due to geography (tertiary academic centers vs rural hospitals for instance) where male physicians work is "less desirable" locations that don't have as many ancillary services to help them.

 

[tr]

1) Assigned physician doesn't take into account the confounding variables such as use of other consulting services. Maybe the female physician used consulting services far more often to "decrease readmission rates by 4%" but the overall costs increased dramatically? We can't tell from this "study".

2) Yes they do but if the female physicians use them at a far higher level than the male physicians, the cost to the system could be significantly higher, making the cost/benefit ratio untenable over the longer term.

It would also be important to know the cost of ancillary services ordered by the female vs male physicians to determine the overall cost to "decrease readmission by 4%". Did they order far more CT scans, MRIs, lab work, Xrays, etc? Too little information is being given on the cost side of the equation.

True, looks like cost was not an outcome under study here

3) Sample bias can occur due to geography (tertiary academic centers vs rural hospitals for instance) where male physicians work is "less desirable" locations that don't have as many ancillary services to help them.

They adjusted for hospital fixed effects, effectively comparing male and female physicians within the same hospital.

 

[DrCommonSense]

True, looks like cost was not an outcome under study here



They adjusted for hospital fixed effects, effectively comparing male and female physicians within the same hospital.

Interesting but if cost isn't taken into account, the study is largely useless.

If someone spends twice as much on a patient with far more consulting services included with usage of radiology, labs, etc, then the cost/benefit analysis shifts dramatically.

Also, did the female physicians have as many patients on average as male physicians?

How do we know the male physicians didn't hold larger census numbers of patients that could affect their ability to spend the same level of time per each patient. Its far easier to give "personalized" care if you have fewer patients but far fewer people will be treated.

 

[tr]

Interesting but if cost isn't taken into account, the study is largely useless.

If someone spends twice as much on a patient with far more consulting services included with usage of radiology, labs, etc, then the cost/benefit analysis shifts dramatically.

Also, did the female physicians have as many patients on average as male physicians?

How do we know the male physicians didn't hold larger census numbers of patients that could affect their ability to spend the same level of time per each patient. Its far easier to give "personalized" care if you have fewer patients but far fewer people will be treated.

They adjusted for patient volume (number of hospitalized Medicare patients each physician treated annually).
You could also, y'know, read the paper. It's free. Link is in the general-media article above but here it is again.

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255



By the way, regarding your concern about the 'PC police,' there are certainly many articles that accurately report outcome differences favoring men in various fields. For example, male academics generally publish more papers than female academics and that's been pretty thoroughly documented.

http://onlinelibrary.wiley.com/doi/10.1093/ei/cbg027/abstract
http://psycnet.apa.org/journals/psp/39/5/896/
http://www.jstor.org/stable/2096282?seq=1#page_scan_tab_contents

Who are the 'PC police' and why should they be uniquely concerned with physicians?

 

[----x----]

I don't mind assuming the study is correct and looking at the implications of that. It's important to know if it's inherently flawed so perhaps is not worth thinking about, but from what I looked at it seems to give some data that is worth considering.

It wouldn't show that patients of female physicians in general do better than patients of male physicians. It is looking at medicare patients who are hospitalized and being treated by an internist. So all the patients I've seen at the oncology clinic I work at bringing this up - well it doesn't directly apply to their physician but is worth considering.

What does this do for me personally as I start medical training? Well - nothing much really. I'm male, but unfortunately this study is just that first step saying there may be a patient outcome disparity. As the authors rightly mention, the next steps are to look into reasons behind the disparity though this will likely be less of a data analytic perspective and more of a psycho-social or anthropological paper.

If there comes a paper which outlines ways in which female physicians outperform their male counterparts I'll eagerly read it, as I'd of course prefer my own patients not to suffer the consequences of my gender should that impair my judgement or quality of practice in some way.

Thank you for linking this, I hadn't read the primary paper before this.

 

[DrCommonSense]

They adjusted for patient volume (number of hospitalized Medicare patients each physician treated annually).
You could also, y'know, read the paper. It's free. Link is in the general-media article above but here it is again.

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255



By the way, regarding your concern about the 'PC police,' there are certainly many articles that accurately report outcome differences favoring men in various fields. For example, male academics generally publish more papers than female academics and that's been pretty thoroughly documented.

Determinants of Scholarly Productivity among Male and Female Economists
http://psycnet.apa.org/journals/psp/39/5/896/
Rank Advancement in Academic Careers: Sex Differences and the Effects of Productivity on JSTOR

Who are the 'PC police' and why should they be uniquely concerned with physicians?

It's very OBVIOUS the difference in the TONE of the articles being published.

For instance, when female physicians SUPPOSEDLY produce better mortality outcomes, the general TONE of the article is basically "wow women are great and better than men".

When an article states that male academics PUBLISH more than female academics, well thats a big "injustice that must be corrected due to sexism".

See the difference?

 

[DokterMom]

There's just so many confounding variables it's hard to really draw much out of this. I found it strange that they float the idea that females spend more time counseling patients as a likely reason for their results yet the things that counseling would seemingly matter most (like CHF) have mortality and readmission rates that aren't even statistically significant meanwhile sepsis was significant... so at least in that portion I think they're talking out their ass

Counseling is only one area where better communication skills might have an impact. I'd suggest that counseling is the most obvious answer, but not necessarily the most important answer. Half of communication is listening (if not more), and this is an area where, IMO, most women far surpass most men.

N=1 but as a female patient, I can't tell you how many times my relatively minor and/or non-specific symptoms have been discounted, downplayed and even ignored altogether by male physicians. This has almost never happened with female doctors. I'd even go so far as to suggest that female physicians would be more inclined (on average) to believe what their patients are telling them and look a little harder for an explanation. So better results for sepsis? Doesn't surprise me in the least.

 

[DrCommonSense]

Counseling is only one area where better communication skills might have an impact. I'd suggest that counseling is the most obvious answer, but not necessarily the most important answer. Half of communication is listening (if not more), and this is an area where, IMO, most women far surpass most men.

N=1 but as a female patient, I can't tell you how many times my relatively minor and/or non-specific symptoms have been discounted, downplayed and even ignored altogether by male physicians. This has almost never happened with female doctors. I'd even go so far as to suggest that female physicians would be more inclined (on average) to believe what their patients are telling them and look a little harder for an explanation. So better results for sepsis? Doesn't surprise me in the least.

Interesting how we now can define male physicians as "poor listeners" who "discount their patients complaints" compared to supposedly "compassionate" female physicians.

Imagine me reversing this statement about female's being emotional hormonal wrecks that can't hold up to the rigors of being on call or more stressful specialities in medicine?

Or women lack to upper body strength to do Orthopedic surgery due to lack of testosterone, making them worse physicians that shouldn't generally go into that field.

I guess its only "sexist" when we disparage women though based on gender stereotypes? Making all kinds of negative statements based upon gender norms when it comes to men is perfectly fine.

Feminism 101

 

[DokterMom]

Interesting how we now can define male physicians as "poor listeners" who "discount their patients complaints" compared to supposedly "compassionate" female physicians.

Imagine me reversing this statement about female's being emotional hormonal wrecks that can't hold up to the rigors of being on call or more stressful specialities in medicine?

Or women lack to upper body strength to do Orthopedic surgery due to lack of testosterone, making them worse physicians that shouldn't generally go into that field.

I guess its only "sexist" when we disparage women though right based on gender stereotypes? Making all kinds of negative statements based upon gender norms when it comes to men is perfectly fine.

Feminism 101

Of course, not all men are poor listeners and not all women are good listeners (never said they were), but as a general rule, men are less inclined to listen carefully to women in particular, and I feel this tendency has the potential to greatly compromise quality of care.

There are numerous studies on communication differences between genders (many, many more if you'd care to look) --

http://www.economist.com/blogs/prospero/2014/07/conversation-and-sexes
Gender Styles in Computer Meditated Communication
Why men are prone to interrupting women
https://www.napequity.org/nape-content/uploads/R1e-Gender-Communications-Quiz.pdf

 

[DrCommonSense]

Of course, not all men are poor listeners and not all women are good listeners (never said they were), but as a general rule, men are less inclined to listen carefully to women in particular, and I feel this tendency has the potential to greatly compromise quality of care.

There are numerous studies on communication differences between genders (many, many more if you'd care to look) --

http://www.economist.com/blogs/prospero/2014/07/conversation-and-sexes
Gender Styles in Computer Meditated Communication
Why men are prone to interrupting women
https://www.napequity.org/nape-content/uploads/R1e-Gender-Communications-Quiz.pdf

There are numerous studies that women have poor upper body stength compared to men on average by a LARGE measure.

Gender differences in strength and muscle fiber characteristics. - PubMed - NCBI

So by that logic, women should avoid Orthopedics due to their inability to perform the job as well compared to men. So in general, due to their poor upper body function, women should AVOID fields such as Orthopedic surgery that require significant physical strength.

Right?

 

[DokterMom]

There are numerous studies that women have poor upper body stength compared to men on average by a LARGE measure.

Gender differences in strength and muscle fiber characteristics. - PubMed - NCBI

So by that logic, women should avoid Orthopedics due to their inability to perform the job as well compared to men. So in general, due to their poor upper body function, women should AVOID fields such as Orthopedic surgery that require significant physical strength.

Right?

Women should avoid surgeries for which they personally lack sufficient physical strength - yes. (duh?)

 

[DrCommonSense]

Women should avoid surgeries for which they personally lack sufficient physical strength - yes. (duh?)

Yes so since most Ortho surgeries require significant upper body strength, men are more suitable for that role right?

So women should go into peds due to their compassion and men into ortho due to their physical strength.

Makes sense. Thanks for clarifying that for me.

 

[ldiot]

Yes so since most Ortho surgeries require significant upper body strength, men are more suitable for that role right?

So women should go into peds due to their compassion and men into ortho due to their physical strength.

Makes sense. Thanks for clarifying that for me.

When it comes to areas that men excel in they want to be treated equal, but in areas that they excel then they have 18 studies on hand to drill it into your head.

The funny thing is that she is basically saying the women are best suited for peds and psych, two fo the lowest paid specialties. I guess that's a fair and reasonable explanation for any sort of gender pay gap; turns out it's not discrimination. I'm glad she has cleared this up for us.

 

[DrCommonSense]

When it comes to areas that men excel in they want to be treated equal, but in areas that they excel then they have 18 studies on hand to drill it into your head.

The funny thing is that she is basically saying the women are best suited for peds and psych, two fo the lowest paid specialties. I guess that's a fair and reasonable explanation for any sort of gender pay gap; turns out it's not discrimination. I'm glad she has cleared this up for us.

The hypocrisy of feminism is ENDLESS.

My comment just takes their arguments about "compassion" to the logical conclusion.

However, once they realize this makes them "relegated" to the "lower paid" specialities, they will immediately claim its sexism in the next breath.

So there is no real attempt at "equality" with this stuff but really supremacy. Equalize the stuff they are weak at and keep the BENEFITS of the stuff they are traditionally better at.

This is common among feminists with divorce laws, affirmative action in schooling, hostility towards males in academia, etc.

 

[ldiot]

The hypocrisy of feminism is ENDLESS.

My comment just takes their arguments about "compassion" to the logical conclusion.

However, once they realize this makes them "relegated" to the "lower paid" specialities, they will immediately claim its sexism in the next breath.

So there is no real attempt at "equality" with this stuff but really supremacy. Equalize the stuff they are weak at and keep the BENEFITS of the stuff they are traditionally better at.

This is common among feminists with divorce laws, affirmative action in schooling, hostility towards males in academia, etc.

I agree. Over 90% of the population supports equality in opportunity and treatment between men and women, but under 15% support feminism. The fact of the matter is that feminism has nothing to do with equality and most people have already realized this.

This isn't to say that our society is without discrimination, but my point is that this extreme, entitled, man-hating wave of feminism is probably hurting the cause more than helping. A lot of women who have adopted these views are quite honestly miserable and unhappy with their life. Perhaps they merely want to blame an external factor (the "patriarchy"), rather than take personal responsibility for their own circumstances, actions, and decisions.

 

[MBVT]

Whether the study was biased or totally accurate I am not in a position to say, but as a male I choose not to go to any female physician for anything that potentially involves intimate exposure. Why? Not because I object to the physician herself but rather because so many female physicians ambush their male patients by bringing in female chaperones, oftentimes low level non-professional clerical workers, medical assistants, or CNA's. That turns it into a spectator sport and I will not be a participant in that indignity. If you want a witness to protect you from claims of impropriety, then bring in a male chaperone. Until that starts happening, I will continue to go to male physicians.

 

[Smurfette]

Whether the study was biased or totally accurate I am not in a position to say, but as a male I choose not to go to any female physician for anything that potentially involves intimate exposure. Why? Not because I object to the physician herself but rather because so many female physicians ambush their male patients by bringing in female chaperones, oftentimes low level non-professional clerical workers, medical assistants, or CNA's. That turns it into a spectator sport and I will not be a participant in that indignity. If you want a witness to protect you from claims of impropriety, then bring in a male chaperone. Until that starts happening, I will continue to go to male physicians.

That's interesting. I generally never use a chaperone. The exception is a male patient who makes me feel uncomfortable enough for me to go find someone (maybe happens once a year; it's more likely that I get uncomfortable during/after the exam after there's an inappropriate comment made to me but by then it's over.). However, the issue is more that physician support staff is likely all female in the office, so there are no male options as chaperones. I can't think offhand of a single doctor I know with a male RN or MA in their office. Obviously they exist, but they are vastly outnumbered.

 

[MBVT]

Smurfette, I hear you and don't blame you for having a chaperone if a guy makes you uncomfortable. I don't doubt but that all female physicians have had their share of creeps, but far too many female physicians just automatically use chaperones for male patient intimate exams as a matter of course. That most practices won't hire any male staff is on them, rather than something the patient has to accept as OK. There aren't enough male RN's and such out there, but I suspect any physician that wanted to have m/f staff diversity so as to better serve a diverse patient pool would be able to do such.

So lady physicians, hire a male staff member or two and you'll likely see more male patients coming your way. It may not sound rational to you, but for many guys there is a huge comfort difference between one woman in the room and two, especially if the 2nd one is mostly just watching the 1st one (you) doing the exam or procedure.

 

[DrCommonSense]

Whether the study was biased or totally accurate I am not in a position to say, but as a male I choose not to go to any female physician for anything that potentially involves intimate exposure. Why? Not because I object to the physician herself but rather because so many female physicians ambush their male patients by bringing in female chaperones, oftentimes low level non-professional clerical workers, medical assistants, or CNA's. That turns it into a spectator sport and I will not be a participant in that indignity. If you want a witness to protect you from claims of impropriety, then bring in a male chaperone. Until that starts happening, I will continue to go to male physicians.

Interesting perspective.