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The article does provide a explanation that would seem to correspond to the result. > Still, she adds, the study raises many troubling questions about the trea

The article does provide a explanation that would seem to correspond to the result. > Still, she adds, the study raises many troubling questions about the treatment of women in the ER, “like the concern there’s a systematic bias where male physicians are not listening to female patients’ complaints as readily as [those of] a man.” Simply put, if social conditioning causes men to take the concerns of male patients more seriously than female patients (OR inversely, social conditioning makes female patients less likely to share potentially relevant information with male doctors in the first place), it would explain the difference pretty easily. Personally, I always prefer to have a female doctor when given the option. My theory is that even if only 0.1% of male doctors harbor a bias against female patients, and even if it's only a mild bias in most cases, I can avoid that chance pretty much completely by going to a female doctor. I guess it's possible for female doctors to be sexist against women, but it seems very unlikely given that most female doctors themselves would have experienced sexism against women at some point and thus would be more aware of it and more invested in overcoming it.

olavk 8y ago
But shouldn't this effect be across all health issues then, not just heart attacks?
- sudosteph 8y ago
  Yes, and I have strong feeling it probably is. It's a hard statistic to measure in other fields though. Fatalities due to heart failure are pretty open and shut. For other conditions, especially in fields such as psychiatry, the effect of doctors not taking the symptoms of women seriously is more likely to manifest in the form of misdiagnoses, which can't be easily detected or tracked. Furthermore, many criteria for diagnosing diseases were developed based on primarily male subjects, so some conditions (such as autism-spectrum disorders) are somewhat underdiagnosed in women due to confusion over presentation in female patients. That isn't necessarily the doctor's fault, but the outcome can make it hard to distinguish whether the fault is with a doctor who dismissed a patient's symptoms due to sex, or whether it's just insufficient diagnostic criteria.
- Avshalom 8y ago
  as another point of data: https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562 https://www.health.harvard.edu/blog/women-and-pain-dispariti...
jerf 8y ago
"Simply put, if social conditioning causes men to take the concerns of male patients more seriously than female patients (OR inversely, social conditioning makes female patients less likely to share potentially relevant information with male doctors in the first place), it would explain the difference pretty easily." But given the opprobrium currently attached to labeling someone "SEXIST" in our society, personally I'd like to see a bit more evidence, and some alternate explanations explored and ruled out, before we start wheeling that one out and tarring people with it. The other problem with that is more practical... if it "truly is" sexism, then you also foreclose any chance of fixing it, because there's just no way you're going to go to doctors and make them precisely 10% less sexist than they are now. But if it is in fact something else, it may be fixable. (Or illusory.)
- sudosteph 8y ago
  Lots of people have biases that they don't realize can impact the quality of their interactions. There's a frequent issue where people who speak English as their second language are more likely to be perceived as less intelligent. Certain thick regional accents also can cause that issue. Part of the educational process for all professionals, especially doctors, includes learning to monitor for potential prejudices like that and taking steps to ensure it does not impact your ability to deliver high quality care (ie, ask more questions or have a colleague review your work if you are unsure). I'm not tar and feathering people. But when women in our society are constantly saying "Some men don't take me as seriously as my male counterparts despite my equal (or superior) credentials" then maybe there is some truth to that which can bleed over professional interactions in hospitals as well? I've experienced it first hand myself professionally (never been to the ER) only a handful of times, but I don't think it's the norm, and I don't go into professional situations with men assuming it will happen. Still, when it happens, it sucks and I wish other men would talk to those guys and tell them why it sucks so those guys will do better. We've gone a long way towards making sexism less of a problem for everyday women. Just because there are a few examples of it that have slipped by doesn't mean we give up. We just know more of what to watch out for.
  - jerf 8y ago
Waterluvian 8y ago
I also wonder if it might be because men are trained to complain less and "man up". But the whole concept of "hysteria" has a long medical history so we certainly can't ignore that very possible reality.
- chiefalchemist 8y ago
  Actually. I think it's the opposite in this case. That is, these are heart attacks that end up in __ER__ not all HA's. The bias is that women don't have HT's so __if__ they end up in ER then it's likely to be bad.
- orhmeh09 8y ago
  Can you explain what you mean by hysteria and provide some salient evidence, please?
  - Waterluvian 8y ago
    Sure. "Hysteria" being a nonsense medical diagnosis from the past that's basically the poster child for sexism in medicine (https://en.wikipedia.org/wiki/Female_hysteria https://en.wikipedia.org/wiki/Female_hysteria). I bring it up because I'm suggesting that one possible explanation is that maybe this study is revealing yet remaining sexism in medicine. Just like the whole nonsense concept of hysteria, maybe professionals still discriminate by assuming women are just being "hysterical". Not consciously, but more as an artifact of western medicine and society. I also strongly reccommend this fantastic podcast about the topic: http://www.maximumfun.org/sawbones/sawbones-hysteria http://www.maximumfun.org/sawbones/sawbones-hysteria I hope this satisfies your question. I suspect I was just not clear enough that I was not legitimately suggesting hysteria as an actual explanation.
    - orhmeh09 8y ago
      Thank you, this podcast episode looks worthwhile. I did misread your intent, I’m afraid; otherwise the history of hysteria is familiar to me.
acqq 8y ago
Note, also from the article: "In the new study everyone was more likely to survive if they saw a female physician, and a study(1) published last year in JAMA Internal Medicine indicated all patients of female physicians had lower mortality and hospital readmission rates. “It seems that the female doctors practice in a better way or outperform male doctors,” says the JAMA study’s first author, Yusuke Tsugawa, an assistant professor of medicine at the David Geffen School of Medicine at University of California, Los Angeles." 1) https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255 https://jamanetwork.com/journals/jamainternalmedicine/fullar...
- Izkata 8y ago
  That directly contradicts this: > The researchers divided 500,000-plus cases into four categories: male doctors treating men; male doctors treating women; female doctors treating men; and female doctors treating women. “All of those are statistically indistinguishable except for male doctor–female patient,” says Brad Greenwood, an author on the study and a data scientist at the University of Minnesota.
  - magicalist 8y ago
    > That directly contradicts this No, it just means in this study's data, there was no statistically significant signal that there was a difference between the groups treated by a male doctor vs a female doctor. That doesn't mean there's not a difference in outcomes, just that one isn't suitably demonstrated by this data, but it's also a result over a completely different subset of the population than was looked at by the study in the GP's link (which was of hospitalized Medicare patients age 65 or over).
  - tedsanders 8y ago
    Actually if you look at their full sample data you'll see that women physicians had higher survival rates for both make and female patients. It's just that only female patients were statistically different from zero. And note that just because female-female was statistically significant and female-male was not, that doesn't by itself imply that female-female was statically distinguishable from female-male. (Though it may have been, I don't understand all the controls.)

olavk 8y ago

But shouldn't this effect be across all health issues then, not just heart attacks?

sudosteph 8y ago
Yes, and I have strong feeling it probably is. It's a hard statistic to measure in other fields though. Fatalities due to heart failure are pretty open and shut. For other conditions, especially in fields such as psychiatry, the effect of doctors not taking the symptoms of women seriously is more likely to manifest in the form of misdiagnoses, which can't be easily detected or tracked. Furthermore, many criteria for diagnosing diseases were developed based on primarily male subjects, so some conditions (such as autism-spectrum disorders) are somewhat underdiagnosed in women due to confusion over presentation in female patients. That isn't necessarily the doctor's fault, but the outcome can make it hard to distinguish whether the fault is with a doctor who dismissed a patient's symptoms due to sex, or whether it's just insufficient diagnostic criteria.
Avshalom 8y ago
as another point of data: https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562 https://www.health.harvard.edu/blog/women-and-pain-dispariti...

jerf 8y ago

"Simply put, if social conditioning causes men to take the concerns of male patients more seriously than female patients (OR inversely, social conditioning makes female patients less likely to share potentially relevant information with male doctors in the first place), it would explain the difference pretty easily." But given the opprobrium currently attached to labeling someone "SEXIST" in our society, personally I'd like to see a bit more evidence, and some alternate explanations explored and ruled out, before we start wheeling that one out and tarring people with it. The other problem with that is more practical... if it "truly is" sexism, then you also foreclose any chance of fixing it, because there's just no way you're going to go to doctors and make them precisely 10% less sexist than they are now. But if it is in fact something else, it may be fixable. (Or illusory.)

sudosteph 8y ago
Lots of people have biases that they don't realize can impact the quality of their interactions. There's a frequent issue where people who speak English as their second language are more likely to be perceived as less intelligent. Certain thick regional accents also can cause that issue. Part of the educational process for all professionals, especially doctors, includes learning to monitor for potential prejudices like that and taking steps to ensure it does not impact your ability to deliver high quality care (ie, ask more questions or have a colleague review your work if you are unsure). I'm not tar and feathering people. But when women in our society are constantly saying "Some men don't take me as seriously as my male counterparts despite my equal (or superior) credentials" then maybe there is some truth to that which can bleed over professional interactions in hospitals as well? I've experienced it first hand myself professionally (never been to the ER) only a handful of times, but I don't think it's the norm, and I don't go into professional situations with men assuming it will happen. Still, when it happens, it sucks and I wish other men would talk to those guys and tell them why it sucks so those guys will do better. We've gone a long way towards making sexism less of a problem for everyday women. Just because there are a few examples of it that have slipped by doesn't mean we give up. We just know more of what to watch out for.
- jerf 8y ago

Waterluvian 8y ago

I also wonder if it might be because men are trained to complain less and "man up". But the whole concept of "hysteria" has a long medical history so we certainly can't ignore that very possible reality.

chiefalchemist 8y ago
Actually. I think it's the opposite in this case. That is, these are heart attacks that end up in __ER__ not all HA's. The bias is that women don't have HT's so __if__ they end up in ER then it's likely to be bad.
orhmeh09 8y ago
Can you explain what you mean by hysteria and provide some salient evidence, please?
- Waterluvian 8y ago
  Sure. "Hysteria" being a nonsense medical diagnosis from the past that's basically the poster child for sexism in medicine (https://en.wikipedia.org/wiki/Female_hysteria https://en.wikipedia.org/wiki/Female_hysteria). I bring it up because I'm suggesting that one possible explanation is that maybe this study is revealing yet remaining sexism in medicine. Just like the whole nonsense concept of hysteria, maybe professionals still discriminate by assuming women are just being "hysterical". Not consciously, but more as an artifact of western medicine and society. I also strongly reccommend this fantastic podcast about the topic: http://www.maximumfun.org/sawbones/sawbones-hysteria http://www.maximumfun.org/sawbones/sawbones-hysteria I hope this satisfies your question. I suspect I was just not clear enough that I was not legitimately suggesting hysteria as an actual explanation.
  - orhmeh09 8y ago
    Thank you, this podcast episode looks worthwhile. I did misread your intent, I’m afraid; otherwise the history of hysteria is familiar to me.

acqq 8y ago

Note, also from the article: "In the new study everyone was more likely to survive if they saw a female physician, and a study(1) published last year in JAMA Internal Medicine indicated all patients of female physicians had lower mortality and hospital readmission rates. “It seems that the female doctors practice in a better way or outperform male doctors,” says the JAMA study’s first author, Yusuke Tsugawa, an assistant professor of medicine at the David Geffen School of Medicine at University of California, Los Angeles." 1) https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255 https://jamanetwork.com/journals/jamainternalmedicine/fullar...

Izkata 8y ago
That directly contradicts this: > The researchers divided 500,000-plus cases into four categories: male doctors treating men; male doctors treating women; female doctors treating men; and female doctors treating women. “All of those are statistically indistinguishable except for male doctor–female patient,” says Brad Greenwood, an author on the study and a data scientist at the University of Minnesota.
- magicalist 8y ago
  > That directly contradicts this No, it just means in this study's data, there was no statistically significant signal that there was a difference between the groups treated by a male doctor vs a female doctor. That doesn't mean there's not a difference in outcomes, just that one isn't suitably demonstrated by this data, but it's also a result over a completely different subset of the population than was looked at by the study in the GP's link (which was of hospitalized Medicare patients age 65 or over).
- tedsanders 8y ago
  Actually if you look at their full sample data you'll see that women physicians had higher survival rates for both make and female patients. It's just that only female patients were statistically different from zero. And note that just because female-female was statistically significant and female-male was not, that doesn't by itself imply that female-female was statically distinguishable from female-male. (Though it may have been, I don't understand all the controls.)