Women Die More from Heart Attacks Than Men Unless ER Doc Is Female

https://www.scientificamerican.com/article/women-die-more-from-heart-attacks-than-men-unless-er-doc-is-female/

by draenei • 8 years ago

214 153 8 years ago

aszantu• 8 years ago

There is a case where test animals in laboratories have more stress when a male human is there, compared to female humans.

https://www.nature.com/articles/nmeth.2935

tomp• 8 years ago

Interesting. Could it be pheromones? Or maybe the combination of men sweating more (I actually don't know if that's true, maybe it's just my bias, as I'm a male and men generally smell worse to me than women) and women having a better sense of smell. Or maybe men are more prone to stress (I don't necessarily mean negative stress, men also seem to prefer positive stress, i.e. adrenaline-filled activities), and animals/humans smell that...

jules• 8 years ago

In my experience male chickens act more aggressively to male humans than female humans. I think they are aware of our sex.

cimmanom2• 8 years ago

Another possibility is that women are socialized to move more "gracefully" (i.e. less suddenly) than men; and their body language is thus less threatening to animals.

rossdavidh4• 8 years ago

I absolutely believe that male doctors (in America, anyway, the only place I have experience) may be less receptive to hearing patients' symptoms and issues, but: "...about 11.9 percent of the time overall—but the research team found women with heart attacks will die about 12.4 percent of the time if their cases are handled by male doctors" My first thought on reading that was, 0.5 percent is not a huge number, and is the kind of "difference" that could easily fail to replicate.

maxxxxx• 8 years ago

0.5% difference seems a little questionable to draw conclusions. Agreed.

UncleMeat• 8 years ago

Why? With a sufficient sample size you can demonstrate even low power effects. The magnitude of the difference does not prevent good scientific analysis at all.

random3• 8 years ago

0.5% is not irrelevant when you talk about deaths. Statistically if you consider the sample size and significance (P = 0.001) it actually looks very non questionable. https://jamanetwork.com/journals/jamainternalmedicine/fullar...

chc• 8 years ago

I feel like our impressions might be slightly thrown off by the fact that the two numbers are percentages. It's a difference of 0.4 percentage points, but that works out to a 4.2% increase in mortality, which seems a bit more substantial.

opencl• 8 years ago

The other interpretation of those stats is that women with male doctors are 4% more likely to die (0.5/11.9), which looks like a pretty meaningful difference. And the sample size is pretty huge especially by medical study standards at over 500k patients.

nialv7• 8 years ago

A small difference can still be statistically significant.

jwaggie• 8 years ago

The preceding sentence says "If a heart attack patient is a woman and her emergency physician is a man, he says, her risk of death suddenly rises by about 12 percent."

The 11.9 percent mentioned in your quote refers to probability of death for the population (i.e. a random person where the gender of the patient and the doctor is unknown).

The 12.4 percent refers to probability of death for a woman given a male doctor. If that is 12 percent higher, as the quote above says, then the probability of death for a woman given a female doctor is about 11.07%

So its an increase of 1.3 percentage points. The article kind of obfuscates that though.

autokad• 8 years ago

I am willing to bet once you account for other things, such as geography, the effect goes away.

Look at the map at the end. It clearly shows women being higher percentage in areas that have better mortality rates for heart disease which are both heavily influenced by access (response time) to medical care and other socioeconomic factors

this is not perfect, but it shows that other factors are probably more likely to be the reason other than jumping to conclusions about which sex is a better doctor.

https://www.kff.org/other/state-indicator/medical-school-gra...

ilove_banh_mi• 8 years ago

Not clear whether the slight death-rate difference while in ER carries over to the 5-year survival rate, which favors men over women by a large factor.

olavk2• 8 years ago

This is really fascinating (and troubling) statistics, but I can imagine what the explanations can be? Some of the possible explanations suggested in the article does not seem to correspond to the result. For example, if female doctors are better in general, then it should also affect the survival rate of male patients. If current medical research favors male patients, then it should affect the survival rate regardless of the gender of the doctor. If you are better at treating your own gender, then it should also affect women doctors treating men.

whateveracct3• 8 years ago

I don’t have sources but I remember reading that heart issues manifest differently in women than men and that women weren’t taken as seriously when explaining their symptoms (indicative of heart issues) to male docs. I think that would explain why the reverse situation doesn’t arise.

heartbreak• 8 years ago

Like this [0] issue, but for heart problems specifically? How pervasive is this...

[0] https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi...

sudosteph5• 8 years ago

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.

olavk2• 8 years ago

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

jerf2• 8 years 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.)

Waterluvian2• 8 years 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.

acqq• 8 years 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/fullar...

skywhopper• 8 years ago

I'm guessing it's a combination. Heart attack signs and symptoms are different for men and women. But most of the awareness and training, especially in the past, has been more focused on the typically male symptoms.

Add to that the likely facts that 1) women doctors are, on average, more recently trained than men doctors; 2) women doctors are probably far more likely to be aware of the differences in symptoms between the traditionally discussed symptoms and those that are specific to women, simply from a self-interest perspective; 3) men are likely to be a higher percentage of heart attack patients, so the effect of fewer men being as aware of women-specific symptoms of heart attacks would be amplified by the relative frequency of the occurrences (ie, they see few female heart attacks and so the differences in appropriate treatment are less likely to sink in with someone who doesn't have a personal awareness ("what if this were me having the heart attack?")).

But yes I agree it's too bad these topics were skipped in the article in favor of less likely differences (such as "women are better doctors"--something that I wonder if it's controlled for age, but might just be the effect of the fact that women who do make it through medical school and continue to practice are probably just far more driven and serious about the career than similar men, because the obstacles women face in reaching the same point in their career are much higher, so the women who do make it through will naturally be better doctors than the "average" man doctor).

klodolph4• 8 years ago

You're discussing things which are discussed in the abstract of the linked study... which makes it all the more frustrating that these things are omitted from the article.

Patients treated by female physicians had lower 30-day mortality (adjusted mortality, 11.07% vs 11.49%; adjusted risk difference, –0.43%; 95% CI, –0.57% to –0.28%; P < .001; number needed to treat to prevent 1 death, 233) and lower 30-day readmissions (adjusted readmissions, 15.02% vs 15.57%; adjusted risk difference, –0.55%; 95% CI, –0.71% to –0.39%; P < .001; number needed to treat to prevent 1 readmission, 182) than patients cared for by male physicians, after accounting for potential confounders.

smogcutter• 8 years ago

2) women doctors are probably far more likely to be aware of the differences in symptoms between the traditionally discussed symptoms and those that are specific to women, simply from a self-interest perspective;

Meanwhile here we are on a forum of randos from the internet, and half the thread is people noting that heart attacks have different symptoms in men and women. So what's the doctor's excuse?

I'm not saying this to argue with you, I mostly agree. The point is if that's the explanation, it's a pretty pitiful one.

cimmanom2• 8 years ago

Heart attack symptoms differ in men and women. The most common ones in men (chest and left arm pain) are less common in women.

Perhaps female doctors are more likely to be familiar with the symptoms of heart attack in women.

Additionally, I think there's a stereotype of a heart attack being a male affliction (probably because the difference in symptoms led to underdiagnosis in women in the mid-20thC). It's conceivable that male doctors are less likely to consider heart attack as a diagnosis for a woman even when the symptoms are typical of a heart attack?

jewelthief91• 8 years ago

I'm curious what people would propose we do about this? What if it turns out that doctors of the same ethnic group treat their co-ethnics better, even if it isn't conscious? I fear the conclusion people will draw is just a new form of segregation in every area of life.

whateveracct3• 8 years ago

Train them better. There’s nothing inherent about these studies’ results. Doctors are well-educated human beings and are capable of correcting for their subconscious biases.

geofft2• 8 years ago

If that is true (which I think there isn't a real reason to believe a priori, but sure, it's a possible hypothesis), I feel like I'd prefer a world where more people live to a world with less segregation, if I had to choose.

skybrian2• 8 years ago

Or maybe it's an argument in favor of diversity:

"The male doctors in their study were better at treating women with heart attacks when they had more experience treating such patients—and especially when they worked in hospitals with more female doctors. This suggests that whatever female doctors are doing that’s better is also transferable."

https://www.theatlantic.com/science/archive/2018/08/women-mo...

Rapzid• 8 years ago

"These differences persisted even after the team accounted for factors like the doctors’ years of experience.."

So, I'm having a little bit of trouble reconciling these two statements. Who are "such patients" and why wouldn't doctors with more years of experience have more experience treating them?

h4b4n3r0• 8 years ago

Try to replicate in a more rigorous statistical setting. Do nothing until the result is replicated. I’d be willing to bet a significant amount of money that this result is due to a missed latent variable (or a few) that explains everything without making it seem like gender is causal to the outcome.

whack• 8 years ago

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,”
Female doctors may also simply be performing at least some parts of the job better than their male counterparts do. In the new study everyone was more likely to survive if they saw a female physician, and a study published last year in JAMA Internal Medicine indicated all patients of female physicians had lower mortality and hospital readmission rates.

Both of the above findings are at least somewhat contradictory, given that the first study found no statistical difference between male-patient-outcomes when being treated by male vs female doctors. Before jumping to conclusions, I think it's worth studying this effect more rigorously first. The female cardiologist they quoted said it best:

It is a little early to say male physicians have trouble treating female heart attack patients based on these data alone, says Michelle O’Donoghue, a cardiologist at Brigham and Women’s Hospital and Harvard Medical School who did not work on the new study. “Spurious signals sometimes come up [in research], so this should be replicated,”

Or as xkcd would put it: https://xkcd.com/882/

omginternets• 8 years ago

Haven't RTFAed (on mobile with shit internet). Does the gender of the ER doc effect a change in male mortality rates as well?

jabagawee• 8 years ago

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. If a heart attack patient is a woman and her emergency physician is a man, he says, her risk of death suddenly rises by about 12 percent.

PurpleBoxDragon4• 8 years ago

I wanted to look at the actual numbers and see how close the findings were, but I don't see the study linked nor the title of the study (I do see a different study, but it isn't the one those numbers are from).

A different article someone else linked seemed to have the study, but it is behind a pay wall.

http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115

This seems to have the actual numbers though.

http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...

I'm having trouble grasping how to read the tables (especially given it seems Female Physician Female Patient is repeated twice on tables S2 and S3, but I think that is just a title error.

Here are the numbers, best as I can grasp.

S2 is full, S3 is matched

Mean then standard deviation.

    M/MS2:.881/.114
    M/MS3:.870/.124
    M/FS2:.854/.353
    M/FS3:.861/.121
    F/MS2:.887/.120
    F/MS3:.867/.130
    F/FS2:.857/.116
    F/FS3:.862/.112

Figure S2 looks interesting (M/F and F/F seem equal while M/M seems better than F/M), but I'm not sure what the real axis are.

Edit: formatting

TazeTSchnitzel• 8 years ago

This is an area which exposes how subconscious discrimination is itself a significant problem, not just overt sexism. Doctors who don't take women's reported symptoms as seriously results in more women dying, without any malice or intentional discrimination.

simion314• 8 years ago

Your assumption is possible to be true but is not the only possible cause and the article it is very clear about the conclusions, as an example someone linked in this comments some differences were notices with animals too.

toomuchtodo• 8 years ago

An objective test would fix the problem (removing subconscious bias).

https://newsroom.heart.org/news/more-sensitive-blood-test-di...

A new high-sensitivity blood test for heart attacks successfully diagnosed heart attacks faster and more accurately in the emergency room than the existing test.
The new high-sensitivity blood test for cardiac troponin, given in a hospital emergency room, was also found to be safe and effective. When patients present to emergency rooms with heart attack symptoms, doctors assess them in part by using a cardiac troponin test to measure a protein released into the blood when the heart is damaged.
“We did not miss any heart attacks using this test in this population,” said lead author Rebecca Vigen, M.D., M.S.C.S., a cardiologist at the University of Texas Southwestern Medical Center. “The test also allowed us to determine faster that many patients who had symptoms of a heart attack were not having a heart attack than if we had relied on the traditional test.”

I would even advocate for this test being administered by EMTs and other first responders, instead of waiting until the patient arrives at the ER.

gammateam3• 8 years ago

Put another way, a heart attack patient dies in the ER about 11.9 percent of the time overall—but the research team found women with heart attacks will die about 12.4 percent of the time if their cases are handled by male doctors.

Isn't this a very dangerous headline? A 0.5% difference?

What are your thoughts on this

modells• 8 years ago

In addition to a tendency towards arrogance, doctors hold unconscious biases like everyone. Unsurprising.

Anecdotally, I recently had a same-gender doctor recount his glory day (just one day) in the ER solving a hypertensive crisis by syringe bloodletting onto the floor and tell me that my autonomic dysreflexia was “all in my head,” and that fixing stress was the panacea. Meanwhile myoclonus, nystagmus, anhedonia, (autoimmune?) inflammation/swelling, tremors keep getting worse. Thanks doc, you really solved everything.

wahern3• 8 years ago

Patients also hold unconscious biases. Perhaps patients, especially women, are more equivocal in their accounts when talking to male doctors.

darkerside2• 8 years ago

FTA> There have definitely been several studies that have shown that women are slower to be diagnosed, and that might be explained by the fact that women are more likely to have ‘atypical’ symptoms

Also FTA> Female doctors are more likely to speak with their patients longer and provide more evidence-based care than their male colleagues... This could help them to pick up on heart attacks, even if women have more atypical symptoms.

Seems like women have a naturally higher likelihood of dying from heart attack. This is offset by a higher likelihood of methodical individual care (perhaps at cost of speed) if the doctor happens to be female.

whatshisface3• 8 years ago

This is offset by a higher likelihood of methodical individual care (perhaps at cost of speed) if the doctor happens to be female.

Then why wouldn't the female doctors provide better care for the men as well? The study concluded that the female-female match was better off, not that women were better doctors than men overall.

darkerside2• 8 years ago

Because heart attacks in men are typically more straightforward to diagnose. In women they often require additional diagnostic effort, which coincidentally female doctors are more likely to undertake.

cm21874• 8 years ago

I can't help reading this article, thinking that if you were to swap "male" for "female" and vice versa, this would be an absolute scandal that would trigger a twitter mob and get the author fired for being sexist.

drxzcl3• 8 years ago

If you change the words, you change the meaning.

Let's try and get to the bottom of why the swapped version is meaningfully different. What makes "men" and "women" fundamentally different in this context, so much so that they can't be exchanged without significantly altering the effect of the headline?

cm21874• 8 years ago

The author is basically implying that men are worse at that profession than females because of their natural behavior. Isn't it exactly the sort of arguments that got that google guy fired?

kikokikokiko• 8 years ago

The article states that 3 out of four ER doctors are male.

So, out of 50% of 75% of the sample, they found a very slim, close to noise, discrepancy.

They are not focusing on a very strict group, they are simply taking 60% of the group and comparing it to the rest 40%. A small discrepancy in the data is obviously expected, even on large samples.

The article's author even has the courage of saying that the lack os women working as ER doctors is a sign of a lack of gender equality on medicine. Cmon now. Women make up a larger percentage of medicine graduates over the whole western world. Maybe they simply would prefer to work on less stressful environments than ER and it's not a matter of prejudice?

PC took over the world. Idiocracy is already a reality.

sctb2• 8 years ago

If you're going to post in this thread, please do so according to the guidelines. Eschew flamebait especially.

https://news.ycombinator.com/newsguidelines.html

crazygringo• 8 years ago

There's really not much you can do with this without more investigation.

For example, what about ages? Are male doctors more likely to be older and it's actually a generational effect, say, of not listening? Or to the contrary, are male doctors more likely to be older and more experienced, and riskier female cases are sent to them disproportionately out of some bias towards extra care? If a male has more female colleagues, does this affect his behavior or is this simply because they tend to be better-run institutions in general which already seek to be more diverse?

It feels like there are a million ways it could be sliced, and while I'd totally buy the "men without the influence of women tend to not listen to women or pay as much attention to them" if that were backed up causally... it also seems like it's jumping to a click-baity conclusion whose causality is completely unsubstantiated. (No mention that they also measured how much a patient felt listened to, for example.)

jamra• 8 years ago

I spoke to a doctor about publishing statistics and the major concern with him and his peers was exactly what you mentioned. Riskier cases will make your statistics drop, but the more experienced doctors would almost always get the most difficult cases.

candiodari• 8 years ago

That's not true ... after all, that would mean putting MBA type managers in charge of hospitals (like is being done all across the US) is going to lead to disastrously bad decisions as they will institute individual incentives. Giving those experienced doctors little choice : either refuse cases that might die ... or get fired.

MarkMc• 8 years ago

I wonder what the doctor thinks of publishing risk adjusted statistics. That is, publishing the difference between expected and actual outcome.

ksenzee• 8 years ago

Ed Yong at the Atlantic looked into that:

"These differences persisted even after the team accounted for factors like the doctors’ years of experience and the patients’ age, ethnicity, other diseases, educational level, or the hospitals to which they were admitted."

https://www.theatlantic.com/science/archive/2018/08/women-mo...

epicureanideal• 8 years ago

Years of experience isn't the only way to measure skill. There are software engineers with 20 years experience that aren't as good as one with 2 years experience. I'd like to see the skill levels of the doctors normalized by something else, like whether they can somehow be identified as part of a group that specializes in high risk cases.

PurpleBoxDragon4• 8 years ago

Here is a link to far more specific data from the main study in the article. I suggest people look over the data themselves.

http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...

The data appears to not be in the friendliest of formats (tables with an axis labeled 'X'? No way my professors would've let that slide).

efm• 8 years ago

There's also a mis-labled column in table S2. Which one is Female Doctors Male Patients?

08-152• 8 years ago

Thanks for the link. With that paper in hand, I can say confidently that the Scientific American article is a flat out lie, starting from the headline.

Chart S1 plots the distribution of the predicted probability for survival in four conditions. The distributions for "Male Doc, Female Patient" and "Female Doc, Female Patient" are visually indistinguishable and peak at around 0.96. "Female Doc, Male Patient" peaks at around 0.97, "Male Doc, Male Patient" at 0.98 or so. The difference in the position of the maximum is real, but tiny; the distributions for female patients are much wider (which visually exaggerates the difference). The math seems to agree with my reading, as it says: "when physician gender (male / female) is regressed upon (ŷ), conditional upon controls, there is no significant correlation between ex ante probability of survival and the gender of the physician."

So, dear "Scientific American": It is completely untrue that "Women Die More from Heart Attacks Than Men—Unless the ER Doc Is Female". The data says that "Women Die More from Heart Attacks Than Men—No Matter Who Treats Them" and that "Men Die More from Heart Attacks Than Other Men—When the ER Doc Is Female"

No thanks for turning a study that found tiny differences into a politically charged statement.

But then why would Brad Greenwood, the author of the study, state that "All of those are statistically indistinguishable except for male doctor–female patient", when it's obvious to the naked eye that there are other difference? I guess one difference made it over the arbitrary threshold of significance, and others didn't. That's just the nature of SHIT (Statistical Hypothesis Inference Testing).

dahdum• 8 years ago

I’d also posit that female ER doctors could as a group, simply be better than the average male.

Not inherent to their gender, but because they are a more motivated group to overcome the systemic bias in medicine to get there.

If you get to 50/50 this would mean the stats converge, but the same findings would need to be repeated across other conditions as well.

Axsuul2• 8 years ago

Then we would've seen the same trend with female doctors treating male patients.

sitkack• 8 years ago

I have noticed the same thing in tech. Only the healthiest orgs I been at have had women clustered around the median, most are at least a std deviation above the median.

bsder• 8 years ago

I'd also like to see if the female doctors simply follow the checklist better than male doctors.

ER outcomes have been shown over and over to improve when there is a checklist available and followed.

Axsuul2• 8 years ago

That would only apply if we saw the same trend with female doctors treating male patients.

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

LouisSayers• 8 years ago

The article to me seems to be pushing a specific viewpoint which is essentially jumping to a conclusion that male doctors treat women patients poorly.

Without context these numbers don’t mean anything. There could be many factors why these statistics exist - are older / more severe female cases more likely to see a male doctor? As an example.

I really dislike this being presented as news and having all sorts of negative connotations towards men. It’s a finding that requires more investigation and is meaningless without context.

nowarninglabel• 8 years ago

There are numbers, linked to in the article: http://www.pnas.org/content/early/2018/07/31/1800097115

shadowtree• 8 years ago

Well, diagnosis relies on hard data and empathy. It is a personal observation of mine (male) that women have general higher empathy.

For medicine in particular, female biology forces you to experience symptoms and treatments earlier, more often (male teenagers do not experience menstruation and OB/GYN visits, to spell it out).

I can absolutely see how this shapes behavior.

A lot of patients complain about western medicines inhuman conveyor belt methods, which plays into this. Diagnosis practices in TCM are wondrous in comparison (male and female!).

wuliwong• 8 years ago

I fail to see how your comment supports the claims in the article. If what you say is true than the results would be that in general female doctors are better but this data shows that they are only better with other female patients.

carbocation3• 8 years ago

What I really wanted to understand about this study: (1) whether they accounted for the number of years out of residency the physician was, and (2) whether they accounted for cumulative physician experience in some more rigorous way. I skimmed and searched with keywords rather than reading exhaustively, but I don't see a good description of these features.

Re: (1), if the guidelines are correct and effective, I would expect women to score better because of the probability density of older men. That is, the average woman is younger and "closer to the data".

Re: (2), if experience is helpful, I would expect those with more experience to do better.

A priori, the person least likely to do well is a person who is far out from residency but who hasn't practiced a bunch. That person is more likely to be male than female (based on the above, basically, the historical consequence of systematic discrimination against women in medicine), and is less likely to have been trained to recognize symptoms uncommon in men.

In their tables, they describe "Physician experience control." I don't see a rigorous definition of this. They have a section in the supplement on variable definitions where they do not describe this. What does this mean? From Table S2, you can see that the men have accrued a mean of ~14 physician experience points, while women have accrued a ~mean of 10, a tremendous difference at this sample size. Does this score refer to (1) or does it refer to (2)? If it refers to (1), then I'm not surprised that men do worse. If it refers to (2), then this is all the more surprising.

Supplementary Table S2 also has incorrect labels (they seem to have duplicated female-physician / female-patient and left out the female-physician / male-patient). More confusingly, in the male-physician / male-patient section, the label appears to say that 10% of the male physicians are female. That can't be what they mean - but can anyone else interpret this? Edit -- I think this is referring to the average physician at that hospital. Not well named in the supplement, but that's OK.

Finally, 25% of their data is with physicians with names that preclude gender assignment by their algorithm. If we assume that to be a mix of men and women, that group should perform somewhere between the male and female physicians. Why exclude this data from the analysis, rather than analyze it to confirm the trend?

Study is here: http://www.pnas.org/content/pnas/early/2018/07/31/1800097115...

Supplement is here: http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...

sudosteph5• 8 years ago

Finally, 25% of their data is with physicians with names that preclude gender assignment by their algorithm. If we assume that to be a mix of men and women, that group should perform somewhere between the male and female physicians. Why exclude this data from the analysis, rather than analyze it to confirm the trend?

I think leaving that out makes a lot of sense actually. You can't assume that the mix is 50-50 just because you don't know the data. Anecdotally, I know more women who use a male or gender-agnostic version of their name professionally than I do men. It may be more common in fields other than medicine, but for example we only know "JK Rowling" as "JK" because her publishers were worried that having an author with a feminine name would make it harder to sell the book to boys.

carbocation3• 8 years ago

You can't assume that the mix is 50-50

I don't assume that it's a 50/50 split. I assume it's somewhere between 0% female to 100% female. And it's a big sample. If a mix of (men and women) doesn't perform somewhere between the all-male and all-female groups, that's a big problem with their hypothesis.

They're saying something equivalent to Group A scores mean 90 and Group B scores mean 95. If you then take a very large set of people that is drawn from Group A and Group B with an unknown proportion and they score mean 85 or 100, that would be fairly devastating to the claim.

I'm not saying that this should be weighted into the main analysis. I'm saying they should test their hypothesis with this.

SiempreViernes• 8 years ago

Since you don't know the relative mix, including those 25% adds another nuisance parameter but not that much more statistical power, so why bother?

carbocation3• 8 years ago

I'm not saying that this should be weighted into the main analysis. I'm saying they should test their hypothesis with this.

karmakaze• 8 years ago

TL;DR

  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,”

PurpleBoxDragon4• 8 years ago

There was more than that. There was the match and the non-match division, and there was the case where they couldn't determine the gender of the Physician. Also, some of the data doesn't look exactly indistinguishable.

Look at Fig.S2 here http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...

It looks like male and female doctors result in the same probability curve for female patients, but male doctors result in a higher probability curve for male patients.

DuckHuntMaster6• 8 years ago

There is a lot of assumptions made in this article, and it's interesting that we never see publications on the superior performance of male surgeons ETC. I guess those facts would be offensive to some though.

Here is the most likely reason for this statistic. (Of you can call it that since it is objectively statistically insignificant, being that male doctors treated 150X more women overall).

The male doctors are better doctors (all factors such as age and experience being the same), and its well documented that they can handle higher stress levels and make Less emotionally influenced mistakes. So they get the tougher cases to begin with. This is a plausible of an argument as any in the article or mentioned here.

Is funny that those who fight gender biases the most are some of the most biased.

sykhic3• 8 years ago

So they get the tougher cases to begin with.

Do you have evidence that this happens in the ER? When my wife did her ER rotation it wasn't like this.

We have a study that shows women with heart attacks do worse in ERs unless they are treated by a female doctor. You are presenting facts (without attribution) about surgeons. ER doctors are not surgeons. So what evidence do you have from the ER that contradicts the apparent conclusion of the study?

Is funny that those who fight gender biases the most are some of the most biased.

It's quite ironic that you wrote the above sentence given your post. The only evidence you provide is about surgeons and conclude that male superiority in medicine is the most likely reason for the statistics in the study. That is quite a stretch there.

DuckHuntMaster6• 8 years ago

Thanks, it's meant to be ironic. There are only guesses all around based on a numbers with a similar ratio of 5 cases for women physicians and 700 for men. How can this be considered serious reporting? If the numbers favored men, we wouldn't be having this conversation for a number of reasons.

learnstats2• 8 years ago

So [men] get the tougher cases to begin with.

This argument has come up several times here as though it is an obvious possibility, but I have significant reason to doubt it.

In politics, it is known that women end up being given statistically riskier elections to defend - i.e. those that are the most critical ones for a political party, while also offering individuals less secure career prospects.

Why, then, is it assumed that the exact opposite must be true in medicine?

DuckHuntMaster6• 8 years ago

How can we begin comparing political strategy to sub minute life and death medical decisions? I am confused, or missing your point.

orhmeh094• 8 years ago

“And its well documented that they can handle higher stress levels and make Less emotionally influenced mistakes.”

Can we see some of this documentation, please?

DuckHuntMaster6• 8 years ago

There have been countless studies. Mostly by the military. Google it. Of course those studies were all biased so I can't expect you to believe them.

tom_• 8 years ago

What do you think will come from your posting this here? I know men are stereotypically more prone to taking action that has an uncertain payoff, but this is (if I may be so bold) ridiculous.

DuckHuntMaster6• 8 years ago

Its completely relevant and my original guess explaining this unlikely variance may actually be factual. The stress coping capabilities of a physician is one of the largest predictors of proper patient treatment in the ER

sctb2• 8 years ago

We detached this subthread from https://news.ycombinator.com/item?id=17701593.

ezoe• 8 years ago

Once upon a time, mortality rate of the pregnant women were higher at the male doctor than the traditional female midwife.

Some people try to explain that statistics with a hypothesis that the presence of male doctor stress the pregnant women.

The real reason was, male doctor at that time treat pregnant woman immediately after they perform the dissection WITHOUT washing their hands! Killing pregnant women by infection.

njarboe• 8 years ago

“Spurious signals sometimes come up [in research], so this should be replicated”

As the replication crisis becomes more apparent, if you are looking to fill your mind with true facts in sociology, psychology or health, replication should be the bare minimum before even spending time to decide if a study's conclusions are likely to be true.

GhostVII• 8 years ago

It's important to note that men are also more likely to survive if the ER doc is female.

rossdavidh4• 8 years ago

Thanks to the person who linked to the original data. In the table S2, it lists the standard deviations for a lot of the measures, including survival. Lots of other interesting stuff there in that table. I totally believe that there are good reasons to have more women doctors, and I'd advise looking at the article itself rather than Scientific American's summary, which is not the greatest.

rossdavidh4• 8 years ago

Oh geez I forgot to post the link myself so you don't have to find it in another thread: http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...

rossdavidh4• 8 years ago

...and there it is, right in table S4, a p-test just barely under the old 0.05 threshold (0.0468).

entwife• 8 years ago

In addition to differences in doctor competence and behavior, perhaps the female patients behaved differently when treated by a male doctor.

onomonomono2• 8 years ago

There's a typo that appears twice in the appendix where both 'female physician/female patient' and 'female physician/male patient' were labeled female/female in both Table S2 and Table S3.

Also interesting are the raw numbers from Table S2 of patient survival:

                        Female Dr.        Male Dr.
    Female Patient        0.866            0.854
    Male Patient          0.888            0.883

These numbers make it look like both male and female doctors have a harder time saving female patients, the difference being a 2.5% vs 3.3% harder time. It's hard to reconcile this with the paper's abstract where they say "Male patients and female patients experience similar outcomes when treated by female physicians, suggesting that unique challenges arise when male physicians treat female patients."

These numbers are obviously too broad to tell the whole story but if you trained the male doctors to have the same male-to-female patient mortality drop as female doctors, that still leaves 3/4 of the male doctor male-to-female patient mortality difference untouched. That is unless you throw out the .888->.866 drop, which they apparently did, and I wish I had the whole paper in front of me right now to figure out why.

It looks to me like there might be more productive questions to answer here: Why are female doctors outperforming male doctors in this area? Why are female patients (ballpark) twice as sensitive to the gender of their doctor?

source: http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...

onomonomono2• 8 years ago

Somebody with more expertise than me needs to chime in here.

If you take the data from Table S2 and perform a two-sample binomial test (as seen here[0] and at 3 minutes here[1]) you can directly contradict a statement in the paper's abstract ("Male patients and female patients experience similar outcomes when treated by female physicians") Using the female doctor numbers I get a z-value of 8.36 which is well over the standard two-tailed significance value of 1.96 for p<0.05. With N being so large it looks like the gender of the patient is absolutely statistically significant with female doctors as well as male.

I feel like I must be missing something here but I'm such a beginner with statistics that I don't know what it is. Is it not a binomial distribution, is it not normally distributed? Am I plugging my numbers in wrong?

[0] https://stats.stackexchange.com/questions/113602/test-if-two... [1] - https://www.coursera.org/lecture/biostatistics-2/two-sample-...

sporkland• 8 years ago

Did they control for hand size?

8bitsrule• 8 years ago

In the new study everyone was more likely to survive if they saw a female physician

Now that's worth noting. And I'm not surprised.

username90• 8 years ago

We see that female patients treated by male physicians stay in the hospital significantly longer than any other dyad.

I'd guess that male doctors are a bit more protective of female patients thus letting them stay too long in the hospital hindering rehabilitation.

Women Die More from Heart Attacks Than Men Unless ER Doc Is Female

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