From U Toronto: Knee surgery and gender bias

http://www.ncbi.nlm.nih.gov/pubmed/23401380

Arthritis Care Res (Hoboken). 2013 Feb 11. doi: 10.1002/acr.21970. [Epub ahead of print]

The influence of patients' gender on informed decision making regarding total knee arthroplasty: What if your physician doesn't ask you to dance?

Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG.

Source

Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. cory.borkhoff@wchospital.ca.

Abstract

OBJECTIVE:

To investigate the effect of patient gender on patient-physician communication in the process of recommendation for total knee arthroplasty (TKA).

METHODS:

Seventy-one physicians (38 family physicians and 33 orthopaedic surgeons) in Ontario performed blinded assessments of two standardized patients (one man and one woman) with moderate knee osteoarthritis and otherwise identical scenarios. Four surgeons did not consent to including their data. Standardized patients and accompanying mock family members recorded elements of informed decision making (IDM) present/absent in the patient-physician discussion and rated physicians' interpersonal skills.

RESULTS:

Overall, the completeness of informed decision making was low but lower still for the woman. Only 57% (38/67) and 15% (10/67) of physicians discussed the nature of the decision and elicited the patients' preference, while consulting the man and woman, respectively. Even after adjusting for physicians' recommendations regarding TKA, physicians when interacting with the woman, included fewer IDM elements (adjusted mean difference in IDM score, 1.2; 95% CI 0.6-1.8; P<0.001) and had poorer interpersonal skills (adjusted mean difference, 14.1; 95% CI 9.0-19.2; P<0.001) compared with their consultation with the man.

CONCLUSIONS:

Physicians provided less medical information and less encouragement to participate in the decision to undergo TKA to a woman compared with a man, irrespective of their recommendation regarding TKA. Our findings suggest that in addition to directly influencing physicians' clinical decision making, gender bias may also influence physicians' interpersonal behaviour.