Saturday, July 25, 2009

Sexism Effects Clinical Decision-Making as Well

In repsonse to my last two blog posts, a number of readers responded that women, not just people of color, experience bias and disrespect in the health care system. This brought to mind a study done over 20 years ago by a brilliant colleague of mine, Dr. Jonathan N. Tobin. His 1987 Study published in the July 1 issue of the Annals of Internal Medicine (Volume 107, pp 19-25) revealed that there was substantial "Sex Bias in Considering Coronary Bypass Surgery".

The abstract of that study reads in part:
" In a study of 390 patients consecutively referred for nuclear exercise testing, abnormal results found in 31% of the women and in 64% of the men affected physicians' decisions to recommend catheterization in men only; 4% of the women with abnormal radionuclide scans were referred for catheterization compared with 40% of the men (p < 0.001). This 10:1 ratio was independent of age."

Gender bias, racial bias, bias against obese individuals, bias against those who speak a language other than English - all affect the care that patients recieve in the health care system. And they have secondary effects as well - as some of the commentors on my previous blogs pointed out - they make one loathe to go to the doctor at all. And with no medical visit, the odds are that people neglect needed preventive care and comprehensive care for chronic conditions. Can this problem be helped through training? Perhaps. But we have a very long way to go. And tragically - for decades since the Tobin article was published, there is little evidence that we have made any substantial progress.


Bob O'Donnell said...

I have gone thru several decades of "reform" and we are still "fixing" the same issues; namely lack of quality, lack of access and cost. What hopefully these decades have brought are better definitions of the obstacles that affect these issues, i.e your biases discussions and now it's time to pull the trigger on real reform. We have reasonable solutions before us now for IT initiatives, and then Health Reform legislation should address the millions unserved. The remaining issue again comes down to "at what cost". We need to tear away at this issue, demand reduction/elimination of totally unnecessary administrative costs and prosecute heavily for fraud and abuse. Time to deliver.

Marly said...

I hope its ok for non-clinical people to comment. Thanks for this post - very interesting topic. I think a lot of people think that discrimination against women is a thing of the past. I think it has moved underground some, but it still very alive and real today.