Invisible Women: hapless male doctors
survival rates were two to three times higher for female patients treated by female physicians compared with female patients treated by male physicians.
Well hello there, GFPs, and here it is again, another Wednesday email from me. This isn’t going to become a real habit — I like the whole 7am Monday start your week off with some data rage thing, but I have a new toy available to me that I’d like to play with and, well, here it is
Ta-da! Neat isn’t it! So this Wednesday thing may stick for the rest of the season and then we’ll revert to usual service.
Anyway, this week’s podcast is on concussions, which, it will surprise no GFP to hear (partly because I’ve written about it a fair bit before) are, um, sporting a fairly hefty data gap when it comes to women….
But while I’ve written about it before in the context of sport, which was where this episode starts off, while researching this episode I came across a far larger data gap when it comes to concussions that I’m truly embarrassed to say I’d never considered before: domestic violence, which as GFPs will also know, is a highly female dominated condition. And, as one of the experts in this episode points out, domestic violence is “an area where by almost by definition, you know, partner violence, you can expect some type of damage to some part of the body, right?”
So why has so little attention been paid to this serious issue?
A heads-up here that this episode contains distressing testimony from a victim of domestic violence, so some of you may need to give this one a miss. I hope the rest of you listen though, because this is something we really need as many people as possible to hear about if we’re going to fix this one.
Gender data gap of the week
As any GFP who has read Invisible Women will know, women who have a heart attack are worse off than men by pretty much any metric you care to consider.
A recent analysis of data from 22 million people from North America, Europe, Asia and Australasia found that women from lower socio-economic backgrounds are 25% more likely to suffer a heart attack than men in the same income bracket.
Since 1989, cardiovascular disease has been the leading cause of death in US women and, following a heart attack, women are more likely to die than men. This disparity in deaths has been the case since 1984, and young women appear to be particularly at risk: in 2016 the British Medical Journal reported that young women were almost twice as likely as men to die in hospital. This may be in part because doctors aren’t spotting at-risk women: in 2016, the American Heart Association also raised concerns about a number of risk-prediction models ‘commonly used’ in patients with acute coronary syndrome, because they were developed in patient populations that were at least two-thirds male. The performance of these risk-prediction models in women ‘is not well established’.
Common preventative methods may also not work as well in women. Acetylsalicylic acid (aspirin) has been found to be effective in preventing a first heart attack in men, but a 2005 paper found that it had a ‘nonsignificant’ effect in women aged between forty- five and sixty-five. Prior to this study, the authors noted, there had been ‘few similar data in women’. A more recent study from 2011 found that not only was aspirin ineffective for women, it was potentially harmful ‘in the majority of patients’. Similarly, a 2015 study found that taking a low dose of aspirin every other day ‘is ineffective or harmful in the majority of women in primary prevention’ of cancer or heart disease.
Perhaps the greatest contributor to the numbers of women dying following a heart attack, however, is that their heart attacks are simply being missed by their doctors. Research from the UK has found that women are 50% more likely to be misdiagnosed following a heart attack (rising to almost 60% for some types of heart attack). (IW, pp.217-218)
And so on. By the way, heart attack patients who are misdiagnosed, perhaps unsurprisingly, have a 70% higher risk of dying.
This may partly be because we are not only bad at spotting heart disease in women, we are also worse at treating them. Again, as I wrote in Invisible Women:
Assuming a woman gets lucky and has her heart disease diagnosed, she must then navigate the obstacle course of male-biased treatment: sex differences have not generally been integrated either into ‘received medical wisdom’ or even clinical guidelines. For example, say a man and a woman are both diagnosed with a swollen aorta (the aorta is the main blood vessel that runs from the heart down through the chest and stomach). They are both suffering from an equal level of swelling – but their risk is not the same: the woman has a higher risk of rupture, which carries with it a 65% chance of death. And yet, in Dutch clinical guidelines, the thresholds for surgery don’t differ for each sex. (IW, p.220)
Invisible Women is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
A study in Florida of patients admitted to hospital for a heart attack over a 19 year period found that female patients have significantly worse outcomes when treated by a male doctor rather than a female doctor (male and female patients had similar outcomes when treated by female doctors). The results showed that “female patients treated by male physicians were the least likely to survive an episode of care.” In fact, “survival rates were two to three times higher for female patients treated by female physicians compared with female patients treated by male physicians.” (my emphasis).
This would suggest that, contrary to the traditional explanations for women’s worse outcomes following a heart attack (you know, the old classics like it’s our fault for not presenting early enough, or being too complicated to diagnose), the issue is in fact not the women, but doctors of the male variety.
The good news, according to the study is that the fix is fairly easy. Option a) let male doctors practice more on female patients because the evidence suggests they do improve with practice. This, however, is not ideal for the poor female guinea pigs who are among their early patients.
A better alternative, suggest the paper authors, is for hospitals to surround their hapless male doctors with female doctors, as this also tends to improve the male doctors’ performance. By the way, this would likely also work out well for male patients, as the study also found that “patients treated by female physicians were, in the unmatched sample, more likely to survive, regardless of patient gender.”
Despite making up over half of medical students and CMTs in the UK, recent data show that women represent 28% of cardiology trainees and only 13% of cardiology consultants. In the United States the proportion of female cardiology consultants is almost identical. (Source)
I came across this, let’s face it, pretty disturbing study in a Guardian article by Dr Sian Harding, who is emeritus professor of cardiac pharmacology at Imperial College London, and has a new book out, also this month. I was particularly struck by the study she cited, because it reminded me, as I’m sure it will have many other GFPs of this Canadian research, published in December last year, which found that women are 32% more likely to die after being operated on by a male surgeon rather than a female surgeon. The full study is behind a paywall and this journal annoyingly isn’t on my academic access, but the Guardian write-up reports that the study found women “are 15% more liable to suffer a bad outcome, and 32% more likely to die, when a man rather than a woman carries out the surgery”
They found that men who had an operation had similar outcomes regardless of whether their surgeon was male or female (an exception being significantly decreased mortality for men, 13%, when the surgeon was female). However, women experienced better outcomes if the procedure had been performed by a female surgeon compared with a male surgeon. There were no gender differences in how surgery went for either men or women operated on by a female surgeon.
Default male of the week
Meanwhile in Glasgow…
I checked, GFPs, and yes, it’s real:
Professor John Paul Leach, a consultant neurologist who is head of undergraduate medicine at the University of Glasgow, displayed a graphic of the female brain as part of a teaching session with a large area designated the ‘headache generator’.
It comes after research by the British Medical Association showed nine in 10 female doctors have experienced sexism at work in the UK, including unwanted physical contact and denial of opportunities.
The BMA said the results were appalling and the incidents made for shocking reading.
The survey shows that 91% of female doctors have experienced sexism at work.
It found that, while just 4% of men felt that their clinical ability had been doubted or undervalued because of their gender, 70% of women who responded said that it had
Gee I wonder why female doctors doubt their ability. THE IRONY when it’s male doctors who are actually failing their patients smfh. And how is this going to impact our ability to recruit more life-saving female doctors?
Poppy pic of the week
Let’s cheer ourselves up with this shall we?
That’s it! Until next time, my dear GFPs…xoxoxo