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Gender bias may affect care of people with
Osteoarthritis
Newswise — Unconscious prejudices among doctors may explain why
women complaining of knee pain are less
likely than men to be recommended for total
knee replacement surgery, a study in today's
issue of the Canadian Medical Association
Journal suggests.
Toronto researchers used two standardized or
"mystery" patients, one male and one female,
both with moderate knee osteoarthritis
reporting the same symptoms of knee pain.
The patients received assessments from 67
physicians in Ontario.
Physicians were twice as likely to recommend total knee
replacement surgery (known as arthroplasty)
to a male patient compared to a female
patient. Overall, 67% of physicians
recommended total knee arthroplasty to the
male patient compared with 33% who
recommended it to the female patient.
“Disparity in the use of medical or surgical interventions is an
important health care issue, and this
research suggests a gender bias in the
treatment of patients who may need
orthopedic surgery,” says lead author Dr.
Cornelia Borkhoff, about the article based
on her doctoral thesis while in the Clinical
Epidemiology Program at the University of
Toronto Faculty of Medicine’s Department of
Health Policy Management and Evaluation.
This new study, the first ever demonstration of physician bias in
an actual clinical setting (i.e., with
patients during actual office visits with
physicians in their offices) involved 38
family physicians and 29 orthopaedic
surgeons because the researchers were
interested in whether barriers for women
exist between the family physician and the
patient in obtaining a referral to an
orthopaedic surgeon or between the surgeon
and the patient in the decision to offer
total knee replacement.
A male patient was referred to an orthopaedic surgeon 35% more
often than a female patient. The study also
found that a man was nine times more likely
than a woman to be recommended for a total
knee replacement.
“Physicians may be at least partially responsible for the
sex-based disparity in the rates of use of
total joint arthroplasty,” says Dr. Borkhoff.
“Physicians are susceptible to the same social stereotyping that
affects all of our behavior. Decisions that
stem from unconscious biases are not
deliberate - physicians would be unaware of
their unconscious biases affecting their
decisions.”
“Acknowledging that a gender bias may affect physicians’
decision-making is the first step toward
ensuring that women receive complete and
equal access to care,” says the principal
investigator of the study, Dr. James Wright,
a Professor at the University of Toronto
Faculty of Medicine’s Department of Health
Policy Management and Evaluation and the
Surgeon-in-Chief at The Hospital for Sick
Children.
“The next step is to develop creative interventions to address
these disparities in health care.”
More than 90% of orthopedic surgeons recommended total knee
replacement to the male patient, which also
suggests that surgery is the right decision
and represents the best care for patients
with moderate knee osteoarthritis for whom
medical therapy has failed.
“Our results support the need for clinician education programs to
better inform physicians of the true risks
of total joint arthroplasty, when and for
whom to consider surgery, as well as, the
potential benefits of early treatment,” says
Dr. Borkhoff.
The research team also includes representatives from Women’s
College Hospital, Sunnybrook Health Sciences
Centre, St. Michael’s Hospital and the
University Health Network.
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