
Elderly Cared For By Female Doctors Fare Better Than Those Treated By Men - SmkyMt
http://www.npr.org/sections/health-shots/2016/12/19/506144346/patients-cared-for-by-female-doctors-fare-better-than-those-treated-by-men
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colechristensen
It's a pretty weak signal given all the sorts of things you'd have to correct
for. 11.07% vs. 11.49%, a 4% relative difference.

For example, they exclude all data from ICU doctors because they're
disproportionately men – suppose only the best doctors work in the ICU, by
excluding that you're excluding more of the best male doctors than the best of
the female doctors resulting in leaving a better population of women in your
study.

They correct for illness but not for doctor specialty, perhaps females
specialize in things that happen to have lower mortality rates.

... and on and on and on. There are so many variables to possibly correct for
that a study like this (especially having skimmed it) is pretty much useless.
It would be trivial to do a study like this and get whatever result you
wanted. Just stop doing statistical corrections when you get the result you're
looking for. P-value doesn't mean anything here because it doesn't capture the
ways the study could be wrong.

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paviva
Actually, their methodology seems pretty sound, with robust findings,
including in the subgroup of patients cared by hospitalists, where -- as the
authors correctly point out -- patients are pretty much randomized to a female
or male hospitalist.

The question is "in a given medical speciality -- internal medicine in this
study --, are patient's outcomes related to the admitting physician sex?", not
if women make better doctors than females. As such, your point about the best
doctors not being in internal medicine is pretty a non sequitur.

Basically, I see two potential biais that could explain at least part of the
difference in outcomes :

1\. Its is "common knowledge" that male doctors tend to refuse admissions more
often than females. (I am not aware of any hard data to prove this point) It
could be that the patients that they do admit are somewhat sicker that those
they let go directly home. That could explain both higher mortality and re-
admission rates.

2\. It is again, "common knowledge" (again, I'm not aware of any study) that
women write better discharge summaries, including all co-morbid conditions.
When coded in a database, those patients will appear sicker than similar ones
treated by male doctors, and this could skew any analyses.

A final confounder is that patients often have many doctors during the stay,
both male and female, and the study assigned as "the" doctor the one who
billed most for the patient, which may not be the one who had the most impact
on outcomes. It is difficult to say how this would advantage any particular
sex, however.

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belorn
I can find other potential bias that would explain the difference in outcomes,
like for example internal competition. If female and male doctors move
different within the profession and compete on different aspects (a common
finding in many other professions), the outcome will also reflect that. The
result might thus simply be explained that male doctors compete more for
medical positions in areas outside of elder care.

If that data is true, then we should see a reversed result in other medical
areas. It could be that if you wanted the best result of surgery, pick a male
doctor. If you want the best result afterward, pick a female doctor.

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djsumdog
This is an interesting study. Men and women are different. We tend to forget
that in this pseudo-post-equality world we live in. We forget that equality
isn't something that's intrinsic to humanity, but rather it's a social
construction we artificially impose upon biological reality:

[http://khanism.org/society/created-
equal/](http://khanism.org/society/created-equal/)

It is important that this study is limited to elderly patients. It does use a
lot of data though from many doctors and physicians, but only over the course
of a 30 day window.

I'd like to see studies that do this with younger patients as well, as well as
studies done over a longer timespam. If the same percentage present
themselves, it be interesting to see if there was some kind of training or
something that could be added to the medschool/education process to help male
physicians implement the natural practices used by the female physicians to
reduce the overall mortality rates.

If studies on younger patients or longer timespans show the percentages
converging down to zero, than maybe this study was an isolated result from 30
days in that one facility and the differences aren't really statically
significant. Studies like this really need to be reproduced.

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flukus
> Men and women are different. We tend to forget that in this pseudo-post-
> equality world we live in.

This is why we need to focus on equality of opportunity, not equality of
outcome.

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jerkstate
NPR has been getting pretty clickbaity recently. They had a segment recently
about how scandalous it was that CharityBuzz was auctioning a coffee with
Ivanka Trump, but they totally ignored the fact that they were also auctioning
lunch with Tony Podesta. I guess with 40% of their funding coming from the
public, it's important that they push certain narratives that resonate with
their audience, rather than being impartial.

~~~
maxerickson
Only one of the people you mention is sitting in on Presidential transition
meetings.

To be clear, having connections to the Clinton's really is different than
sitting in on meetings with foreign heads of state.

(I'm not sure I think that Ivanka having coffee with someone is problematic,
but it's still different than a lobbyist doing it)

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sp332
Here's the paper:
[https://jamanetwork.com/journals/jamainternalmedicine/fullar...](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255)
I don't know if I just missed it, but I didn't see a direct link anywhere. It
lays out the study design and results on the first page.

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thedevil
I was about to argue that the HN title should say "Elderly patients..." since
there's no guarantee that the study generalizes. However, it looks like NPR
also generalized the conclusion in their title.

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elevensies
Looking forward to future research on doctors' race, age, and nationality, so
we can fully optimize the system.

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J-dawg
Ha! If we assume the goal of such research is to improve patient care (rather
than grab headlines) then is there any benefit to comparing demographic groups
like this? If the hypothesis is that female doctors get better outcomes
because they follow clinical guidelines more closely, then surely we should be
looking at something like patient outcome vs. how closely clinical guidelines
were followed.

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tahoeskibum
This could also indicate that women have to be much better than men in order
to become a doctor.

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gozur88
It could indicate a lot of things, some flattering, some not.

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ZeroGravitas
I wonder if someone has collected together the timescales on which professions
went from "of course women can't do that, don't be ridiculous" to "of course
women can do that". I'd guess some would start earlier than others, and some
would make the transition faster than others. Our own profession of
programming seems to be one of the laggards in both, potentially even going
backwards in its youth. Would probably be interesting to see the data laid out
graphically if it could be made objective in some way (first admitted to
college, first professor, achievement of parity in numbers perhaps?)

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YuriNiyazov
Not elderly, and anecdote is not data, but I agree. I've personally had much
better outcomes with female doctors.

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bradjohnson
HN submission and article title omit the "Elderly" part of the study. Why?

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dang
No doubt the HN title doesn't say that because the article title doesn't.

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bradjohnson
I think my criticism is valid. Not only was this particular title not the
original one, it still relies on the same false generalization that the
article is using to bait people into clicking through.

From the guidelines:

> please use the original title, unless it is misleading or linkbait.

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dang
That's quite different from what your earlier comment said.

We reverted the HN title to the article title. I'm not sure the absence of
'elderly' counts as misleading but s/patients/elderly/ is probably ok.

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basicplus2
"The actual effect reported in the study is small, but multiplied over a huge
population it does add up to something significant."

In my experience women tend to go to female doctors and given women live
longer than men..

hey presto magico.. patients of women doctors live longer

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ZeroGravitas
I thought that as more younger doctors are women, then perhaps younger doctors
are better. I'm always a bit disappointed that science news doesn't dig that
one level deeper. You'd hope they'd cover both the ideas we came up with in 5
seconds in the paper, but if they don't mention it in the story then you're
left guessing.

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stevekemp
> perhaps younger doctors are better.

That's an interesting observation. On the one hand younger doctors have been
more recently exposed to "current" ideas, research, and stuff. On the other
hand younger doctors lack the experience to catch things that are unusual and
often discussed as theoretical.

I'd be curious to see if there were research on this topic now!

