
Women Die More from Heart Attacks Than Men Unless ER Doc Is Female - draenei
https://www.scientificamerican.com/article/women-die-more-from-heart-attacks-than-men-unless-er-doc-is-female/
======
sctb
If you're going to post in this thread, please do so according to the
guidelines. Eschew flamebait especially.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

------
crazygringo
There's really not much you can do with this without more investigation.

For example, what about ages? Are male doctors more likely to be older and
it's actually a generational effect, say, of not listening? Or to the
contrary, are male doctors more likely to be older and more experienced, and
riskier female cases are sent to them disproportionately out of some bias
towards extra care? If a male has more female colleagues, does this affect his
behavior or is this simply because they tend to be better-run institutions in
general which already seek to be more diverse?

It feels like there are a million ways it could be sliced, and while I'd
totally buy the "men without the influence of women tend to not listen to
women or pay as much attention to them" if that were backed up causally... it
also seems like it's jumping to a click-baity conclusion whose causality is
completely unsubstantiated. (No mention that they also measured how much a
patient felt listened to, for example.)

~~~
jamra
I spoke to a doctor about publishing statistics and the major concern with him
and his peers was exactly what you mentioned. Riskier cases will make your
statistics drop, but the more experienced doctors would almost always get the
most difficult cases.

~~~
candiodari
That's not true ... after all, that would mean putting MBA type managers in
charge of hospitals (like is being done all across the US) is going to lead to
disastrously bad decisions as they will institute individual incentives.
Giving those experienced doctors little choice : either refuse cases that
might die ... or get fired.

~~~
wahern
Right, which is why some experienced doctors can be overly conservative. The
ones that take up the hard cases are therefore penalized even more.

You see the same thing with lawyers. The ones with a 100% trial success rate
are very choosy about which cases they accept or are more inclined to pressure
clients to settle.

The phenomenon is real. Whether it exists at the heart of this study or is
simply being used to excuse underperforming doctors....

------
carbocation
What I really wanted to understand about this study: (1) whether they
accounted for the number of years out of residency the physician was, and (2)
whether they accounted for cumulative physician experience in some more
rigorous way. I skimmed and searched with keywords rather than reading
exhaustively, but I don't see a good description of these features.

Re: (1), if the guidelines are correct and effective, I would expect women to
score better because of the probability density of older men. That is, the
average woman is younger and "closer to the data".

Re: (2), if experience is helpful, I would expect those with more experience
to do better.

 _A priori_ , the person least likely to do well is a person who is far out
from residency but who hasn't practiced a bunch. That person is more likely to
be male than female (based on the above, basically, the historical consequence
of systematic discrimination against women in medicine), and is less likely to
have been trained to recognize symptoms uncommon in men.

In their tables, they describe "Physician experience control." I don't see a
rigorous definition of this. They have a section in the supplement on variable
definitions where they do not describe this. What does this mean? From Table
S2, you can see that the men have accrued a mean of ~14 physician experience
points, while women have accrued a ~mean of 10, a tremendous difference at
this sample size. Does this score refer to (1) or does it refer to (2)? If it
refers to (1), then I'm not surprised that men do worse. If it refers to (2),
then this is all the more surprising.

Supplementary Table S2 also has incorrect labels (they seem to have duplicated
female-physician / female-patient and left out the female-physician / male-
patient). More confusingly, in the male-physician / male-patient section, the
label appears to say that 10% of the male physicians are female. That can't be
what they mean - but can anyone else interpret this? _Edit -- I think this is
referring to the average physician at that hospital. Not well named in the
supplement, but that 's OK._

Finally, 25% of their data is with physicians with names that preclude gender
assignment by their algorithm. If we assume that to be a mix of men and women,
that group should perform somewhere between the male and female physicians.
Why exclude this data from the analysis, rather than analyze it to confirm the
trend?

Study is here:
[http://www.pnas.org/content/pnas/early/2018/07/31/1800097115...](http://www.pnas.org/content/pnas/early/2018/07/31/1800097115.full.pdf)

Supplement is here:
[http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...](http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115.DCSupplemental/pnas.1800097115.sapp.pdf)

~~~
sudosteph
> Finally, 25% of their data is with physicians with names that preclude
> gender assignment by their algorithm. If we assume that to be a mix of men
> and women, that group should perform somewhere between the male and female
> physicians. Why exclude this data from the analysis, rather than analyze it
> to confirm the trend?

I think leaving that out makes a lot of sense actually. You can't assume that
the mix is 50-50 just because you don't know the data. Anecdotally, I know
more women who use a male or gender-agnostic version of their name
professionally than I do men. It may be more common in fields other than
medicine, but for example we only know "JK Rowling" as "JK" because her
publishers were worried that having an author with a feminine name would make
it harder to sell the book to boys.

~~~
carbocation
> You can't assume that the mix is 50-50

I don't assume that it's a 50/50 split. I assume it's somewhere between 0%
female to 100% female. And it's a big sample. If a mix of (men and women)
doesn't perform somewhere between the all-male and all-female groups, that's a
big problem with their hypothesis.

They're saying something equivalent to Group A scores mean 90 and Group B
scores mean 95. If you then take a very large set of people that is drawn from
Group A and Group B with an unknown proportion and they score mean 85 or 100,
that would be fairly devastating to the claim.

I'm not saying that this should be weighted into the main analysis. I'm saying
they should test their hypothesis with this.

------
onomonomono
There's a typo that appears twice in the appendix where both 'female
physician/female patient' and 'female physician/male patient' were labeled
female/female in both Table S2 and Table S3.

Also interesting are the raw numbers from Table S2 of patient survival:

    
    
                            Female Dr.        Male Dr.
        Female Patient        0.866            0.854
        Male Patient          0.888            0.883
    

These numbers make it look like both male and female doctors have a harder
time saving female patients, the difference being a 2.5% vs 3.3% harder time.
It's hard to reconcile this with the paper's abstract where they say "Male
patients and female patients experience similar outcomes when treated by
female physicians, suggesting that unique challenges arise when male
physicians treat female patients."

These numbers are obviously too broad to tell the whole story but if you
trained the male doctors to have the same male-to-female patient mortality
drop as female doctors, that still leaves 3/4 of the male doctor male-to-
female patient mortality difference untouched. That is unless you throw out
the .888->.866 drop, which they apparently did, and I wish I had the whole
paper in front of me right now to figure out why.

It looks to me like there might be more productive questions to answer here:
Why are female doctors outperforming male doctors in this area? Why are female
patients (ballpark) twice as sensitive to the gender of their doctor?

source:
[http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...](http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115.DCSupplemental/pnas.1800097115.sapp.pdf)

~~~
onomonomono
Somebody with more expertise than me needs to chime in here.

If you take the data from Table S2 and perform a two-sample binomial test (as
seen here[0] and at 3 minutes here[1]) you can directly contradict a statement
in the paper's abstract ("Male patients and female patients experience similar
outcomes when treated by female physicians") Using the female doctor numbers I
get a z-value of 8.36 which is well over the standard two-tailed significance
value of 1.96 for p<0.05. With N being so large it looks like the gender of
the patient is absolutely statistically significant with female doctors as
well as male.

I feel like I must be missing something here but I'm such a beginner with
statistics that I don't know what it is. Is it not a binomial distribution, is
it not normally distributed? Am I plugging my numbers in wrong?

[0] - [https://stats.stackexchange.com/questions/113602/test-if-
two...](https://stats.stackexchange.com/questions/113602/test-if-two-binomial-
distributions-are-statistically-different-from-each-other) [1] -
[https://www.coursera.org/lecture/biostatistics-2/two-
sample-...](https://www.coursera.org/lecture/biostatistics-2/two-sample-
binomial-tests-comparing-2-binomial-proportions-eIL8m)

------
olavk
This is really fascinating (and troubling) statistics, but I can imagine what
the explanations can be? Some of the possible explanations suggested in the
article does not seem to correspond to the result. For example, if female
doctors are better in general, then it should also affect the survival rate of
male patients. If current medical research favors male patients, then it
should affect the survival rate regardless of the gender of the doctor. If you
are better at treating your own gender, then it should also affect women
doctors treating men.

~~~
sudosteph
The article does provide a explanation that would seem to correspond to the
result.

> Still, she adds, the study raises many troubling questions about the
> treatment of women in the ER, “like the concern there’s a systematic bias
> where male physicians are not listening to female patients’ complaints as
> readily as [those of] a man.”

Simply put, if social conditioning causes men to take the concerns of male
patients more seriously than female patients (OR inversely, social
conditioning makes female patients less likely to share potentially relevant
information with male doctors in the first place), it would explain the
difference pretty easily.

Personally, I always prefer to have a female doctor when given the option. My
theory is that even if only 0.1% of male doctors harbor a bias against female
patients, and even if it's only a mild bias in most cases, I can avoid that
chance pretty much completely by going to a female doctor. I guess it's
possible for female doctors to be sexist against women, but it seems very
unlikely given that most female doctors themselves would have experienced
sexism against women at some point and thus would be more aware of it and more
invested in overcoming it.

~~~
jerf
"Simply put, if social conditioning causes men to take the concerns of male
patients more seriously than female patients (OR inversely, social
conditioning makes female patients less likely to share potentially relevant
information with male doctors in the first place), it would explain the
difference pretty easily."

But given the opprobrium currently attached to labeling someone "SEXIST" in
our society, personally I'd like to see a bit more evidence, and some
alternate explanations explored and ruled out, before we start wheeling that
one out and tarring people with it.

The other problem with that is more practical... if it "truly is" sexism, then
you also foreclose any chance of fixing it, because there's just no way you're
going to go to doctors and make them precisely 10% less sexist than they are
now. But if it is in fact something else, it may be fixable. (Or illusory.)

~~~
sudosteph
Lots of people have biases that they don't realize can impact the quality of
their interactions. There's a frequent issue where people who speak English as
their second language are more likely to be perceived as less intelligent.
Certain thick regional accents also can cause that issue.

Part of the educational process for all professionals, especially doctors,
includes learning to monitor for potential prejudices like that and taking
steps to ensure it does not impact your ability to deliver high quality care
(ie, ask more questions or have a colleague review your work if you are
unsure).

I'm not tar and feathering people. But when women in our society are
constantly saying "Some men don't take me as seriously as my male counterparts
despite my equal (or superior) credentials" then maybe there is some truth to
that which can bleed over professional interactions in hospitals as well? I've
experienced it first hand myself professionally (never been to the ER) only a
handful of times, but I don't think it's the norm, and I don't go into
professional situations with men assuming it will happen. Still, when it
happens, it sucks and I wish other men would talk to those guys and tell them
why it sucks so those guys will do better.

We've gone a long way towards making sexism less of a problem for everyday
women. Just because there are a few examples of it that have slipped by
doesn't mean we give up. We just know more of what to watch out for.

~~~
jerf
"We've gone a long way towards making sexism less of a problem for everyday
women."

I couldn't have asked for a better example of precisely what I was talking
about. We are so primed to jump down people's throat because of SEXISM that by
the time you reached the end of your post, you've already slipped into the
assumption that it's the only possible explanation, and are lecturing the
doctors in question about how sexist they are and how they should stop it.

It is counter to the principles of science to be so sure, though. It's not
that large of an effect, even with the population size, and there's plenty of
room for some other systematic error to be the problem.

But you've been programmed to assume that if I'm bringing up the possibility
that a _scientific paper_ may have a second explanation, then _politically_ I
must also be denying the existence of sexism in the universe and must
therefore be downvoted and also lectured to about how important it is that we
not be sexist.

But I reject your attempt to exert moral superiority, for the exact reasons I
gave in the original post. What's important is not shutting down sexism and
scoring moral preening points for having Right Opinions. What's important is
finding the real cause, so we can address it. Science is filled unto
overflowing with examples and inductive proof that when people go into
something with a predetermined conclusion about the causes of some phenomenon,
they are often wrong, and end up doing _great harm_ because of it. If we have
to choose between getting to yell at people because Sexism, or actually fixing
the real problem, which is it going to be?

Unfortunately, as your own message demonstrates, which I have no reason to
believe is particularly exceptional, I know the answer. In 2018, it's getting
to yell at people Because Sexism, and to hell with whatever the real reason
may be. We already know the real reason, and it's Sexism. Because in 2018,
even if the real reason isn't sexism, the real reason is _still_ sexism, you
just must not be looking hard enough.

~~~
sudosteph
I'm flattered by your interpretation of my comment as one which allows me to
"exert moral superiority". I have made no judgements against your morals, only
against the merits of your arguments. Now let me correct your other
misconceptions.

>> "We've gone a long way towards making sexism less of a problem for everyday
women."

> I couldn't have asked for a better example of precisely what I was talking
> about. We are so primed to jump down people's throat because of SEXISM that
> by the time you reached the end of your post, you've already slipped into
> the assumption that it's the only possible explanation, and are lecturing
> the doctors in question about how sexist they are and how they should stop
> it.

You misunderstand context. That last line was there to convey the sentiment
that society HAS successfully addressed sexism in the past. It was a direct
refutation of your claim:

> if it "truly is" sexism, then you also foreclose any chance of fixing it...

> But you've been programmed to assume that if I'm bringing up the possibility
> that a scientific paper may have a second explanation, then politically I
> must also be denying the existence of sexism in the universe and must
> therefore be downvoted and also lectured to about how important it is that
> we not be sexist.

1\. Calling people "programmed" for disagreeing with you is rude, and hacker
news readers tend to prefer polite discourse - this may have affected your
votes.

2\. You did not propose a second explanation at all. You simply said that the
one I proposed should not even be investigated until every other alternative
is ruled out. How can you claim to care about science but not even be willing
to investigate a hypothesis that is supported by data, just because you don't
like the idea that it relates to a political and social topic? Take your anger
out on the people tar-and-feathering, not the people trying to figure out how
to stop women from dying disproportionately due to preventable health issues.
If you really have a strong theory on an alternative reason behind this data,
then propose it and make your own case.

3\. "lectured"? I disagree with your assessment of tone there. I simply re-
iterated my argument with context that is more relatable to hacker news
readers and shared a relevant experience.

The point is: Even if it's NOT sexism underlying the root cause of this
particular issue, you appear logically biased when you dismiss the role it
could play for no reason other than "I don't like when people blame sexism for
things". Dismissing it out of hand due to a purely emotional appeal makes it
seem like your analysis is troubled. It's as short-sighted and illogical as
people who blame sexism for every little thing ever. Morality aside, the
downvotes you earned were well deserved due to the poor quality of argument
and the uncivil tone.

Also, "sexism" doesn't need to have the "s" capitalized.

------
rossdavidh
I absolutely believe that male doctors (in America, anyway, the only place I
have experience) may be less receptive to hearing patients' symptoms and
issues, but: "...about 11.9 percent of the time overall—but the research team
found women with heart attacks will die about 12.4 percent of the time if
their cases are handled by male doctors" My first thought on reading that was,
0.5 percent is not a huge number, and is the kind of "difference" that could
easily fail to replicate.

~~~
chc
I feel like our impressions might be slightly thrown off by the fact that the
two numbers are percentages. It's a difference of 0.4 percentage points, but
that works out to a 4.2% increase in mortality, which seems a bit more
substantial.

------
aszantu
There is a case where test animals in laboratories have more stress when a
male human is there, compared to female humans.

[https://www.nature.com/articles/nmeth.2935](https://www.nature.com/articles/nmeth.2935)

~~~
tomp
Interesting. Could it be pheromones? Or maybe the combination of men sweating
more (I actually don't know if that's true, maybe it's just my bias, as I'm a
male and men generally smell worse to me than women) and women having a better
sense of smell. Or maybe men are more prone to stress (I don't necessarily
mean _negative_ stress, men also seem to prefer _positive_ stress, i.e.
adrenaline-filled activities), and animals/humans smell that...

~~~
cimmanom
Another possibility is that women are socialized to move more "gracefully"
(i.e. less suddenly) than men; and their body language is thus less
threatening to animals.

~~~
sridca
Maybe there is more to it (possibly in the realm of emotions) than body
language or pheromones.

------
LouisSayers
The article to me seems to be pushing a specific viewpoint which is
essentially jumping to a conclusion that male doctors treat women patients
poorly.

Without context these numbers don’t mean anything. There could be many factors
why these statistics exist - are older / more severe female cases more likely
to see a male doctor? As an example.

I really dislike this being presented as news and having all sorts of negative
connotations towards men. It’s a finding that requires more investigation and
is meaningless without context.

~~~
nowarninglabel
There are numbers, linked to in the article:
[http://www.pnas.org/content/early/2018/07/31/1800097115](http://www.pnas.org/content/early/2018/07/31/1800097115)

------
njarboe
“Spurious signals sometimes come up [in research], so this should be
replicated”

As the replication crisis becomes more apparent, if you are looking to fill
your mind with true facts in sociology, psychology or health, replication
should be the bare minimum before even spending time to decide if a study's
conclusions are likely to be true.

------
shadowtree
Well, diagnosis relies on hard data and empathy. It is a personal observation
of mine (male) that women have general higher empathy.

For medicine in particular, female biology forces you to experience symptoms
and treatments earlier, more often (male teenagers do not experience
menstruation and OB/GYN visits, to spell it out).

I can absolutely see how this shapes behavior.

A lot of patients complain about western medicines inhuman conveyor belt
methods, which plays into this. Diagnosis practices in TCM are wondrous in
comparison (male and female!).

~~~
wuliwong
I fail to see how your comment supports the claims in the article. If what you
say is true than the results would be that in general female doctors are
better but this data shows that they are only better with other female
patients.

------
rossdavidh
Thanks to the person who linked to the original data. In the table S2, it
lists the standard deviations for a lot of the measures, including survival.
Lots of other interesting stuff there in that table. I totally believe that
there are good reasons to have more women doctors, and I'd advise looking at
the article itself rather than Scientific American's summary, which is not the
greatest.

~~~
rossdavidh
Oh geez I forgot to post the link myself so you don't have to find it in
another thread:
[http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...](http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115.DCSupplemental/pnas.1800097115.sapp.pdf?bcsi_scan_e37e3cdb4dc1fe17=guyu7gXOKbf8P6pHGjl97AiZQwMPAAAA9MepTg==&bcsi_scan_filename=pnas.1800097115.sapp.pdf)

------
ezoe
Once upon a time, mortality rate of the pregnant women were higher at the male
doctor than the traditional female midwife.

Some people try to explain that statistics with a hypothesis that the presence
of male doctor stress the pregnant women.

The real reason was, male doctor at that time treat pregnant woman immediately
after they perform the dissection WITHOUT washing their hands! Killing
pregnant women by infection.

------
TazeTSchnitzel
This is an area which exposes how subconscious discrimination is itself a
significant problem, not just overt sexism. Doctors who don't take women's
reported symptoms as seriously results in more women dying, without any malice
or intentional discrimination.

~~~
simion314
Your assumption is possible to be true but is not the only possible cause and
the article it is very clear about the conclusions, as an example someone
linked in this comments some differences were notices with animals too.

------
darkerside
FTA> There have definitely been several studies that have shown that women are
slower to be diagnosed, and that might be explained by the fact that women are
more likely to have ‘atypical’ symptoms

Also FTA> Female doctors are more likely to speak with their patients longer
and provide more evidence-based care than their male colleagues... This could
help them to pick up on heart attacks, even if women have more atypical
symptoms.

Seems like women have a naturally higher likelihood of dying from heart
attack. This is offset by a higher likelihood of methodical individual care
(perhaps at cost of speed) if the doctor happens to be female.

~~~
whatshisface
> _This is offset by a higher likelihood of methodical individual care
> (perhaps at cost of speed) if the doctor happens to be female._

Then why wouldn't the female doctors provide better care for the men as well?
The study concluded that the female-female match was better off, not that
women were better doctors than men overall.

~~~
darkerside
Because heart attacks in men are typically more straightforward to diagnose.
In women they often require additional diagnostic effort, which coincidentally
female doctors are more likely to undertake.

------
toomuchtodo
An objective test would fix the problem (removing subconscious bias).

[https://newsroom.heart.org/news/more-sensitive-blood-test-
di...](https://newsroom.heart.org/news/more-sensitive-blood-test-diagnoses-
heart-attacks-faster)

> A new high-sensitivity blood test for heart attacks successfully diagnosed
> heart attacks faster and more accurately in the emergency room than the
> existing test.

> The new high-sensitivity blood test for cardiac troponin, given in a
> hospital emergency room, was also found to be safe and effective. When
> patients present to emergency rooms with heart attack symptoms, doctors
> assess them in part by using a cardiac troponin test to measure a protein
> released into the blood when the heart is damaged.

> “We did not miss any heart attacks using this test in this population,” said
> lead author Rebecca Vigen, M.D., M.S.C.S., a cardiologist at the University
> of Texas Southwestern Medical Center. “The test also allowed us to determine
> faster that many patients who had symptoms of a heart attack were not having
> a heart attack than if we had relied on the traditional test.”

I would even advocate for this test being administered by EMTs and other first
responders, instead of waiting until the patient arrives at the ER.

------
modells
In addition to a tendency towards arrogance, doctors hold unconscious biases
like everyone. Unsurprising.

Anecdotally, I recently had a same-gender doctor recount his glory day (just
one day) in the ER solving a hypertensive crisis by syringe bloodletting onto
the floor and tell me that my autonomic dysreflexia was “all in my head,” and
that fixing stress was the panacea. Meanwhile myoclonus, nystagmus, anhedonia,
(autoimmune?) inflammation/swelling, tremors keep getting worse. Thanks doc,
you really solved everything.

~~~
wahern
Patients also hold unconscious biases. Perhaps patients, especially women, are
more equivocal in their accounts when talking to male doctors.

------
username90
> We see that female patients treated by male physicians stay in the hospital
> significantly longer than any other dyad.

I'd guess that male doctors are a bit more protective of female patients thus
letting them stay too long in the hospital hindering rehabilitation.

------
GhostVII
It's important to note that men are also more likely to survive if the ER doc
is female.

------
ilove_banh_mi
Not clear whether the slight death-rate difference while in ER carries over to
the 5-year survival rate, which favors men over women by a large factor.

------
8bitsrule
_In the new study everyone was more likely to survive if they saw a female
physician_

Now _that 's_ worth noting. _And_ I'm not surprised.

------
entwife
In addition to differences in doctor competence and behavior, perhaps the
female patients behaved differently when treated by a male doctor.

------
omginternets
Haven't RTFAed (on mobile with shit internet). Does the gender of the ER doc
effect a change in male mortality rates as well?

~~~
jabagawee
> The researchers divided 500,000-plus cases into four categories: male
> doctors treating men; male doctors treating women; female doctors treating
> men; and female doctors treating women. “All of those are statistically
> indistinguishable except for male doctor–female patient,” says Brad
> Greenwood, an author on the study and a data scientist at the University of
> Minnesota. If a heart attack patient is a woman and her emergency physician
> is a man, he says, her risk of death suddenly rises by about 12 percent.

~~~
PurpleBoxDragon
I wanted to look at the actual numbers and see how close the findings were,
but I don't see the study linked nor the title of the study (I do see a
different study, but it isn't the one those numbers are from).

A different article someone else linked seemed to have the study, but it is
behind a pay wall.

[http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115](http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115)

This seems to have the actual numbers though.

[http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...](http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115.DCSupplemental/pnas.1800097115.sapp.pdf?bcsi_scan_e37e3cdb4dc1fe17=guyu7gXOKbf8P6pHGjl97AiZQwMPAAAA9MepTg==&bcsi_scan_filename=pnas.1800097115.sapp.pdf)

I'm having trouble grasping how to read the tables (especially given it seems
Female Physician Female Patient is repeated twice on tables S2 and S3, but I
think that is just a title error.

Here are the numbers, best as I can grasp.

S2 is full, S3 is matched

Mean then standard deviation.

    
    
        M/MS2:.881/.114
        M/MS3:.870/.124
        M/FS2:.854/.353
        M/FS3:.861/.121
        F/MS2:.887/.120
        F/MS3:.867/.130
        F/FS2:.857/.116
        F/FS3:.862/.112
    

Figure S2 looks interesting (M/F and F/F seem equal while M/M seems better
than F/M), but I'm not sure what the real axis are.

Edit: formatting

------
sporkland
Did they control for hand size?

------
karmakaze
TL;DR

    
    
      The researchers divided 500,000-plus cases into four categories:
      male doctors treating men;
      male doctors treating women;
      female doctors treating men;
      and female doctors treating women.
      
      “All of those are statistically indistinguishable except for male doctor–female patient,”

~~~
PurpleBoxDragon
There was more than that. There was the match and the non-match division, and
there was the case where they couldn't determine the gender of the Physician.
Also, some of the data doesn't look exactly indistinguishable.

Look at Fig.S2 here
[http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115...](http://www.pnas.org/content/pnas/suppl/2018/07/31/1800097115.DCSupplemental/pnas.1800097115.sapp.pdf?bcsi_scan_e37e3cdb4dc1fe17=guyu7gXOKbf8P6pHGjl97AiZQwMPAAAA9MepTg==&bcsi_scan_filename=pnas.1800097115.sapp.pdf)

It looks like male and female doctors result in the same probability curve for
female patients, but male doctors result in a higher probability curve for
male patients.

------
jewelthief91
I'm curious what people would propose we do about this? What if it turns out
that doctors of the same ethnic group treat their co-ethnics better, even if
it isn't conscious? I fear the conclusion people will draw is just a new form
of segregation in every area of life.

~~~
skybrian
Or maybe it's an argument in favor of diversity:

"The male doctors in their study were better at treating women with heart
attacks when they had more experience treating such patients—and especially
when they worked in hospitals with more female doctors. This suggests that
whatever female doctors are doing that’s better is also transferable."

[https://www.theatlantic.com/science/archive/2018/08/women-
mo...](https://www.theatlantic.com/science/archive/2018/08/women-more-likely-
to-survive-heart-attacks-if-treated-by-female-doctors/566837/)

~~~
Rapzid
"These differences persisted even after the team accounted for factors like
the doctors’ years of experience.."

So, I'm having a little bit of trouble reconciling these two statements. Who
are "such patients" and why wouldn't doctors with more years of experience
have more experience treating them?

~~~
skybrian
"Such patients" means women who had heart attacks. Apparently, "years of
experience" doesn't necessarily mean the same thing? Maybe some kinds of
experience are better than others?

But if you really want to dig into this you'll probably have to read the
paper.

------
DuckHuntMaster
There is a lot of assumptions made in this article, and it's interesting that
we never see publications on the superior performance of male surgeons ETC. I
guess those facts would be offensive to some though.

Here is the most likely reason for this statistic. (Of you can call it that
since it is objectively statistically insignificant, being that male doctors
treated 150X more women overall).

The male doctors are better doctors (all factors such as age and experience
being the same), and its well documented that they can handle higher stress
levels and make Less emotionally influenced mistakes. So they get the tougher
cases to begin with. This is a plausible of an argument as any in the article
or mentioned here.

Is funny that those who fight gender biases the most are some of the most
biased.

~~~
sykhic
_So they get the tougher cases to begin with._

Do you have evidence that this happens in the ER? When my wife did her ER
rotation it wasn't like this.

We have a study that shows women with heart attacks do worse in ERs unless
they are treated by a female doctor. You are presenting facts (without
attribution) about surgeons. ER doctors are not surgeons. So what evidence do
you have from the ER that contradicts the apparent conclusion of the study?

 _Is funny that those who fight gender biases the most are some of the most
biased._

It's quite ironic that you wrote the above sentence given your post. The only
evidence you provide is about surgeons and conclude that male superiority in
medicine is the most likely reason for the statistics in the study. That is
quite a stretch there.

~~~
DuckHuntMaster
Thanks, it's meant to be ironic. There are only guesses all around based on a
numbers with a similar ratio of 5 cases for women physicians and 700 for men.
How can this be considered serious reporting? If the numbers favored men, we
wouldn't be having this conversation for a number of reasons.

~~~
sykhic
There hasn't been thousands of years of gender bias in favor of women so it's
expected that results that show men are better than women in some areas are
not necessarily newsworthy. Sometimes such results are newsworthy.

~~~
DuckHuntMaster
You miss my point. No statistician worth his salt would ever consider these
numbers relevant, Yet here it it's all over the news. Why the over
compensation for women? A whole story making women out to be superior to men
in some way with trash to back it up. Why? If women are capable, give them
props. Don't make up stuff based on horrible data.

~~~
sykhic
_If the numbers favored men, we wouldn 't be having this conversation for a
number of reasons._

I think you missed my point. I was responding solely to the above quote that
you made.

------
cm2187
I can't help reading this article, thinking that if you were to swap "male"
for "female" and vice versa, this would be an absolute scandal that would
trigger a twitter mob and get the author fired for being sexist.

~~~
drxzcl
If you change the words, you change the meaning.

Let's try and get to the bottom of why the swapped version is meaningfully
different. What makes "men" and "women" fundamentally different in this
context, so much so that they can't be exchanged without significantly
altering the effect of the headline?

~~~
cm2187
The author is basically implying that men are worse at that profession than
females because of their natural behavior. Isn't it exactly the sort of
arguments that got that google guy fired?

~~~
drxzcl
What what?

That's what you took away from the article?

~~~
cm2187
Quoting the article:

> _Female doctors may also simply be performing at least some parts of the job
> better than their male counterparts do_

Imagine writing the vice versa about any other profession.

~~~
drxzcl
That's the point I'm trying to make. You instinctively feel that the exchanged
version isn't the same. That the exchanged version isn't kosher. Now try and
figure out why. You are already halfway there.

~~~
cm2187
I am implying that suggesting these days that men are intrinsically better at
one profession than women would get someone fired.

> _Now try and figure out why. You are already halfway there._

You can keep your condescension for yourself.

------
kikokikokiko
The article states that 3 out of four ER doctors are male.

So, out of 50% of 75% of the sample, they found a very slim, close to noise,
discrepancy.

They are not focusing on a very strict group, they are simply taking 60% of
the group and comparing it to the rest 40%. A small discrepancy in the data is
obviously expected, even on large samples.

The article's author even has the courage of saying that the lack os women
working as ER doctors is a sign of a lack of gender equality on medicine. Cmon
now. Women make up a larger percentage of medicine graduates over the whole
western world. Maybe they simply would prefer to work on less stressful
environments than ER and it's not a matter of prejudice?

PC took over the world. Idiocracy is already a reality.

------
whack
> _The researchers divided 500,000-plus cases into four categories: male
> doctors treating men; male doctors treating women; female doctors treating
> men; and female doctors treating women. “All of those are statistically
> indistinguishable except for male doctor–female patient,”_

> _Female doctors may also simply be performing at least some parts of the job
> better than their male counterparts do. In the new study everyone was more
> likely to survive if they saw a female physician, and a study published last
> year in JAMA Internal Medicine indicated all patients of female physicians
> had lower mortality and hospital readmission rates._

Both of the above findings are at least somewhat contradictory, given that the
first study found no statistical difference between male-patient-outcomes when
being treated by male vs female doctors. Before jumping to conclusions, I
think it's worth studying this effect more rigorously first. The female
cardiologist they quoted said it best:

> _It is a little early to say male physicians have trouble treating female
> heart attack patients based on these data alone, says Michelle O’Donoghue, a
> cardiologist at Brigham and Women’s Hospital and Harvard Medical School who
> did not work on the new study. “Spurious signals sometimes come up [in
> research], so this should be replicated,”_

Or as xkcd would put it: [https://xkcd.com/882/](https://xkcd.com/882/)

------
gammateam
> Put another way, a heart attack patient dies in the ER about 11.9 percent of
> the time overall—but the research team found women with heart attacks will
> die about 12.4 percent of the time if their cases are handled by male
> doctors.

Isn't this a very dangerous headline? A 0.5% difference?

What are your thoughts on this

