My last post discussed the problem of women being misdiagnosed at rates higher than those for men, with sometimes fatal consequences. This post will discuss a few ideas for improving how physicians diagnose women.
If we are to solve the problem of women being over-misdiagnosed, one thing we need to dig into is how physicians make decisions. First, let’s give physicians credit and not forget about the harried professional lives they lead. Their days are increasingly clogged with administrative tasks, such as the unending need to feed the electronic health record beast. This puts a squeeze on the amount of time physicians can spend with patients. And the result is physicians are sometimes forced to make quick decisions with less information than they’d like. How do they cope? By leaning heavily on heuristics (i.e., rules-of-thumb). These rules-of-thumb often work well but sometimes they lead to snap judgments that are wrong.
Some of these heuristics rely on cognitive biases, one of which is confirmatory bias. Confirmatory bias causes doctors and everyone else to look for evidence that confirms their expectations. When expectations are clouded by gender stereotypes, we can get some really skewed thinking. Thus, a physician who’s quick to suspect that her female patient’s symptoms are caused by her anxiety will home in on any symptoms of anxiety and possible causes of it (e.g., a divorce) while discounting physical observations.
However, let’s not be so quick to get on our high horses and call physicians sexist. I’m thinking, and I have no data to prove this, that doctors are not that different from the general public in terms of the extent of their gender biases. And we shouldn’t automatically assume that the gender bias problem in medicine lies exclusively with male physicians. Female physicians’ thinking about the women they treat can also be biased.
Five Ways to Diagnose Women Better
This list is in no way meant to be exhaustive (that would probably require a book or three!) but it will hopefully add to a very necessary discussion.
Way #1: Teach doctors how to lose the biases that can creep into their decision making
Dr. Jerome Groopman (author of How Doctors Think) cites Pat Croskerry, an ER physician in Halifax, Nova Scotia who has written about physician decision making. Groopman quotes Crosskerry as saying, “Currently, in medical training, we fail to recognize the importance of critical thinking and critical reasoning. The implicit assumption in medicine is that we know how to think. But we don’t.” And part of not knowing how to think is making decisions without being aware of one’s subconscious biases. One encouraging sign: at Harvard’s medical school students are taught how to identify their biases and manage them.
Way #2: Continue expanding our understanding of the differences between female and male bodies
Seriously? Actually, there’s more to gender differences than what we learned in eighth grade health class or even what experienced physicians know, as I discussed in my prior post. Research into these differences should continue and the results should be widely disseminated to physicians and medical students via medical schools, continuing medical education, and journal articles.
Way #3: Women, stick with your gut
Dr. Fiona Gupta, a neurologist and director of wellness and health in the department of neurosurgery at the Icahn School of Medicine at Mount Sinai, says, “As women, we’ve been taught from an early age to rationalize warning signs of physical or mental health problems. If you feel like something isn’t right with your health, honor that — even if a doctor is disagreeing with you.”
Way #4: Checklist the way to more consistent diagnoses
A review of trauma cases at Johns Hopkins found that women were getting clot-preventing drugs at a lower rate than men until Hopkins instituted a computerized checklist that requires healthcare providers to follow the same assessment of clotting risk across all patients.
Way #5: Make doctors’ work environments more supportive
No, we can’t make all the externally imposed hassles of being a doctor in 2019 magically go away but hospital executives and other healthcare leaders can remove other physician stressors that can compromise the quality of care. An article in Harvard Business Review cites a study that “found that the quality of care offered at hospitals was positively correlated with hospital leaders who engage front-line clinicians, support clinicians in improvement efforts, and build a blame-free environment.” I know this solution is not gender-specific but I’m thinking more along the lines of “a rising tide lifts all boats.”
There are many other instances where the quality of care received by different groups is all over the map. Speaking of which, success rates of many health outcomes do vary by geography. They also vary by ethnic/racial group and economic group. I plan to explore these disparities in future posts.
