Docs show gender bias for knee replacement

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Docs show gender bias for knee replacement

Study found twice as many physicians

recommended the surgery for menReuters

updated 3:04 p.m. ET, Wed., March. 19, 2008

NEW YORK - Unconscious bias may make some doctors less likely to

recommend knee replacement surgery to women than to men, a new study

suggests.

Canadian researchers found that when they sent two knee arthritis

patients ­ one woman and one man ­ to 71 Ontario doctors, twice as many

physicians recommended knee replacement surgery to the man as to the

woman.

This was despite the fact that both patients were identical in the

severity of their knee arthritis and reported the same symptoms, such as

morning knee stiffness and difficulty climbing stairs. Both also told the

doctors they’d failed to improve with physical therapy, pain medication

or cortisone injections.

The findings suggest that many doctors harbor an unwitting bias against

recommending knee replacement to women, the researchers report in the

Canadian Medical Association Journal.

“I’d be shocked if this were a case of overt discrimination,” said senior

researcher Dr. James Wright of the University of Toronto and the Hospital

for Sick Children.

Instead, he said, doctors, like everyone else, have preconceptions about

different groups of people that can unconsciously affect their

decisions.

Wright said that many doctors may, for example, believe that women with

arthritis do not benefit from knee replacement as much as men do ­ based

on their own experience or from what other doctors have told

them.

There are studies showing that, compared with men, women tend to have the

surgery when their arthritis is at a more advanced stage. This fact may

explain why women, as a group, tend to fare more poorly than men after

knee replacement.

For the current study, Wright and his colleagues recruited two patients

with moderate knee arthritis and coached them in how to present their

symptoms so that their cases would be identical.

The doctors ­ 38 family physicians and 33 orthopedic surgeons ­ knew that

they would be seeing patients who were part of the study, but did not

know which patients they were. Nor did they know the purpose of the study

was to see how a patient’s sex affected medical decision-making.

Overall, Wright’s team found, 67 percent of the doctors recommended knee

replacement surgery to the male patient, while only 33 percent

recommended it to the woman.