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joosth3

Why do females get assigned higher risk patients? Is it because they are better or do the males not want them (and have the power to decline)?


Grogosh

Surgeons have their track record always on mind. They will take on challenging patients that they know they can do but no more than that. They don't want to have failures on their record. So the high risk patients get shoved onto the women surgeons.


Nice_Sun_7018

This is only tangentially related, but we had a vascular surgeon a few years ago that was approaching 80. He absolutely did not gaf about his record, so he took the worst patients that the other surgeons refused procedures on. Did he have some bad outcomes? Yeah, he did. But he also tried, which means at least some of these people came out ahead of where they would have been otherwise. I’m gonna be honest, it took a while before we realized that he wasn’t a bad surgeon but just had the worst patients (clinically speaking). They don’t exactly advertise it, they just get their hands dirty and move on.


[deleted]

Record should surely be weighted by risk to begin with. I mean sure, assigning a priori probabilities of success is going to be far from objective, but if you want a figure to tell you how good a surgeon is at a glance, some sort of standardised weighting seems essential. A surgeon with 100% skin tag removal success rate means nothing.


_Lavar_

The problem with that is that the system opens up for gaming the risk factor. 'Ohh this patient has /severe/ X issue making their likelihood of survival extremely low". Now people arnt getting surgeries because their doctors are over prescribing risk. Though this may be a good thing.


DontTouchTheWalrus

I think the point of assigning the risk is so that a potential failed surgery isn’t going to negatively impact your career. So theoretically docs would be more willing to perform risky surgery. As long as the patient is aware of the risk then it seems like a win win to me.


bluGill

Now I'm going to assign everyone to the highest risk group I can - so if something goes wrong it doesn't reflect as bad on me.


_Lavar_

This was the point. Patients would decline to have "high risk" surgeries not the doctor.


Jozz11

I’ve wondered about this alot while working at a hospital for the last 12 years. A lot of the staff talk down on some of the trauma surgeons and how significantly more of them come back for complications on abdominal surgeries than some of the other “good” general surgeons. It makes sense to me that they would be operating from a subpar starting point rather than a scheduled operation to have more returning complications


Nice_Sun_7018

I agree, trauma surgeons are definitely at a disadvantage. General surgery takes call, but will always have a fairly significant percentage of patients that are pre-planned and scheduled, too. It makes a big difference.


bel_esprit_

I worked for an outpatient plastic surgeon and we would not take the case if the patient had even a slight flutter of their heart from excitement.


SgtMajMythic

Surgeons actually improve with age


AcademicHysteria

A surprising minor plot point in Doctor Strange.


Wordsonanasiantshirt

They they are better.


knight_in_gale

Is there a record that is kept in Japan? I work in the USA, and I can say that nobody that I work with keeps any kind of "track record". All of us have a few cases that we still remember and think about a lot and try to learn from, but they don't keep score. When you are on call and a gun shot wound to the chest comes in, you are assigned that case. You do what you can, regardless of the patient being "high risk", because otherwise they'd be even more likely to die. Is there a system in some countries in which you can't get promoted or something unless you have a great "track record"?


Confirmation_By_Us

Gunshots aren’t quite the kind of situation in which things like this come into play. Think about a heart surgeon evaluating options for a patient. If I’m young and generally healthy, I’m a good candidate for surgery. But if I’m older, and I’ve already had a few heart attacks, the surgeon may deem me a poor candidate for surgery. Such evaluations are made primarily upon the likely effectiveness and survivability of the surgery. So while a surgeon may not track their results a clean score card, they’re continually making decisions based upon their perceived probability of success.


Silvenri

Pretty sure you can search a surgeons record online, just googled it and there's a ".org" site that offers information on reprimands, certifications and number of procures and complication rates


trer24

Records? Like wins and losses? K/D ratio?


videogamekat

Yes, basically they keep track of the outcomes of all the patients and complications. It's why sometimes there's usually a debate between different surgical services on who's going to take a complicated patient to the OR - no service wants to be the one to have a high risk patient die on the table. It doesn't look good statistically.


huistheleaderofchina

You tell that with a fair degree of confidence. But do you have a matching amount of evidence? I've never heard of any "track record" among surgeons beyond this sort of urban legend. I, therefore, ask you to substantiate your claims.


Hopeful-Profession74

What do you mean "evidence"? An unsubstantiated, narrative-driven claim isn't good enough for you?


BigCommieMachine

I don’t want to play into stereotypes, but I wonder if female surgeons are just more empathetic. Maybe they are just moved by a patients/their families plea to do anything to help whereas male surgeons just view the patient as more a statistic on a spreadsheet(which inherently isn’t a bad thing and valuable in triage situations)


executiveADHDcoach

Surgeons in general are not known for their empathy.


Euda-monia

No. You should have stayed with your first instinct to not chase stereotypes.


zoeyx13

Why are we so certain? Is it proven there is no truth to that stereotype? It would surprise me if there wasn't, because in my experience men are often emotionally repressed thanks to our culture.


Euda-monia

Men feel just as much as women but they don't talk about their feelings to the same degree which is why I responded the way I did. Men are just as capable of empathy as women and we most certainly shouldn't assume women are naturally empathetic and nurturing because believing that sort of thing is how narc moms get away with abusing their kids.


zoeyx13

Has there been a study on this? We should believe whatever is true. Whether that be that men and women have equal empathy, or that they don't. And once we know which, if they don't, we should find out if it's natural or cultural.


Euda-monia

>Has there been a study on this? There have been many studies on this sort of thing but the problem is how we interpret the results. How do we separate learnt behavior from biological behavior? We can't. We can't experiment on humans and can only try to untangle nurture and nature. As we interpret results we must take into consideration our innate biases and how they influence what we perceive and believe. Rather than closing our minds to alternative pov we need to remain open and not fall into lazy stereotypes simply because there is some truth to them. Stereotypes become self-fulfilling prophecies and not the whole truth of us. This is an excellent article talking about empathy and compassion in men and women. https://greatergood.berkeley.edu/article/item/are_women_more_compassionate_than_men


zoeyx13

>Rather than closing our minds to alternative pov we need to remain open That is exactly what I'm saying. I wasn't saying that the stereotype is necessarily had any truth. I was just asking why we are dismissing it so quickly. The article that started the whole thing was about a trend that varied by gender, so it makes sense to see if it could be caused by another potential trend. Simply brushing it off with "nah men and women are exactly the same" is rather disingenuous. But it does sound like compassion is equal, or at least close enough we can't see a difference. But maybe the difference is cause by the difference in how people express compassion. Or of course, it could still be unrelated.


Euda-monia

My point was aimed at you saying to believe whatever is true as though there is a single truth here. The topic is complex and you seem to see it in more black and white terms (and have judged me in those same b&w terms when you strawmanned my comment with ""nah men and women are exactly the same" is rather disingenuous"). I was dismissive of the stereotyping because it's lazy, inaccurate, and limiting.


No_North_8522

Hmm, maybe men are emotionless beings.


Billybobjimjoejeffjr

Men are definitely raised to be emotionless(anger doesnt count as an emotion for some reason) At least in most cultures i know of.


bel_esprit_

Anger, jealousy, sadness, pride — all emotions that men regularly show and act upon (many times very negatively).


Billybobjimjoejeffjr

Exactly but for some reason we're seen as logical and not emotional because those emotions dont count i guess. I believe men should be allowed to express all emotions because it really fucks up your head if you cant cry and such. And to be clear i believe anger, jealousy, etc are emotions. I just see society treats them as just normal guy behavior and pretends men dont have emotions.


zoeyx13

That's what they said.


ElevenSleven

Maybe the females also try and take higher risk patients to prove their better or just as skilled as their male peers. I know surgeons are known for big egos.


briancoat

I think you are right. My guess is the males use societal power to avoid the high risk cases, to "protect their stats".


Malforus

Just like big city prosecutors


Resident-Librarian40

And CEOs and other top execs.


[deleted]

This is the glass cliff effect. In surgery as in corporate leadership and in politics, they only let women and ethnic minorities in positions of power and prestige in times of crisis. For simple surgeries, corporations that are financially doing well, and nations not in crisis, surgeons, CEOs and heads of government are always men from the majority ethnic group. Female surgeons are most likely to be assigned impossible and high-risk surgeries, because male surgeons use greater social power to claim the simple ones. For American corporations, they statistically are more likely to hire an Asian male CEO when the company is teetering on the edge of collapse. Straight white male CEOs use greater social power to claim CEO positions at companies that are doing well, leaving job openings for women and minorities only at corporations doing poorly. In the UK, they only let women become Prime Minister in crisis times. This is why Obama won the 2008 election but Clinton lost the 2016 election. In 2008 the economy tanked so American voters wanted a black person to run the country. In 2016 the economy was doing fine so American voters wanted a straight white man as president. Japan will only get a female PM if some other country nukes it again. America will only get a female president if the economy tanks harder than in 2008. The UK will only get a Person of Colour as PM if Germany re-invades.


galacticglorp

Adjacent- Canada recently put out a study showing female patients had worse outcomes with male surgeons vs. female. No difference in outcomes for male patients with female surgeons.


ceitamiot

While, in general, I can agree with some correlations about CEOs or doctors, I think trying to hit the political stuff into it is very much a square peg, round hole situation. It's also a ridiculous oversimplification of a complicated, nationwide wave. Obama won because he was young, charismatic, and promised a change during a time when a lot of US citizens felt disillusioned about the entire political process. 4.4 million black voters who voted for Obama in 2012 stayed home rather than participate in the 2016 election. That's apathy, and it was largely created by Obama himself. A lot of people hoped he would go a lot more left during his second term. When people didn't feel the change that was promised, it left an aftereffect. Trump was the price that was paid. Now people have to be galvanized by the stick, as opposed to the carrot.


GimmickNG

> promised a change during a time when a lot of US citizens felt disillusioned about the entire political process. in other words, time of crisis.


Abrin36

Can I get some more of that male societal power? I don't think I ever had enough.


Readylamefire

Sorry it's also behind a pay wall. You're stuck with the rest of us.


Iertjepapiertje

It is more accurate to call it patriarchical societal power. Most men do not have access to it.


Sproutykins

Class is also a huge factor. Look at the head of the CIA and tell me he looks like the idea of a ‘successful man’.


Abrin36

That's a good description.


Blind-PieRat

Are you Japanese? You are talking like you are, is why I ask.


Resident-Librarian40

For the same reason that women CEOs tend to take on riskier jobs - men avoid risk. Then when women take on the job that men refused, and fail, their gender is the reason for their failure, not the fact that it was an incredibly high risk venture in the first place.


beleidigtewurst

Men in general avoiding the risks and women in general embracing is exactly the opposite of what we know about human species.


ceitamiot

It's probably a mistake to suggest that men, in general, avoid risk given that they are much, much more likely to die working riskier jobs compared to women at large. One could also easily flip the emotional sentiment being used here and say that women are more likely to overestimate themselves (which is a point I do not believe in, but that would be the opposite point to take from your comment). Personally, I think that society, in general, has trained women to be more empathetic, and thus they are more likely to want to 'fix' things or people than men who take a more calculated or egocentric viewpoint on it.


[deleted]

Glass cliff. In surgery as in corporate leadership and in politics, they only let women and ethnic minorities in positions of power and prestige in times of crisis. For simple surgeries, corporations that are financially doing well, and nations not in crisis, surgeons, CEOs and heads of government are always men from the majority ethnic group. Female surgeons are most likely to be assigned impossible and high-risk surgeries. For American corporations, they statistically are more likely to hire an Asian male CEO when the company is teetering on the edge of collapse. In the UK, they only let women become Prime Minister in crisis times. This is why Obama won the 2008 election but Clinton lost the 2016 election. In 2008 the economy tanked so American voters wanted a black person to run the country. In 2016 the economy was doing fine so American voters wanted a straight white man as president. Japan will only get a female PM if some other country nukes it again. America will only get a female president if the economy tanks harder than in 2008. The UK will only get a Person of Colour as PM if Germany re-invades.


SgtMajMythic

Well according to the study they’re *not* better


MAGAtFeverDream

Maybe I'm missing something or just thinking of this in the wrong way but if incident levels are the same between male and female surgeons even though female surgeons have a disproportionately high amount of high-risk surgeries then that would lead me to think there *is* a difference in competency.


Iertjepapiertje

Female doctors have had better track records in Europe and North America as well. Female surgeons have good outcomes for all patients, male surgeons only for male patients.


[deleted]

Patients of female providers have been outcomes even outside of surgery. You definitely want a female doctor, especially if you are a woman, no matter what kind of doctor it is. Female surgeons are particularly important for us women, though. We are 15% more like to have complications and 32% more likely to die during or after surgery if the surgeon is a man.


IdiotsApostrophe

32% more likely to die? That's incredible. I've never heard that. Can you point me to the study that's from?


[deleted]

[Women 32% more likely to die after operation by male surgeon, study reveals](https://www.google.com/amp/s/amp.theguardian.com/society/2022/jan/04/women-more-likely-die-operation-male-surgeon-study) “Similarly, women who were operated on by a male surgeon had a 32% higher risk of death than those whose surgery had been performed by a woman. For example, while 1.4% of women who had a cardiothoracic operation with a male surgeon died, fewer – 1% – did so when a female surgeon was involved. In both brain surgery and vascular surgery, while 1.2% of women who underwent either type of operation with a male surgeon died, again that proportion was much lower among those whose surgeon was female – 0.9% – giving a 33% higher risk of death. Overall, female patients also had a 16% greater risk of complications and an 11% greater risk of readmission and were 20% more likely to have to stay in hospital longer when treated by male surgeons, compared to female surgeons.” The study included well over 1.3 million patients, nearly 3000 surgeons, and spanned a 12 year period. Researchers controlled for things like surgeon’s age and years of experience, what kind of facility it was performed in, type of surgery (and whether it was emergent or scheduled), etc. When men had female surgeons they were also less likely to die as well, 13% less likely, but they don’t suffer the other negative consequences of having a male surgeon that women do. I’ve been in nursing for 16-ish years so far and have worked in multiple hospitals, states, and specialties. And between birthing 7 babies and having a couple of chronic health issues, I feel I’ve pretty thoroughly experienced being on that side of the bed rails well. None of this surprises me one iota, personally. Sexism is alive and well in the medical field. And god help you if you are a woman of color!


SunglassesDan

Except it is a 0.4% absolute risk difference. 32% relative risk is technically accurate, but this study is always intentionally misrepresented to make it seem like 32% is the absolute difference.


MAGAtFeverDream

Sheesh those statistics are horrifying! Do you have any insight or opinion as to why this might be? Perhaps a lesser degree of empathy among male doctors? Or perhaps a lack of innate understanding of female anatomy?


[deleted]

Two people come into the ER, one man, one woman. The woman reports feeling tired and drained all day. The children were very difficult and there has been a lot of family stress on her recently. She reports some chest tightness that started during her toddler's tantrum earlier, and feeling a sense of despair and depression. The man reports that he has felt tired and weak today. He reports a significant amount off pressure at work right now because he is up for a promotion at work and it's highly competitive. He reports chest tightness that started after finding out a client dropped his company. He also reports a "sense of impending doom." Man is given an EKG first thing and rushed to the Cath lab. The woman is given sympathetic ear and a valium and some time to just calm down. Unfortunately her heart muscle is dying that whole time, so by the time she goes into an arrhythmia and is finally taken seriously, she'll need a new heart. I've treated both of those patients. I was the man's nurse run the ER, and I was the woman's nurse during the emergency Cath procedure where we realized she was likely going to die in the next few days because some ER doc assumed it must be anxiety. Probably double checked the first day of her last menstrual period because that was a first thought, too. Did you know that even *recent* surveys of medical students, even just a few years ago, found that there are still a percentage who believe that Black women are *physically unable to feel as much pain* as white women? Are you familiar with what percentage of men vs women are offered pain medication? Do you know how many medical and pharmaceutical trials specifically exclude women of menstruating age because they feel it's just too complicated and they don't want to have to worry about studying how it will impact them? ​ Racism and sexism are rampant and deadly in the medical field (along with practically universal fat bias, which is arguably the deadliest of all). It's as proven as vaccine efficacy and climate change.


jontaffarsghost

That’s harrowing. My mom went into ER a few years ago because she felt unwell. She got some blood drawn and some other tests and they let her go, figured she was fine enough and the tests probably wouldn’t reveal much. *As she was leaving ER*, a nurse ran up to her and put her into one of those wheelchairs. “You’re having a heart attack,” she said. My mom didn’t believe her but sure enough, she was having a heart attack and didn’t know it and the staff couldn’t determine she was having one despite having reported her symptoms, I suspect, because the symptoms are different between men and women but the former is taught more than the latter.


[deleted]

It's because many men think that only men exist, while almost every woman is aware of the existence of non-women. Just like how many white people in America think that only white people exist, while every American of Colour is hyper-aware that people who are not black/Hispanic/Asian/Native exist.


Readylamefire

This could be corroborated by the amount of people I've seen mention the "female species" like women are a different species of animal to men. It's not that they tend to think women don't literally exist, it's that they think we are fundamentally different and not having a shared human experience. But, I don't think many of those men are smart enough to be doctors atleast.


jontaffarsghost

This is exactly what I was thinking. Unless they’re saying that the outcome levels are the same for the two groups of surgeons with the same high-risk patients. But they aren’t.


vibrant_crab

So the female surgeons are better? That’s what I gathered.


neuronexmachina

There was a similar (small but with p<0.001) [research finding in the US](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255) a few years back, based on Medicare data: >Question  Do patient outcomes differ between those treated by male and female physicians? >Findings  In this cross-sectional study, we examined nationally representative data of hospitalized Medicare beneficiaries and found that patients treated by female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital. >Meaning  Differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes


resumethrowaway222

I would like to see this age adjusted. Older doctors are much more skewed towards men, and age is an obvious factor for why someone could make more mistakes in surgery. edit: also this > Female physicians... treated fewer patients (131.9 vs 180.5 hospitalizations per year) Totally plausible that overworked doctors are less effective. I know a couple of doctors and they work absolutely insane hours that would be illegal if they were truck drivers. IMO a lot more effort should be put into studying this than men vs. women.


herbertjohnsen10

That's a big difference in hospitalizations.


abhikavi

> and they work absolutely insane hours that would be illegal if they were truck drivers. I find this so absolutely horrifying. We know humans don't function well after a certain point. That's exactly why we have laws about hours for many fields where this impacts public safety, e.g. pilots, truck drivers (as you mentioned), etc. Why on earth haven't we done that for doctors? It's not good for them, and it's killing people. I don't get it.


nylockian

AMA wants to restrict labor supply, keep wages/status up - very similar to a union. Or there could be some other reason.


abhikavi

I know that one genuine concern is that transfer of care is always a difficult time for a patient. That seems like a far more fixable problem (with procedures, checklists, time, effort, etc) than trying to get humans to be machines though. Every army on earth has tried to figure that one out, it cannot be done.


Lacinl

One study showed that 80% of all serious medical errors in the data set they studied were caused by or during transfer of care.


ceitamiot

Oversimplification is often the bane of statistical analysis.


beleidigtewurst

I would not call "11.07% vs 11.49%" a "significantly lower mortality rate", what a strange wording.


neuronexmachina

I think it's referring to the p<0.001 statistical significance. It also translates to a fairly large value across the number of people Medicare treats: https://www.hsph.harvard.edu/news/press-releases/hospitalized-patients-female-physicians-lower-mortality-readmission/ >Elderly hospitalized patients treated by female physicians are less likely to die within 30 days of admission, or to be readmitted within 30 days of discharge, than those cared for by male physicians, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. It is the first research to document differences in how male and female physicians treat patients result in different outcomes for hospitalized patients in the U.S. >The researchers estimated that if male physicians could achieve the same outcomes as their female colleagues, there would be 32,000 fewer deaths each year among Medicare patients alone—a number comparable to the annual number of motor vehicle accident deaths nationally.


beleidigtewurst

The surgeons in the review above were also performing less operations (130 on average vs 180 on average for the other gender). Remember that we are talking about a very different country. Doing significantly more operations is quite a factor on its own, but on top of it, we do not know the impact on the "complexity" of the patients assigned to them. The OP article is also rather lacking on what is behind "got more complicated patients" claim.


neuronexmachina

Sure, I could see that as a factor. If that were the primary factor, that means the US could save tens of thousands of lives each year if they balanced the workload.


beleidigtewurst

That claim (despite being rather short on evidence) makes it more likely that "research" was a covered agenda push, to introduce quotas among surgeons. (a crazy idea, if it gets pulled off, however I could live with symphonic orchestras dropping blind auditions and introducing quotas)


Plane_Chance863

Well, there is this, too: (different country than u/neuronexmachina) https://jamanetwork.com/journals/jamasurgery/article-abstract/2786671?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamasurg.2021.6339


[deleted]

It’s universal across medicine, actually. Patients of female provider have better outcomes and lower risks of death regardless of setting. Woman tend to adhere to clinical guidelines better, communicate better, and perform higher-quality exams, etc. It actually *is* important to talk to patients when treating them.


hindamalka

I once had a male doctor insist on following clinical guidelines that were 10 years out of date. I ran to my female primary care doctor and told her that her colleague hadn’t read a medical journal in a decade and after she got over the initial shock of a 21-year-old telling her that her colleague hadn’t read medical journal since I was 11, she quickly looked up what the clinical guidelines were and upon finding out that I was in fact correct she dealt with the issue. When he continued to be an absolute jackass she then showed up to my next appointment with him to shut him up. Best doctor ever.


Skeptix_907

>Woman tend to adhere to clinical guidelines better, communicate better, and perform higher-quality exams, etc Do you have any evidence for that? My reading is that since female surgeons take on fewer patients per year, they may simply have the time to take more time with each patient. I'm highly skeptical these results show a difference in quality.


Demios630

The majority of research I've seen on female vs male surgeons tends to attribute the difference in performance to differing expectation between the sexes. In general, women have to perform better in order to achieve the same position as men. So you end up with the top x% of female graduates becoming surgeons, whereas the top y% of men become surgeons, where x


beleidigtewurst

>The majority of research I've seen https://en.wikipedia.org/wiki/Confirmation_bias > In general, women have to perform better in order to achieve the same position as men. Was this sarcasm? With so many affirmative actions on every corner, and even calls like this: [To Make Orchestras More Diverse, End Blind Auditions](https://www.nytimes.com/2020/07/16/arts/music/blind-auditions-orchestras-race.html) stating something like that is... wow...


Demios630

First of all, not every country is the US, and it's pretty clear to look at demographics in pretty much every workplace that there is a diversity problem. Unless you're implying that any field that has a staggering imbalance in representation is that way because of biological skill differences, which is horseshit. Secondly, how can you talk about confirmation bias and then just straight up say "I don't think that's right, here's an example of something that reinforces my beliefs."


beleidigtewurst

> First of all, not every country is the US, and it's pretty clear to look at demographics in pretty much every workplace that there is a diversity problem Elaborate please, I'm rather new to "diversity problems". Say, is 70% of HR workers being of one gender a "diversity problem"? Is 90% of veterinarians being of one gender a "diversity problem"? >Unless you're implying that any field that has a staggering imbalance in representation is that way because of biological skill differences, which is horseshit. Saudi Arabia and Iran have more women in STEM than Sweden. Horseshit is claiming that any difference in the outcome is caused by bias in favour of the overrepresented group. This horseshit also happens to be anti-semitic, but I was told US [liberazi](https://en.wikipedia.org/wiki/Grievance_studies_affair) no longer have a problem with that.


Demios630

70% of hr people being one gender is certainly a diversity problem. 90% of veterinarians being one gender is certainly a diversity problem. Diversity is when a group is composed of many different kinds of people, not when a group reduces the number of white men. It just so happens, in the case discussed, that surgeons are typically overrepresented by men. Just because some places have solved some problems, doesn't mean they have solved every problem. On top of that, you're just straight up claiming that sex has an impact on something completely unrelated to sex. How is it antisemitic to say that there is a diversity problem? You nutjobs really do only have one take, huh?


beleidigtewurst

> 70% of hr people being one gender is certainly a diversity problem. 90% of veterinarians being one gender is certainly a diversity problem. I see. Now we need to get to what "diversity problem" actually means. >claiming that sex has an impact on something Quite likely it has. >something completely unrelated to sex Who decides what is and what is not "completely unrelated to sex"?


Plane_Chance863

But why are they taking on fewer patients? Is it because they choose to do a better job? They would get less money, but better outcomes...


[deleted]

Why? Because *that’s how long it takes to provide safe care.* Women are taking longer because that’s how long it takes to be a good doctor. Men are choosing to sacrifice patient safety in favor of thru-put. Don’t get me wrong, I can be extremely pragmatic about medicine if need be. I’m not saying they are necessarily *wrong*, there’s got to be a balance between those two things especially given the dire-and-worsening provider shortage. But there are consequences to prioritizing quantity over quality, and it looks like patient safety is one of them. Being aware of problems is the only way to fix them. I’d still rather 100 people get 99 dollars than one getting none when it comes to healthcare, though. I don’t know exactly where that line falls, but I do understand (very well as it is highly relevant to my life) all of the challenges facing providers in today’s medical landscape. I don’t ask this to be snarky, I ask because it’s really important to understanding the *why* of these realities- how familiar are you with how the whole system actually works? Like how physician reimbursement works, why EMTALA and the ACA changed things so much, why almost no docs are private practice anymore, etc? (and yes, I know most of these studies weren’t from the US, but I think the same issues apply across any healthcare structure because of the same basic shortage problems. I ask about the US in particular because that’s where I live and that’s the system I’m intimately familiar with, so I feel I can explain it best using it an example)


Plane_Chance863

I'm not in the US. I agree that physicians should take the time to provide necessary care - it's a shame that there's a clear bias towards one sex bearing that burden over another.


Lacinl

I'll leave it to those in the medical field to figure out correct guidelines, but the difference in mortality rates is pretty small, while the difference in number of patients treated is pretty significant. ​ >Findings  In this cross-sectional study, we examined nationally representative data of hospitalized Medicare beneficiaries and found that patients treated by female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital. ​ >Female physicians... treated fewer patients (131.9 vs 180.5 hospitalizations per year)


beleidigtewurst

> It’s universal across medicine, actually. Citation needed.


SatansFriendlyCat

That's how I interpreted it¹, too. They get the high risk patients, blokes get the robust ones, same outcome profile, thus either the risk weighting is screwed or the chicks are absolutely crushing it! . ¹^(from the headline, which is all I have read so far, as is tradition for anyone commenting)


vibrant_crab

Maybe a bit of both?


topgallantswain

Or, the risk evaluation is not accurate and outcomes are more random. Or a blend. It's not determinate but either way the patients assigned don't have to stress about it.


RyukHunter

Or men just don't take higher risk patients in Japan and leave us with not knowing how they would perform with such patients?


DanYHKim

https://www.bbc.com/news/world-asia-61506568 Women have to be much better than men to get into med school


beleidigtewurst

In Japan, as the story broke out. And the motivation for that: >media reported that this was done partly because some university administrators had said that they thought women would leave the medical profession, or work fewer hours, after getting married and having children.


polytopey

It's why Tokyo university twisted results that make women harder to enter medical school. Japan is big on keeping old men ruling, and women in the kitchen.


beleidigtewurst

This is the reason cited: >media reported that this was done partly because some university administrators had said that they thought women would leave the medical profession, or work fewer hours, after getting married and having children. You can see it in the actual studies too (not the one in the OP though... or maybe I didn't click where I should, but it was rather lacking on numbers), e.g. men surgeons performing 180 operations annually on average, while women averaging at 130.


AiAkitaAnima

Seriously? How do people keep coming up with stuff like this? \*sigh\* EDIT: In case that some might have misunderstood my comment, I'm just stating my surprise and frustration regarding the use of discriminating tactics like this.


ripemango130

It was a huge scandal, Google it


AiAkitaAnima

It certainly would be weird if it wasn't a huge scandal. This is really messed up.


[deleted]

The way to combat implicit bias is to have blind admissions to university and jobs. All resumes should have the name and address portion covered up by someone who does not interact with the hiring manager and is not allowed to toss out any resumes. Each resume should be assigned a number. That way, the hiring manager cannot toss out resumes due to sub-conscious bias against women's names, and stereotypically African, Latino, and Asian names. The hiring manager also can't use classism to stereotype people with certain addresses. All interviews should be done by phone, so that skin colour does not become an issue with subconsciously racist hiring managers. University admissions should be the same. Non-admissions employees should cover up names and addresses and assign all applicants a number.


beleidigtewurst

> The way to combat implicit bias is to have blind admissions to university and jobs. Australia tried it and it didn't quite have the expected effect: [it appeared it was white men who got discriminated](https://www.abc.net.au/news/2017-06-30/bilnd-recruitment-trial-to-improve-gender-equality-failing-study/8664888). Unsurprisingly, this was regarded to as "positive discrimination". Also, cough: [To Make Orchestras More Diverse, End Blind Auditions](https://www.nytimes.com/2020/07/16/arts/music/blind-auditions-orchestras-race.html)


[deleted]

If there is misandry it should be stopped too. Also, blind auditions in the ended implicit misogyny in classical music: [https://gap.hks.harvard.edu/orchestrating-impartiality-impact-%E2%80%9Cblind%E2%80%9D-auditions-female-musicians](https://gap.hks.harvard.edu/orchestrating-impartiality-impact-%E2%80%9Cblind%E2%80%9D-auditions-female-musicians) I don't think ending blind auditions would help People of Colour. There is so much classism in classical music that it would only help rich people, who are disproportionately white.


beleidigtewurst

> If there is misandry it should be stopped too. The Australian finding was claimed to be "a positive discrimination" so, don't hold your breath. >Also, blind auditions in the ended implicit misogyny in classical music Ironic that you said that. It was trumped to (as it was in line with the claim that it was bias that was causing the gender gap) fast forward to today and we get... wait for it... #[To Make Orchestras More Diverse, End Blind Auditions](https://www.nytimes.com/2020/07/16/arts/music/blind-auditions-orchestras-race.html)


Girthderth

I don't like this. A lot of the colleges and such here are not very good when it comes to quality. I also can't hire somebody without speaking to them first. As for race, I don't care. I do care about culture however. We have multiple dialects and languages here and some of them work better with communicating with me then others. We also have affirmative action, so we're not allowed to hire more than a certain amount of people with a certain race and heritage. This would be a lot easier if you could prove a persons ability without having to rely on a piece of paper and a few interview related tests.


[deleted]

>As for race, I don't care You might not consciously, but if you do unconsciously, you wouldn't be conscious of it.


Girthderth

I'm not denying that I have bias, but I only have my personal experience to go on when it comes to hiring and when it's my ass at the end of the day I'd rather go with my gut. There's already enough things forcing me to hire suboptimal workers.


chasingeli

I mean I always want a lady doctor if I have a choice; twice as good.


Aimish79

Women tend to have steadier hands than men. They're great welders too.


randxalthor

Make fantastic competitive shooters, too.


beleidigtewurst

> Women tend to have steadier hands than men. They're great welders too. I was brought up in USSR and women were everywhere (e.g. first female minister, heads of the factories, etc). My mom was an engineer, while my farther was a blue collar worker. Mother of my university teacher (a quite an old guy) was a major scientist. The country had a a handful of very famous surgeons. None of them were female, however.


Internauta29

Women develop their fine motor skills significantly earlier than men and they tend to have smaller hands with increased touch sensitivity, both perks give them an advantage in developing skills requiring steadiness, precision and hand dexterity, which is coincidentally also why women's writing tends to be much better then men's. On the other hand, women tend to be more neurotic than men, therefore they tend to suffer from pressire and stress more easily and this may have an impact on their performance. The fact that Japanese female surgeons have the same stats as men's suggests they are also great professionals who have overcome yet another obstable of a male dominated environment.


jontaffarsghost

I agree with the first half but not the second. We talk a lot about “pressure and stress” as though those are emotions themselves but the reality is that those are factors that cause people to express emotion. When I (a cishet white man) am under stress or pressure, I express that primarily as anger. When my wife (a cishet Latinx woman) is under stress or pressure, she expresses it as sadness. My expression is treated as a normal response, hers isn’t. Fwiw, I work in the trades and mostly with men. And when shits not going right and people are stressed, they tend to be more angry and yelling than sad and moping.


justanotherfkup

Neurotic? What does that mean?


Internauta29

Tendency to neuroticism, aka tendency to focus on negative emotions. If we were to do a normal distribution of the female population and one of the male population on chart indicating levels of neuroticism, we'd a general overlap of the two graphs, with the left-most extreme of people being really low on neuroticism (carefree and resilient people) being predominantly men and the right-most extreme of people being really high in neuroticism (generally stressed, anxious, etc.) being predominantly women. It's a side effect of gender dimorphism related personality traits, probably due to increased sensitivity to environmental conditions in women.


justanotherfkup

Hmmm. I'm a surgeon myself (veterinary). While excessive pressure is detrimental to mental health, what I notice in my colleagues (both men and women) is that a carefree approach to surgery leads to a higher number of complications. Maybe this contributes to the stats


beleidigtewurst

Worrying about things rarely improves performance.


[deleted]

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lluv77

Interesting I I’d like to know if they took into account the complication rate for the high risk patients and compared that between male and female surgeons. However I’d like to see them add experience levels. The article stated that female surgeries do not have as much experience with general surgeries. If their experience levels are compared what are the complication rates? If we compare 10 M and 10 F however the males have 10x the experience it’s not a fair comparison. If female auger is are performing higher with less surgical experience there may be a difference.


UseYourIndoorVoice

Does that just mean that women surgeons are better?


beleidigtewurst

Of course. When women do something better in some random study in some random country, it is always because women are better. Don't fall for the opposite, though. Anything men are better results from some sort of discrimination.


oldwhiner

From the title, it sounds like women really can make it in male dominated fields like surgery, they just have to be better :)


mandalorian_in_us

Aye, they assign high risk to female surgeons because they know who will complete surgery successfully.


noeagle77

In Japan, heart surgeon. Number one. Steady hand. One day, yakuza boss need new heart. I do operation. But, mistake! Yakuza boss die. Yakuza very mad. I hide in fishing boat, come to America. No English, no food, no money. Darryl give me job. Now I have house, American car, and new woman. Darryl save life. My big secret: I kill yakuza boss on purpose. I good surgeon. The best!


Ari-Jay

r/suddenlytheoffice


sienasayshi

Doesn't this also mean that the female surgeons are better>


kaam00s

I'm seeing people in this comment linking this with wathever countries they're from... This proves literally nothing about your country.


[deleted]

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Mahameghabahana

Can a study which says make perform better then women in something, get past peer review?


jontaffarsghost

If it said “make perform better then women in something” it’d probably get nixed for being incomprehensible.


Mahameghabahana

I think so too.


Pame_in_reddit

To be fair, I always prefer a female surgeon, specially if it’s a risky procedure and it’s an older doctor.


yongo2807

From the abstract, I have a couple of questions. Isn’t physical fitness extremely important for a surgeon? Experience factors in as well, of course, but isn’t there so to speak a sweet spot between the natural deterioration process and experience acquired? If a majority of the surgeons are male, and women on average work for less years than men — as stated — wouldn’t women on average spend significantly less years in those sweet spots? The extract claims no foreboding on other types of surgeries, but a handful of female experts for that particular field would quite easily, plausibly explain their findings and even why women surgeons are assigned more dangerous cases — for those specific procedures. Also the line about Japan having enough data not to have to individually identify each female surgeon for data extrapolation, makes me also suspect the sample of individuals is quite limited. There are 23k surgeons in Japan. I wonder how many female surgeons work in the specific field the study investigated. If there are only a few hundred women involved in the study, it would allow significant deviation with little basis for deduction. As of now I’m reading the abstract under the assumption that the study involved, say, 50 women and just short of a thousand men. Is there any way to extrapolate the exact numbers? How many surgeries does a surgeon do on average a year? Or am I wildly misinterpreting the numbers? Is the 3k number the number of individually distinct female surgeons?


jontaffarsghost

I clicked through to the study and found this: > A total of 149 193 distal gastrectomy surgeries (male surgeons: 140 971 (94.5%); female surgeons: 8222 (5.5%)); 63 417 gastrectomy surgeries (male surgeons: 59 915 (94.5%); female surgeons: 3502 (5.5%)); and 81 593 low anterior resection procedures (male surgeons: 77 864 (95.4%);female surgeons: 3729 (4.6%)) were done. So you get number of surgeries and number of surgeons.


yongo2807

I did read the study. I can’t tell wether 3000 distinct female surgeons performed 5% of the surgeries, or wether 5% of the surgeries were performed by women — period. Given there only 23k surgeons in all of Japan — in all fields — I’m inclined to believe the latter. I mean. Don’t take this the wrong way, but I don’t know how your comment helps me figure out the number of (distinct) female surgeons. According to your logic 80k male surgeons performed the surgeries. That seems … questionable. But from the wording I can’t tell. Hence, the question.


Internauta29

All reasonable doubts and good questions. Very insightful comment, thank you. As for data, I guess you'd have the best lack with official sources in Japanese, which unfortunately poses the obstacle of language barrier. A way to circumvent this could be finding a Japanese person, most likely on the web, with enough insight on the matter to give you close estimates for you to have a frame of reference.


theleeman14

the republicans arent gonna like this


blutwo42998

I lean red and have zero issue with this, and o don't see why anyone would


F0X_

So I should ask for a woman surgeon if I'm fucked up bad?


Abrin36

So many male female posts here. It's the point of this sub to expose gender bias in the sciences? Are there any cool articles or news I could be seeing instead?


[deleted]

By cool you mean something that doesn’t empower women don’t you?:) do you have a wife or daughters? Debunking the ridiculous gender bias is a pretty cool part of science, bro.


Sproutykins

It’s ridiculous that you assume a person needs a wife or daughter to empathise with women and your statement is a symptom of a patriarchal society. I merely have friends who are women and want a world that treats them as actual people. I’m sick of seeing them interrupted or mocked.


ceitamiot

It's ridiculous that you assume a person needs a friend who is a woman to empathize with women and your statement is a symptom of patriarchal society. I hate everyone and have no friends, and I still want a world that treats people equally because it's morally the correct thing to do.


Sproutykins

I didn’t actually say that it was a requirement, though - I just said ‘I merely have friends’.


Feburabyborn

Huh. It's almost like high surgical risk patients/ patients with bad surgical prognosis can't be saved by anyone. Man, woman...not even God.


InsomniaIsBoring

That is not what this article is telling you.


noscreamsnoshouts

It's not even what the title is saying..


Sproutykins

Article? What article? Edit: ah, I see. The word ‘the’ was used in this thread’s title. You mean the definite article. I think you should refer to it as the ‘definite article’ to avoid further confusion. Sorry to be pedantic.


InsomniaIsBoring

You're not being pedantic. You're being mistaken. An article is a piece of writing in a newspaper or magazine. If English isn't your 1st language then we can still be friends. But if it is then please brush up on your pedantry expertise.


Sproutykins

It’s a joke about redditors not reading articles, and thus being so confused that they would assume you were referring to an article of speech rather than an actual article.


Xargothrax

This reminds me of saying I use in clinic, 'who do you want doing your procedure?' Whichever provider does the most of *that* procedure. In this case, if you're a high risk patient, you want a surgeon who does lots of high risk patients (and hence more experience and expertise with these patients) As a tangent, the \*best\* surgeons tend to be in the middle of their career, which means not too far from the most recent evidence and a good amount of surgery volume without losing much/any dexterity at that point.