Gender Bias at Play in Treatment of Knee Osteoarthritis
Study finds doctors twice as likely to recommend replacement surgery for men as women
MONDAY, March 10, 2008 (HealthDay News) -- Women with knee pain are less likely than men to be recommended for total knee replacement surgery, says a Canadian study that suggests gender bias may be a factor.
The University of Toronto study included a woman and a man with moderate knee osteoarthritis (OA) who reported the same pain symptoms and sought assessments from 67 doctors (38 family physicians and 29 orthopedic surgeons) in the province of Ontario. Overall, doctors were twice as likely to recommend total knee replacement surgery (arthroplasty) for the male patient (67 percent) as for the female patient (33 percent).
The study, published in the March 10 issue of the Canadian Medical Association Journal, is the first to demonstrate gender bias in an actual clinical setting, according to the researchers.
"Disparity in the use of medical or surgical interventions is an important health-care issue, and this research suggests a gender bias in the treatment of patients who may need orthopedic surgery," study author Dr. Cornelia Borkhoff said in a prepared statement.
The study is based on her doctoral thesis, which she conducted while in the clinical epidemiology program at the University of Toronto Faculty of Medicine's Department of Health Policy Management and Evaluation.
"Physicians may be at least partially responsible for the sex-based disparity in the rates of total arthroplasty," Borkhoff said. "Physicians are susceptible to the same social stereotyping that affects all of our behavior. Decisions that stem from unconscious biases are not deliberate -- physicians would be unaware of their unconscious biases affecting their decisions."
The findings "support the need for clinician education programs to better inform physicians of the true risks of total joint arthroplasty, when and for whom to consider surgery, as well as the potential benefits of early treatment," Borkhoff concluded.
"Acknowledging that a gender bias may affect physicians' decision-making is the first step toward ensuring that women receive complete and equal access to care. The next step is to develop creative interventions that address these disparities in health care," principal investigator Dr. James Wright, a professor at the University of Toronto Faculty of Medicine's Department of Health Policy Management and Evaluation, and Surgeon-in-Chief at The Hospital for Sick Children, said in a prepared statement.
The Arthritis Foundation has more about osteoarthritis.