Gender bias may affect care of people with osteoarthritis

Unconscious prejudices among physicians may explain why women complaining of knee pain are less likely than men to be recommended for total knee replacement surgery, according to a study in the Canadian Medical Association Journal.

Toronto researchers used two standardized or "mystery" patients, one male and one female, both with moderate knee osteoarthritis reporting the same symptoms of knee pain. The patients received assessments from 67 physicians in Ontario.

Physicians were twice as likely to recommend total knee arthroplasty to the male patient compared to the female patient. Overall, 67% of physicians recommended total knee arthroplasty to the male patient, compared with 33% who recommended it to the female patient.

"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," co- author Cornelia M. Borkhoff, PhD, said in a press release.

This new study – the first-ever demonstration of physician bias in an actual clinical setting, according to the investigators – involved 38 family physicians and 29 orthopedic surgeons. The researchers were interested in whether barriers for women exist between the family physician and the patient in obtaining a referral to an orthopedic surgeon, as well as between the surgeon and the patient in the decision to offer total knee replacement.

Researchers said the male patient was referred to an orthopedic surgeon 35% more often than the female patient.

"Physicians may be at least partially responsible for the sex-based disparity in the rates of use of total joint arthroplasty," Borkhoff said in the press release. "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."

"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," added James Wright, MD, MPH, FRCSC, principal investigator and professor at the University of Toronto Faculty of Medicine's department of health policy management and evaluation. "The next step is to develop creative interventions to address these disparities in health care."

For more information:
Borkhoff CM, Hawker GA, Kreder HJ, et al. The effect of patients' sex on physicians' recommendations for total knee arthroplasty. Can Med Assoc J. Mar 2008;178:681-687.