Top ways to curtail gender bias in healthcare

After designing a computerized check list tool requiring doctors to review blood clot prevention for every patient, Elliott Richard Haut, MD, PhD, vice chair of quality, safety, and service, department of surgery, and associate professor of surgery, Johns Hopkins Hospital, Baltimore, and his team inadvertently discovered that female trauma patients were in more danger of dying from preventable blood clots than men.

“We knew that patients didn’t always get the right venous thromboembolism prevention, so we implemented tools in the electronic health record system in 2007,” he says. “We had noticed a disparity in patients getting appropriate prophylaxis for deep vein thrombosis and pulmonary embolism, so we performed a study of trauma and internal medicine patients.”

According to data, 31% of male trauma patients did not get the right clot prevention, while 45% of women did not.

Haut and his colleagues didn’t know why the gender disparity occurred, but the tool ultimately improved everyone’s care. “We were pleased to find out that the tool resolved the issue,” he says. “This is because we raised the bar for all patients. Everyone improved such that they are now equal.”

Men are now getting appropriate care 85% of the time and women, 82%.

Common gender disparities 

Janine Austin Clayton, MD, director, office of research on women’s health, National Institutes of Health (NIH), Bethesda, Maryland, says sometimes women experience different standards of care than men. For example, while heart disease is the No. 1 killer of both sexes, symptoms in women are more likely to be missed during exams.

“A major reason for this is that women may not have the same symptoms of heart disease as men,” she says. They are more likely to experience temporary spasms in their arteries that doctors might not notice, Clayton says. And, they have a different and less visible pattern of harmful fatty deposits within their blood vessels. In women, the “pinched” or segmented look of affected arteries does not occur as often.

Even angiography, the gold standard test for diagnosing coronary artery disease-which involves injecting dye into the blood system and heart blood vessels and then observation-is better at detecting the more typical male pattern of disease. Thus, women need more specialized tests. “Whether they are getting those specialized tests, when they need them, is an open question,” Clayton says.

Another example of a gender disparity appeared in a study in the Canadian Medical Association Journal. That study found that doctors are less likely to recommend knee replacement therapy to women than men-despite equal levels of knee arthritis severity and the same symptoms, says Clayton.  

Pain management is another condition where care diverges. Too often, pain in women is associated with mental health problems, when in fact the pain is actually because of a real physical problem, as reported in Global Health Action. Some women suffer for years before receiving appropriate pain treatment.  

Next: Combating gender bias

Combating gender bias

Gina Lynem-Walker, MD, physician consultant, Blue Cross Blue Shield of Michigan, based in Detroit, says the implications of gender disparity include poor patient outcomes, sometimes including death, and an increase in healthcare costs.

A first step in combating gender bias, Haut says, is to acknowledge that it exists. “Data shows that these biases are real,” he says. “We don’t know why they happen. It might be due to a systematic bias of the entire healthcare system.”

Here are more ways to address the problem:

• Bring bias to light. Healthcare providers may have implicit bias when treating patients, he says. That’s why Johns Hopkins asks medical students to undergo testing to show if subconsciously they favor one group over another. “This helps them to appreciate their own subconscious biases,” he says. “By knowing they exist, they can do something about them.”

• Develop check lists and protocols. Lynem-Walker says like Johns Hopkins, some healthcare systems are attempting to combat gender bias by developing patient check lists and protocols to treat each patient equally, regardless of gender or other characteristics.

• Embrace diversity. A diverse workforce, comprised of individuals with various perspectives, can also help, says Clayton, who notes that a JAMAstudy found that older patients tended to have better outcomes when they had female doctors. The study implies that differences in practice patterns between male and female physicians may be the reason.

Other strategies include:

• Increasing public awareness regarding gender bias;

• Involving more women in clinical trials;

• Reporting on sex-specific differences; and

• Increasing patient education such as through the American Heart Association's “Go Red for Women” campaign.

Clayton is hopeful that gender bias in healthcare will decrease over time. “Awareness of the problem is growing, as is an appreciation of the fact that women can have different diagnostic and treatment needs,” she says.

Haut is also optimistic. “I think gender disparity will decline, now that it is out in the open and more people are acknowledging it,” he says. “Interventions can be implemented to make them go away. There has been a big push for this in many fields, not just in healthcare.”

As more women become aware of the issue, Lynem-Walker says they will become more empowered to ask questions and advocate for equity in the way they are evaluated and treated.