A Canadian study recently released, and reported in the New York Times, gives us one more reason to ask our doctors questions, and to insist on second opinions.
Two people, one woman, one man, both 67 years old, and with equally ugly osteoarthritis were sent to 67 doctors. Among them were 29 orthopedic doctors and 38 family physicians. The patients were coached on how to present their symptoms so each doctor visit would be consistent. After examination, each patient asked the doctors whether they would need a knee replacement.
In total, two-thirds of the doctors told the man that yes, he needed to get his knee replaced. Only one-third of the doctors told the woman she needed a new knee.
Keep in mind that this study was done in Canada. We can’t draw any conclusions about money as a motivator in any direction because Canada has a national healthcare system. No money changes hands beyond the taxes paid by patients.
Also, no conclusions can be reached about the tendency of female vs male doctors to make recommendations because not enough female doctors participated in the study.
So where does that leave us?
Clearly, no matter which side of the US-Canadian border, patients need to realize that there are many aspects of care that need to be questioned. There are even additional questions about this study. For example:
This study seems to suggest gender bias. Clearly, twice as many doctors recommended the man have surgery. But is that really the answer? Perhaps the man was more or less physically fit? Maybe the man or the woman was heavier? Could it be that there were other factors that were, even subconsciously, considered by those doctors?
Assuming that the difference truly is one of gender bias, then it doesn’t bode well for either men or women. It tells us men are more prone to being treated surgically then women. But that’s not good for men who don’t really need surgery, and it’s not good for women who could truly benefit from surgery.
And among those men and women who were told they didn’t need surgery — why not? Were they told they needed a different treatment? Were they not well-diagnosed, therefore they didn’t need treatment at all?
What alternatives were offered to those who didn’t “need” surgery?
These questions apply to any situation where a patient has a problem that could possibly be repaired surgically, not just orthopedic problems. If surgery is an option for you, then you’ll need to talk to at least two doctors, and possibly a third.
Two doctors at a minimum — and that’s if they agree on your diagnosis and treatment recommendations. A third doctor if there is disagreement. And don’t believe the one who gives you the better news. How do you know if s/he is right?
All of us atients can learn from this study, even if there are plenty of unanswered questions. Before you go under the knife, for any reason, get a second opinion.