Knee Surgery - It’s a Mans World as far as Diagnosis and Treament
Recent studies show that Men are more likely to get a diagnosis for Knee Surgery than Women.
Women are less likely than men to get recommended for total knee replacement surgery – even if they have the same set of symptoms and complaints, a small University of Toronto study suggests.
And the researchers say subtle gender bias by physicians and surgeons may be to blame.
The study, published yesterday in the Canadian Medical Association Journal, found family physicians were twice as likely to recommend total knee replacement surgery to a male patient than a female patient.
In a type of undercover operation, the researchers sent two “mystery” patients, one male and one female, to 38 family doctors and 29 orthopedic surgeons in Ontario. The patients each had moderate knee osteoarthritis, and both complained of knee pain, listed the same symptoms and asked the physicians whether they “needed a new knee.”
Orthopedic surgeons were nine times more likely to recommend surgery to a man than a woman, according to the findings.
It is the first study to use standardized patients to test physicians for gender bias, said lead author Cornelia Borkhoff, who conducted the research as part of her PhD thesis at U of T’s department of health policy, management and evaluation.
“Our research demonstrates that physicians may be partially responsible for the gender disparity in rates of joint replacement,” she said.
Dr. Bob Bourne, professor of orthopedic surgery at the University of Western Ontario and chair of the Canadian Joint Replacement Registry, said the study, though conducted by well-respected researchers, may be overly sensational.
According to the CJRR, 60 per cent of patients who had knee replacement surgery in 2004-2005 were women.
“We’re doing 50 per cent more knee replacements in Ontario than we were two years ago,” he said, crediting Ontario’s wait-time strategy for reducing delays. “Women are getting substantially more knee replacements than men and growth rates are continuing to increase.”
But Bourne said the study, though small, did show discrepancies and that there should be more research to find out why.
The study found 67 per cent of family doctors recommended total knee replacement surgery to the male patient, while only 33 per cent recommended it to the female.
Other studies have shown women who have knee replacement surgery arrive with more severe symptoms than men, he said. “This warrants further study because we want equal access for everybody.”
Borkhoff said the gender bias may be due to unconscious stereotypes. One is that men only see doctors when the situation is critical, so doctors may take men’s complaints more seriously, she said.
The study was too small to probe whether a physician’s gender, ethnicity or training background influenced their decision, Borkhoff said.
She said the first step to ensure patient equality is to let doctors know about unconscious stereotypes.
“We probably need a public campaign to better inform patients and physicians of the true risks of joint replacement, when and for whom to consider surgery, and the benefits of early treatment.”
