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Getting past physicians biases to the correct diagnosis

Posted Oct 14 2008 9:34am

From MedPage Today ( TCT: Primary Care Physicians Think Zebras When Chest Patin Patient Is an Anxious Woman ):

A stressed out man who sees a primary care physician with symptoms of coronary artery disease (CAD) is more likely to be diagnosed with the condition than a woman with the same complaints, researchers reported here.

The implication was clear, said Alexandra J. Lansky, M.D., of Columbia University — “primary care physicians interpret chest pain or other coronary artery disease symptoms as psychogenic when the patient is an anxious woman.”

Lansky presented detailed clinical scenarios of a 47-year-old man and a 56-year-old woman to 87 general internists. Half of the cases indicated that the patient appeared anxious and had recently undergone a stressful life events. Gender bias was evident only when stress was described in the scenario.

The findings were presented only in the narrow context of CAD diagnosis and are preliminary. However it seems to me that the implications are much broader. I’ve noted before that when obese people visit the doctor their complaints are often ignored; frequently they are just told to lose weight. Older people are also often written off by doctors who figure they’re too old to benefit from treatment. Something similar is probably going on here and in many other doctor/patient encounters. It matters a lot, since after all patients do better with the right diagnosis made as early as possible.

What can be done? Here are some starter thoughts:

  • Physicians should be aware of their own biases (or at least aware that biases exist) so that they question their own assumptions.
  • Patients should seek out empathetic physicians. That doesn’t mean all women need to see female physcians and all obese patients need to see obese physicians –but then again there may be something to that.
  • Patients and physicians should seek second opinions. And in particular they should seek opinions that are truly independent from the original opinion –not an opinion from someone in the same practice or with the same basic outlook on life and medicine.
  • Physicians should rely more on clinical decision support tools, even for seemingly routine diagnoses. This will also help them understand their own biases (see point number one).
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