- Female patients treated in EDs with a higher percentage or a higher number of female physicians were more likely to survive. Although true of both care from a female or male physician, the beneficial survival effect of a greater female physician presence, was more marked when treated by a male doctor.
- Female patients treated by male physicians were also more likely to survive when the male physician had previously seen more female patients (0.02% increased survival for each female patient seen in the last quarter!).
Very interesting study covering 20 years of Floridian ED patient admissions for myocardial infarct, looking specifically at the influence of gender-discordance between patient and doctor.
The headline finding was that female heart-attack patients experienced lower survival when treated by a male physician than when by a female physician. Baseline mortality across all patients was 11.9%, with a 1.5% absolute survival decrease when compared to male patients treated by female physicians.
Although on the surface this absolute effect size could be misinterpreted as small, it represents a 12% relative risk difference – quite meaningful when we are considering mortality from the leading cause of death in the U.S.
Could the researchers suggest a reason?
The authors identified two interesting points:
"These results suggest a reason why gender inequality in heart attack mortality persists: Most physicians are male, and male physicians appear to have trouble treating female patients." – Greenwood, 2018
Female heart-attack patients are less likely to survive when treated by a male physician than a female physician.
Female patients treated by male surgeons more commonly experience post-operative complications and death than when treated by female surgeons.
Consuming a small amount of milk with tea does not slow gastric emptying when compared with the same volume of water.
High-dose epidural fentanyl does not slow gastric emptying in labouring women compared to low-dose fentanyl.
Although reducing excessive anaesthetic depth, closed-loop TIVA did not reduce postoperative neurocognitive complications when compared to manual BIS-guided TIVA.
Infratentorial craniotomies require a longer duration of surgery and higher exposure to anesthetic drugs and analgesics, and consequently are associated with higher rates of PONV. The article describes a 3 drug regimen adding scopolamine to the usual combination of dexamethasone and ondansetron.
Dexmedetomidine does not improve day 3 behaviour among 2-7 year olds after day case surgery.
Propofol-based TIVA may be associated with improved overall survival after cancer surgery than volatile anaesthesia.
Epidural analgesia for video-assisted thoracoscopic lung cancer surgery does not improve cancer recurrence or cancer-specific survival.