While we have made significant progress in our country toward gender, racial and ethnic equality, women still face the challenge of bias in nearly all stages of their lives. Teachers will more often call on boys in the classroom. Women CEO's are few and far between. However, gender-based inequity also reaches into another sector not widely discussed -- health care. Research suggests that a patient's gender may affect a physician's recommendation. This can have a serious impact on one's quality of life -- especially for women living with osteoarthritis.
Osteoarthritis is a type of arthritis that is caused by the breakdown of the cartilage 'cushion' at the joint. It usually affects large weight-bearing joints, such as the hip and knee, and impacts more than 27 million Americans. Osteoarthritis of the knee can severely compromise a patient's mobility and quality of life. The bad news for ladies is that we develop knee arthritis more commonly than men, with greater pain and functional limitations. This also affects the gentlemen, who want to keep dancing with their partners as the years go by.
So where does the bias come in to our discussion? Total knee arthroplasty (TKA), or knee replacement surgery, is a highly effective treatment for patients dealing with osteoarthritis, both male and female. However, in cases of moderate knee arthritis, where a physician's judgment is necessary to determine treatment options, one study showed that an orthopaedic surgeon is 22 times more likely to recommend TKA to a male patient than to a female patient presenting the same level of pain and functional limitations.
It is important to understand that we all have bias, both conscious and unconscious -- it is part of the human condition. Thus, the orthopedic surgeons in the above study may have perceived the female patients to be exaggerating their symptoms compared to the men, making a recommendation for surgery to the women much less likely.
Beyond knee joint replacement, women are also less likely than men to receive other surgical treatments. For example, women receive fewer kidney transplants and heart surgeries. Suggested explanations for this difference have included women being less willing to have surgery due to their obligations as caregivers and greater concerns regarding risk. However, even in adolescents needing kidney transplants, boys are more likely to get a new organ than girls. Therefore, other factors also influence these troubling outcomes; unconscious bias may be one of them.
So, how do we improve this situation? Physicians need to increase their awareness of the biases that may be influencing their recommendations to patients, especially those who are female or from a different racial or ethnic background. Patients should be assured that all treatment options are discussed with them and understand the reasoning behind their doctors' recommendations. Taking steps to prevent or manage knee arthritis and avoid the need for surgery is most important, but women must take a proactive role in their health care decisions to make sure they are getting equal treatment for their knees. Mary I. O'Connor, M.D., is Chair of the Department of Orthopaedic Surgery at the Mayo Clinic in Jacksonville, FL. She is an Associate Professor of Orthopaedics at the Mayo Clinic College of Medicine and member of the Executive Operations Team at Mayo Clinic Florida. She serves as the co-chair for Movement is Life.
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