Gender Bias in the Management of Patients Still Exists

Mackey, Cassandra; Diercks, Deborah B.

doi:10.1111/acem.13394

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Within these findings, differences in rates of ECG acquisition between women and men in most complaint categories were reduced but not eliminated in the time period after the QI interventions. In line with an increasing number of studies that interrogate a wide range of health care settings and practitioners for unconscious bias, [29][30][31] the current study was designed to illuminate a previously unexamined area of practice. The results presented here showing a persistent gender gap oblige providers in this service to reflect on their choices and confront their assumptions in these specific situations.…”

Section: Discussionmentioning

confidence: 99%

Sex and Gender Equity in Prehospital Electrocardiogram Acquisition

McDonald

Little²,

Grierson

et al. 2022

Prehosp. Disaster med.

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Introduction: Research in cardiac care has identified significant gender-based differences across many outcomes. Women with heart disease are less likely both to be diagnosed and to receive standard care. Gender-based disparities in the prehospital setting are under-researched, but they were found to exist within rates of 12-lead electrocardiogram (ECG) acquisition within one urban Emergency Medical Services (EMS) agency. Study Objective: This study evaluates the quality improvement (QI) initiative that was implemented in that agency to raise overall rates of 12-lead ECG acquisition and reduce the gap in acquisition rates between men and women. Methods: This QI project included two interventions: revised indications for 12-lead acquisition, and training that highlighted sex- and gender-based differences relevant to patient care. To evaluate this project, a retrospective database review identified all patient contacts that potentially involved cardiac assessment over 18 months. The primary outcome was the rate of 12-lead acquisition among patients with qualifying complaints. This was assessed by mean rates of acquisition in before and after periods, as well as segmented regression in an interrupted time series. Secondary outcomes included differences in rates of 12-lead acquisition, both overall and in individual complaint categories, each compared between men/women and before/after the interventions. Results: Among patients with qualifying complaints, the mean rate of 12-lead acquisition in the lead-in period was 22.5% (95% CI, 21.8% - 23.2%) with no discernible trend. The protocol change and training were each associated with a significant absolute level increase in the acquisition rate: 2.09% (95% CI, 0.21% - 4.0%; P = .03) and 3.2% (95% CI, 1.18% - 5.22%; P = .003), respectively. When compared by gender and time period, women received fewer 12-leads than men overall, and more 12-leads were acquired after the interventions than before. There were also significant interactions between gender and period, both overall (2.8%; 95% CI, 1.9% - 3.6%; P < .0001) and in all complaint categories except falls and heart problems. Conclusion: This QI project resulted in an increase in 12-leads acquired. Pre-existing gaps in rates of acquisition between men and women were reduced but did not disappear. On-going research is examining the reasons behind these differences from the perspective of prehospital providers.

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Section: Discussionmentioning

confidence: 99%

Sex and Gender Equity in Prehospital Electrocardiogram Acquisition

McDonald

Little²,

Grierson

et al. 2022

Prehosp. Disaster med.

View full text Add to dashboard Cite

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“…Additionally, our patient reported experiencing dismissive attitudes from physicians due to her gender. Gender bias is known to exist in medicine, which can affect patient outcomes [ 8 - 9 ]. It is our sincere belief that this case report will contribute to the medical literature and literacy surrounding Milroy’s disease with the goal of optimizing treatments and patient care by promoting physician understanding of Milroy’s disease and its various presentations.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Left-Sided Pleural Effusions in a Patient With Chronic Lymphedema

Slater¹,

Ahmed²,

Obodo³

et al. 2022

Cureus

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Chronic lymphedema can present with several long-term complications. Causes of lymphedema can be primary, caused by a genetic source, or secondary to procedures, trauma, or other conditions. Primary hereditary lymphedema, as in the case of Milroy's disease is rare. Because of its rarity case reports offer presentations to monitor for. Here we document a case of Milroy's disease in a 70-year-old woman with recurrent left lung effusions.

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“…19,20 With the underdiagnosis and misdiagnosis of SCAD, in addition to poor outcomes reported in women who present with a cardiac events in general, it is important to address the implicit bias likely underlying this patient population to ensure the appropriate diagnostic testing of those "atypical" patients who present with chest pain. 8,21,22,23,24,25,26,27,28…”

Section: Discussionmentioning

confidence: 99%

The presentation of spontaneous coronary artery dissection in the emergency department: Signs and symptoms in an unsuspecting population

Johnson

Rouleau

et al. 2021

Academic Emergency Medicine

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Objectives: Spontaneous coronary artery dissection (SCAD) has emerged as a common cause of acute coronary syndrome (ACS) in young women, although it is rarely discussed in the differential diagnosis for chest pain in the emergency department (ED). In a population otherwise considered low risk for myocardial infarction, there is a danger of incomplete workup and missed diagnosis. In this study, we aim to describe the clinical presentation of those who present to the ED with SCAD to increase awareness of this potentially fatal diagnosis among emergency practitioners.Methods: Data were queried from the Mayo Clinic "Virtual" Multicenter SCAD Registry, a large multisite international disease registry. The registry includes demographic information as well as data from both medical records and surveys administered following the SCAD event. Symptom presentation was abstracted from survey narrative responses. Data analysis was performed using descriptive statistics.Results: Of 1196 subjects included, chest pain was reported during initial SCAD event in 95.7%. Most common chest symptoms descriptors were pain, pressure/weight, and tightness, with radiation most often in one or both arms/shoulders. Other common symptoms included nausea, shortness of breath, and diaphoresis. Most common electrocardiogram (ECG) findings reported were ST elevation, T-wave abnormality, and normal ECG. Initial troponin values were within normal range in 20.1% of patients. Conclusion:With young healthy women often considered "low risk" for ACS, it is important to understand that SCAD is a cause of ACS, and familiarity with presentation can improve awareness among emergency physicians. Our data can provide insight in helping to identify young women who present with chest pain due to SCAD so they can be appropriately evaluated.

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Gender Bias in the Management of Patients Still Exists

Cited by 8 publications

References 18 publications

Sex and Gender Equity in Prehospital Electrocardiogram Acquisition

Sex and Gender Equity in Prehospital Electrocardiogram Acquisition

Recurrent Left-Sided Pleural Effusions in a Patient With Chronic Lymphedema

The presentation of spontaneous coronary artery dissection in the emergency department: Signs and symptoms in an unsuspecting population

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