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Jo-Ann Fellows

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Equality is a basic tenet of the Canadian health care system.

Section 3 of the Canada Health Act requires the facilitation of "reasonable access to health services without financial or other barriers." But recent research indicates there may well be barriers of gender and age bias in the system.

In the first study, a University of Toronto PhD candidate led a research team that sent two supposed patients, whose requirement for knee replacement were identical, to a group of family doctors and orthopedic surgeons. The only difference in the two was one "patient" was a woman and one a man.

Both patients described the same list of symptoms: aged 67, right knee pain that began three years ago, moderate pain that became worse in the past six months, minimal interference with normal daily activities, complete limitation with vigorous activities, physiotherapy and one cortisone shot that failed to help, earlier X-rays that showed results consistent with moderate osteoarthritis, and at the end of their appointments both patients asked, "Do you think that I need a new knee?"

Of the 67 physicians, 29 orthopedic surgeons and 38 family doctors, 67 per cent recommended knee replacement to the man, and 33 per cent recommended it to the woman. In other words, if you're a man, you're twice as likely to be offered a knee replacement than if you're a woman, although both sets of symptoms were identical.

The doctor who directed the study felt the doctors in question were not withholding treatment rationally, but that there was a gender bias in their recommendation.

"They're just not recognizing the seriousness of women's symptoms." The reason has less to do with conscious discrimination than a subconscious bias, she said. There were a few women doctors in the group consulted, but not enough of them to determine if they had a similar bias.

Traditionally, women have been less valued in most societies. If bias is detected in decision-making in health care, then practitioners should be made aware of it, and some degree of education might help. If this study is symptomatic of the attitude of doctors in Canada, then women as a group are getting substandard care.

Another study, this one conducted in 14 Ontario hospitals, and published in the Canadian Medical Journal, analyzed almost half a million patient records. The study was undertaken because there has been some anecdotal evidence that women are less likely than men to be admitted to intensive care units, and to have a corresponding aggressive treatment of their problems.

The results showed that women are less likely than men to be moved into ICUs and to receive life-supporting treatment. They are also more likely to die during a critical illness. The problem is even more pronounced among older women. Thus, both gender and ageism appear to be influencing the type of care provided.

All told, severely ill women are about one-third less likely to be treated in ICUs than men with comparable conditions. Women spend less time in ICUs, are discharged quicker, and are more likely to return to hospital. They are also about 20 per cent more likely to die in ICUs than men.

As the doctor who led the study concluded, "We all want to ensure that women and men have equal access to care, but our subconscious biases are an impediment."

It would be a good idea if health care workers consider their biases or stereotypes in relation to their decision making.

Jo-Ann Fellows is a writer with an interest in health care. She lives in Fredericton. Her column appears every Tuesday. Send comments to letters@dailygleaner.com.