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Is Anesthesia Decided Based on Sex, Race or Ability to Pay?
Recent study results presented at a poster session at the PostGraduate Assembly (PGA) meeting in New York suggest that anesthesiologists may be influenced by gender, race or ability of the patient to pay. The study, performed by Dr. Memtsoudis, found that the possiblity for unconscious bias by anesthesia providers exists.
Specifically, the study looked at patients receiving inguinal hernia repair and compared demographic data with the anesthetic technique that the patient received. Among the findings, the study showed that women were much less likely than men to get epidural, monitored anesthesia care (sedation) or local anesthesia for their care. In addition, black patients were less likely than white patients to receive epidural, monitored anesthesia care or local anesthesia - and much more likely to receive spinal or general anesthesia. Lastly, patients without private insurance were less likely to receive monitored anesthesia care or local anesthesia when compared to privately insured patients.
Dr. Ting's comment: Clearly there are differences in how the studied groups were treated. However, while interesting, this study does not really make the case that differences found were because of bias on the part of the anesthesia provider. More likely, cultural factors that are also tied to demographic data are responsible for the differences found. For example, there might be tremendous differences in what is expected, tolerated or desired between patients of different genders, races or socioeconomic class. While the issues of gender bias, racial discrimination and financial prejudice are not ones to be ignored, much additional study must be performed before data such as this is convincing.
There have indeed been good studies in other specialties that show a difference in treatment options provided to patients of different genders and races. These are significant in that the choice between medical treatment or surgical treatment of certain diseases can result in major differences in morbidity and mortality. This study has not shown that different options were provided, only that different options were chosen in the end. Additionally, it does not demonstrate any differences in morbidity or mortality as a result of those choices.
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