A recent study published in the Journal of the American Heart Association suggests that cardiologists have varying degrees of implicit gender bias and this bias explains some of the gender differences in clinical decision-making for suspected coronary artery disease (CAD).
Stacie L. Daugherty, MD, MSPH, of the Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, and colleagues used Implicit Association Tests (IAT) and a clinical vignette with randomly assigned patient gender to determine the presence of gender bias in clinical decision-making by 503 participating cardiologists. The IAT is a reliable and validated tool to determine unconscious bias. It measures bias through reaction time taken to associate different ideas.
Participants taking the IAT associated pictures of men and women with words synonymous with strength or weakness or risk taking or risk averse. Subjects were asked to respond as quickly as possible.
The majority of respondents associated strength or risk taking with male patients more than with female patients. In addition, 74.7% and 89.9% of participants demonstrated some implicit gender bias on risk taking and strength, respectively, whereas 32.4% and 57.06% of participants had high implicit bias on the same measures.
The majority of participants agreed that stress testing would be useful for patients with symptoms suggestive of CAD regardless of gender. Cardiologists were also more likely to rate angiography as highly appropriate for males than for females (19.7% vs 9.8%; P <.01). For a patient with an abnormal exercise treadmill test and chest pain, respondents were more likely to rate the usefulness of the angiography as high for male vs female patients (73.7% vs 64.3%; P =.03).
Factors independently associated with a higher angiography rating included male patient gender, higher estimated likelihood of CAD, and higher certainty of this estimate (all P <.05). Furthermore, physicians’ bias on risk taking was a significant predictor of gender differences in angiography ratings in patients with symptoms suggestive of CAD.
Potential limitations include the use of case scenarios rather than actual patient encounters and a low response rate, although the authors note that there is no reason to believe that the sample does not reflect the general physician population.
Daugherty SL, Blair IV, Havranek EP, et al. Implicit gender bias and the use of cardiovascular tests among cardiologists. J Am Heart Assoc. 2017;6:e006872.