Women ER doctors less reluctant to err on the side of defensive medicine or proactive care—or maybe both

In emergency settings, female physicians order more tests and admit more patients than their male peers. The difference is not pronounced, but its presence suggests women physicians may have a greater tendency to consider peripheral assessment factors such as symptom management, functional status and social support.

The finding and inference are from a study published July 20 in JAMA Internal Medicine. 

For the study, Dan Ly, MD, PhD, MPP, of UCLA Health and colleagues analyzed EHR data from patients who visited the emergency department of a Veterans Affairs hospital between 2011 and 2019 with chest pain, shortness of breath or abdominal pain. 

Meanwhile the team measured ER physicians’ practice patterns, concentrating on orders for imaging and lab tests as well as admissions to inpatient beds. 

The researchers also tracked patient outcomes, mainly watching for mortality within 30 days of ER visit and inpatient stays of less than 24 hours. 

Modest differences and no reasons for regret  

Ly et al. summarize their key findings as follows: 

• Female physicians ordered more tests and admitted more patients than male physicians in the same EDs, although differences were modest. 
   
• While this additional care was not associated with lower mortality, additional admitted patients were not more likely to be discharged within 24 hours, suggesting they had inpatient needs. 
   
• Female physicians ordered more potentially low-value CT scans, although the researchers could not assess differences in share of scans with a clinically significant finding.
   
• Upon examining differences in test positivity, the team found no differences. 

The latter observation “suggests the additional tests ordered by female physicians may be clinically appropriate,” Ly and co-authors comment. 

Additional doesn’t mean inappropriate  

Among the study limitations the researchers acknowledge are the specificity of the VA setting, an inability to determine whether more or fewer tests and admissions represents higher-quality care, and the study’s use of older data. 

“Sex-based differences, although small, may not dramatically change over time, keeping our findings relevant,” Ly and co-authors comment. “These modest differences may be associated with differences in risk aversion and peer judgment.”

In in-house coverage by UCLA Health, Ly underscores the deduction that female and male ER physicians “may approach diagnostic uncertainty differently” and reiterates that these differences “don’t necessarily represent unnecessary care.”

The study is posted in full for free.