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Should all patients be treated the same?
If a woman is a lawyer, or the wife of a lawyer, does she get better treatment? Lawyers seem to be regarded by doctors as especially litigious patients who should be treated with caution when it comes to risky procedures such as surgery. The rate of hysterectomy in the general population in Switzerland was 16 percent, whereas among lawyers' wives it was only 8 percent -- among female doctors it was 10 percent. In general, the less well educated a woman is and the better private insurance she has, the more likely it is that she'll get a hysterectomy. Similarly, children in the general population had significantly more tonsillectomies than the children of physicians and lawyers. Lawyers and their children apparently get better treatment, but here, better means less.
That is from Gerd Gigerenzer's Gut Feelings: the Intelligence of the Unconscious. It is a good microeconomics question to ponder the conditions under which a) this is efficient, and b) you would rather be the poorer patient or the non-lawyer than the lawyer.
Posted by Tyler Cowen on July 17, 2007 at 05:49 AM in Medicine | Permalink
Comments
In his excellent book "Risk", he points out that in Germany breast-screening is something that doctors recommend for Other Women, not for their wives or themselve.
Posted by: dearieme at Jul 17, 2007 7:20:18 AM
On the other hand, in the States I have lots of anecdotal evidence that lawyers get given more tests, if not more aggressive treatment. Defensive medicine and all.
Posted by: jb at Jul 17, 2007 7:59:49 AM
It may also be that these folks are simply different from the population. The average wife of a lawyer, or a female physician, likely has children at a later age.
Just a paradigm for thought: Many gynecological problems are addressed based on a woman's desire for future pregnancy: if a woman still wants kids, managing through less invasive but less definitive means can make sense for endometriosis, fibroids, etc. It wouldn't be totally uncommon for a woman to decide to have a myomectomy (a fairly complicated procedure that removes fibroid tumors, et al, from the inner uterine wall) rather than a hysterectomy (which actually poses significantly lower risks of bleeding, and prevents any chance of recurrence) if she wanted to have a kid later. After the myomectomy, she may also be able to avoid another procedure until onset of menopause (after which, such problems diminish signficantly without estrogen stimulation).
That might sound like a specific sort of theoretical anecdote, but that's straight-up bread and butter gynecology, the sort of decision that a doc probably has to make several times a week.
Posted by: Pup, MD at Jul 17, 2007 8:35:33 AM
Most doctor mistakes do not result in a lawsuit, in part because the patient does not realize it was a mistake. If the punishment conditional on a successful suit is about right, then the overall deterrent is too small, and so you'd rather be the lawyer patient.
Posted by: Robin Hanson at Jul 17, 2007 8:39:38 AM
Pup has a good point. Hysterectomies have long been associated with wrong-headed treatment, biased treatment, etc. Look no further than the association of the root of the word: hyster, uterus, which is part of hysterical (or crazy).
A more interesting study would be over some more routine and less fraught medical procedure.
Posted by: ah at Jul 17, 2007 9:47:02 AM
Hysterectomies have long been associated with wrong-headed treatment, biased treatment, etc. Look no further than the association of the root of the word: hyster, uterus, which is part of hysterical (or crazy).
I'm pretty sure the word 'hysterical' is a lot older than 'hysterectomy', and derives more from bad ideas about female anatomy than from bad surgery:
"Various texts of the school of Hippocrates, from the fifth century BC onward, explain similarly that a mature women's deprivation of sexual relations causes a restless womb to move upward in search of gratification. As the female reproductive parts move or function irregularly — ascending or descending, convulsing or prolapsing — they cause dizziness, motor paralyses, sensory losses, and respiratory distress (including globus hystericus, the sensation of a ball lodged in the throat) as well as extravagant emotional behaviours."
Posted by: Nick Tarleton at Jul 17, 2007 11:20:57 AM
I'm not sure this make a lot of sense. Most lawyers are not medical liability lawyers, and probably wouldn't take the case themselves if they were injured by medical malpractice. The injured would pay a more expert lawyer to take the case for them. Wouldn't this apply to the nonlawyers as well? Or, at least those with the same income level who can more easily afford a medical liability attorney?
In other words, I wonder if this is just an income/education effect. Does anyone know if the study controlled for income?
Posted by: Scott W at Jul 17, 2007 3:11:56 PM
One can argue based on Steve McGee work back in the 80's (each lawyer subtracting 2 million from GDP) that
not treating lawyers at all could lead to some welfare gains.
Posted by: Robert at Jul 18, 2007 1:26:50 AM
You can't necessarily compare statistics of doctors' relatives to lawyers' relatives. The doctors' relatives have a second channel of medical opinion which can affect treatment decisions.
Posted by: Zach at Jul 18, 2007 9:56:00 AM
Posted by: 鑽石 at Apr 2, 2008 9:17:07 PM
