Sex differences in medico-legal action against doctors: an author Q+A

Today, BMC Medicine published an article looking at the sex differences in medico-legal action for doctors. Here, co-author Emily Unwin answers our questions to explain more about their work.

What led you to research the sex difference in medico-legal action against doctors?

In 2013, we performed a large cross-sectional study of all registered doctors in the UK.

This cross-sectional study demonstrated that the sex of a doctor was an important factor associated with disciplinary action by the General Medical Council, the UK medical regulatory body.

We found that female doctors were less likely to receive disciplinary action, even after taking into account other explanatory variables. This study provided a snapshot of the situation in the UK, but did not include doctors practising outside of the UK.

We were interested in discovering whether our study’s findings were replicated in studies performed in countries outside of the UK, with possibly different medical and legal systems, and whether the association between male sex and experience of medico-legal action varied over time.

This is what led us to perform a systematic review and meta-analysis examining the association between doctors’ sex and medico-legal action.

Why is this important to investigate?

We felt it was important to complete a systematic synthesis of the many peer-reviewed studies examining the sex difference in doctors experiencing medico-legal action across the world.

This is because these studies vary considerably – some conclude male doctors are more likely to be disciplined, but with differing effect sizes, while other highly respected studies have not found a significant association.

The aim of our study was to establish the robustness of the association between doctors’ sex and medico-legal action, internationally and over time.

What were your key findings?

This effect was demonstrated over a number of years; across a range of study designs; across different countries; and with a wide definition of outcome types, and therefore seems robust.

This is the first systematic review and meta-analysis examining the association between doctors’ sex and experience of medico-legal action. It demonstrates that male doctors are more likely to have had experience of medico-legal action, with nearly two and a half times the odds, when compared to female doctors.

This effect was demonstrated over a number of years; across a range of study designs; across different countries; and with a wide definition of outcome types, and therefore seems robust.

The demonstration of a consistent effect size, present in the main analysis, as well as in the subgroup analyses, highlights that there is likely to be a fundamental explanation for why male doctors are at over two times the odds of experiencing a medico-legal action.

Do you think there is a reason behind why males are more likely to face legal action?

Establishing the reasons for why male doctors are more likely to face medico-legal action is vital, not only to ensure patients are receiving the highest standard of medical care, but also because of the personal and financial costs of medico-legal procedures.

Our study did not examine the possible reasons associated with increased likelihood of medico-legal action, but it is the first step for doctors, medical educators, medical regulators, and researchers looking to understand the underlying factors associated with the sex difference in medico-legal action in doctors, and how to promote patient care by bridging this gap.

More research is needed to understand why male doctors are more likely to experience medico-legal action, the causes of which are likely to be complex and multi-factorial.

How could your findings inform medical education and proactive in the future?

The medical profession, along with medical regulators, and medical educators, now need to work together to identify and understand the underlying causal factors resulting in these sex differences.

The aim of better supporting doctors in achieving the standards expected of them, and improving patient care should be a priority.

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