{"id":2743,"date":"2016-08-22T07:21:29","date_gmt":"2016-08-22T12:21:29","guid":{"rendered":"https:\/\/feminem.org\/?p=2743"},"modified":"2016-09-03T10:52:45","modified_gmt":"2016-09-03T15:52:45","slug":"female-decision-making","status":"publish","type":"post","link":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/","title":{"rendered":"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It."},"content":{"rendered":"

Engaging patients in matters of their health and health care is important to me, but I never considered that I might have a special advantage in this area. Then one day, perusing abstracts in a recent issue of Academic Emergency Medicine, I spotted this rather startling finding:\u00a0patients were nearly 5 times more likely to want an active role in their care when the health care provider was female.<\/em>1<\/sup><\/em><\/p>\n

Shared decision making \u2013\u00a0collaborative medical decision making between health care provider and patient that weighs both the best available evidence and the patient\u2019s values and preferences\u00a0\u2013\u00a0has been somewhat slow to take hold, particularly in the ED. Despite widespread endorsement from on high (the Institute of Medicine, the Centers for Medicare and Medicaid Services, the Affordable Care Act, the American Medical Association, the American College of Emergency Physicians) and increasing acceptance by both providers and patients\u00a0in principle<\/em>, actual participation rates are not believed to have kept pace. The reasons are only partly understood. Could the fact that women still comprise only about a third of the physician workforce \u2013 and a quarter of emergency physicians \u2013 have something to do with it?<\/p>\n

It was an intriguing possibility.<\/p>\n

For one thing, it made a certain intuitive sense. Mightn\u2019t there be systematic differences in practice style between male and female providers? Might not patients in any case\u00a0perceive<\/em>\u00a0there to be differences? It isn\u2019t so much of a stretch to imagine that the patient of a provider perceived as having a decisive or authoritative manner would be less likely to assert his or her personal preferences, while the patient of a provider who encourages patients to speak up would be more likely to do so. But are male providers in fact more likely to fit into the first category and females into the second?<\/p>\n

Conveniently, there is a large body of literature to help answer this question, helpfully summarized (through 2008) in Boulis and Jacobs\u2019 book, \u201cThe Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America2<\/sup>.\u201d The authors ask, among other questions, whether female and male physicians differ systematically in their interactions with patients, and the answer they arrive at is an emphatic yes. Visits with female physicians last longer, on average,3,4<\/sup> and involve more talking \u2013 by both physician and patient.3<\/sup> Female physicians appear to talk more than their male counterparts, but patients with female physicians talk longer, too, with the result a more equal ratio between physician and patient. Conversations between female physicians and their patients appear to involve more partnership building, question asking, and information giving.3,4<\/sup> Female residents, in one study, asked more open-ended questions than male residents.5<\/sup> Female physicians express more empathy.5,6 <\/sup> Importantly, such attempts at supportive communication do in fact correlate with greater patient engagement,7<\/sup> and patients of female physicians rate their visits as significantly more participatory than those of male physicians.8<\/sup><\/p>\n

Shared decision making, it would seem, should be a slam dunk for patients with female physicians and sizable challenge when the physician is male \u2013 on average, of course. But the possibility that this is so has received surprisingly little attention in the recent wave of studies looking for predictors of, or barriers to, shared decision-making. Alas, the study by Holland\u00a0et al<\/em>\u00a0that spurred this post sheds no light on the matter whatsoever.<\/p>\n

The study surveyed patients age 60 and over within 24 hours after ED treatment for acute musculoskeletal pain and then again at one week. The main objective was \u201cto assess the impact of shared decision making on change in pain at one week,\u201d but an important secondary objective was to determine, retrospectively, patients\u2019 desired level of involvement or \u201ccontrol preference\u201d in choosing an analgesic for home use. Also assessed or recorded were the degree to which shared decision making took place, patient satisfaction, health literacy, medication side effects, and patient and provider characteristics \u201cwhich might confound the relationship between shared decision making and pain recovery.\u201d<\/p>\n

In short, the study was not actually designed to look for predictors of shared decision making.<\/p>\n

Why should that matter, if it did this anyway? Well, for starters, patients were dropped from\u00a0all<\/em>\u00a0analysis if they couldn\u2019t be reached for the follow-up survey at one week, since this portion of the survey addressed the study\u2019s primary objective, even if it didn\u2019t happen to be ours. And as it happens, a whopping 40% of the original 157 were lost this way.<\/p>\n

Then there\u2019s the issue of how patients\u2019 control preferences were measured. The authors used the Control Preferences Scale,9<\/sup> a single-question measure with five possible responses:<\/p>\n

    \n
  1. I make the final selection about which treatment I will receive (doctor provides medical information; no personal exchange)<\/li>\n
  2. I make the final selection of my treatment after seriously considering my doctor\u2019s opinion<\/li>\n
  3. My doctor and I share responsibility for deciding which treatment is best for me<\/li>\n
  4. My doctor makes the final decision about which treatment will be used but seriously considers my opinion<\/li>\n
  5. I leave all decisions regarding my treatment to my doctor<\/li>\n<\/ol>\n

    And then they collapsed patients\u2019 responses into just three categories:<\/p>\n

      \n
    1. Active (responses 1 or 2 above)<\/li>\n
    2. Collaborative (response 3)<\/li>\n
    3. Passive (responses 4 or 5)<\/li>\n<\/ol>\n

      Now wait a second. Patients having the final say over what\u2019s done to them, even if only after seriously considering the doctor\u2019s opinion, disqualifies the interaction as collaborative? And doctors making the final decision, after weighing the patient\u2019s opinion,\u00a0is\u00a0the same as making the decision without doing so? As an avid practitioner of what I believe to be collaborative medical decision making, I consider the process fluid by its very nature. In many cases, I probably couldn\u2019t even tell you on leaving a patient\u2019s room which of us was ultimately the \u201cdecider.\u201d When patient and doctor are truly open about sharing information and, where appropriate, opinion, it is inevitable that each will be influenced by the other; the mechanics of the ultimate decision are, ironically perhaps, almost beside the point.a<\/sup><\/p>\n

      Because the authors merged disparate response categories into a confusingly heterogeneous \u201cactive\u201d category, ditto the \u201cpassive\u201d category, the results are next to impossible to make sense of. Of the 94 patients included in the analysis, just over half (53%) preferred an \u201cactive\u201d (16%) or \u201ccollaborative\u201d (37%) role in choosing an analgesic; the rest (47%) preferred a \u201cpassive\u201d role. And yes, 24% of patients with a female provider, vs. only 5% with a male provider, desired an active role in decision-making, a nearly fivefold relative difference. But consider this: patients with a male provider were not only more likely to want a so-called passive role in the decision-making\u00a0they were also more likely to want a \u201ccollaborative\u201d one!<\/em><\/p>\n

      It seems almost mean to mention that all the confidence intervals were wide.<\/p>\n

      There is one last reason to abort the mission \u2013 and it\u2019s a doozy. Patients were also much more likely to prefer an active role \u2013 about 3 \u00bd times more \u2013 when the provider was a\u00a0nurse practitioner<\/em>\u00a0as opposed to an attending physician or resident. Could it be that provider gender was merely a confounder for provider type? Scouring the paper for a breakdown of female and male providers by job type and finding none, I contacted one of the authors and my suspicions were confirmed:\u00a0all of the nurse practitioners were female<\/em>. (For patients seen only by attendings or residents, there was a trend toward a preference for collaborative decision making with females vs. males but it didn\u2019t reach significance.)<\/p>\n

      We return to the study by Holland\u00a0et al<\/em>1<\/sup> to see what the authors make of the apparent association between provider gender and patient control preference, and where that leaves us.<\/p>\n

      The authors, seemingly unfazed by the problems of category confusion, confounding, and capacious confidence intervals uncovered in the 2nd post in the series, take the association at face value and offer up two possible interpretations in the Discussion (hint: only one of them is flattering):<\/p>\n

      \u201cA greater preference for an active role by patients seen by female providers and nurse practitioners may reflect that women and nurse practitioners do a better job of listening to and empowering older adults to make their own decisions\u2026(or) older adults may feel less comfortable leaving the decision to women and nurse practitioners.\u201d<\/em><\/p>\n

      Methodologic problems notwithstanding, the authors have in fact hit on something. If a study\u00a0were<\/em>\u00a0to be designed to identify provider characteristics associated with a patient preference for collaborative decision making \u2013 and let me here urge the reader to consider taking up the challenge! \u2013 and it turned out that patients of us female providers\u00a0do<\/em>\u00a0want more of a say in their care than those of our male colleagues, how should we respond? Do we take pride or offense? Design yet another study to sort out which?<\/p>\n

      I say just run with it. When patients are driven to know and understand more \u2013 more about their condition, their treatment options, and the trade-offs that come with these options \u2013 and, as a result, their treatment can be tailored to their personal preferences, values and circumstances, what\u2019s to be gained by asking why? The research literature and my own experiences have together persuaded me that patient engagement, where feasible, is better for patients, better for providers. If there\u2019s anything at all about me that encourages this, well I should be so lucky.<\/p>\n

      But if, on the other hand, the question of a definite female advantage in this area should go unanswered, or future research place it in doubt, no matter. Better communication with patients is not a zero sum game. There\u2019s room for all of us providers \u2013 female and male, doctor, nurse practitioner, and physician assistant \u2013 to be good at what we do; to encourage patients to understand and speak up about their care; to promote greater trust by patients toward all providers; in short, to improve health care for all.<\/p>\n

      a <\/sup>Note that collaboration doesn\u2019t alter the bottom line, which is patient autonomy; patients (those with decisional capacity) ethically and legally get to have the last word, so long as they don\u2019t demand care the provider can\u2019t provide or believes to be of no potential benefit (or greater potential harm than benefit).<\/p>\n

       <\/p>\n

      References<\/p>\n

        \n
      1. Holland, W.C., et al.,\u00a0A Prospective Evaluation of Shared Decision-making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain.<\/em>\u00a0Acad Emerg Med, 2016.\u00a023<\/strong>(3): p. 306-14.<\/li>\n
      2. Boulis, A.K., and Jacobs, \u00a0Jerry A.,\u00a0The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America<\/em>. 2008: Cornell University Press.<\/li>\n
      3. Roter, D., M. Lipkin, Jr., and A. Korsgaard,\u00a0Sex differences in patients’ and physicians’ communication during primary care medical visits.<\/em>\u00a0Med Care, 1991.\u00a029<\/strong>(11): p. 1083-93.<\/li>\n
      4. Roter, D.L. and J.A. Hall,\u00a0Physician gender and patient-centered communication: a critical review of empirical research.<\/em>\u00a0Annu Rev Public Health, 2004.\u00a025<\/strong>: p. 497-519.<\/li>\n
      5. Shapiro, J. and D.D. Schiermer,\u00a0Resident psychosocial performance: a brief report.<\/em>\u00a0Fam Pract, 1991.\u00a08<\/strong>(1): p. 10-3.<\/li>\n
      6. Bylund, C.L. and G. Makoul,\u00a0Empathic communication and gender in the physician-patient encounter.<\/em>\u00a0Patient Educ Couns, 2002.\u00a048<\/strong>(3): p. 207-16.<\/li>\n
      7. Street, R.L., Jr., et al.,\u00a0Patient participation in medical consultations: why some patients are more involved than others.<\/em>\u00a0Med Care, 2005.\u00a043<\/strong>(10): p. 960-9.<\/li>\n
      8. Cooper-Patrick, L., et al.,\u00a0Race, gender, and partnership in the patient-physician relationship.<\/em>\u00a0JAMA, 1999.282<\/strong>(6): p. 583-9.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

        Engaging patients in matters of their health and health care is important to me, but I never considered that I might have a special advantage in this area. Then one day, perusing abstracts in a recent issue of Academic Emergency…<\/p>\n","protected":false},"author":72,"featured_media":2750,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_mi_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":"","_jetpack_memberships_contains_paid_content":false,"jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[1],"tags":[131],"coauthors":[],"jetpack_publicize_connections":[],"acf":[],"yoast_head":"\nPatients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It. - FemInEM<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It. - FemInEM\" \/>\n<meta property=\"og:description\" content=\"Engaging patients in matters of their health and health care is important to me, but I never considered that I might have a special advantage in this area. Then one day, perusing abstracts in a recent issue of Academic Emergency...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/\" \/>\n<meta property=\"og:site_name\" content=\"FemInEM\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/groups\/1383586405303463\/\" \/>\n<meta property=\"article:published_time\" content=\"2016-08-22T12:21:29+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2016-09-03T15:52:45+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"400\" \/>\n\t<meta property=\"og:image:height\" content=\"400\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Erika Newton, MD MPH\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@feminemtweets\" \/>\n<meta name=\"twitter:site\" content=\"@feminemtweets\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Erika Newton, MD MPH\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/\",\"url\":\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/\",\"name\":\"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It. - FemInEM\",\"isPartOf\":{\"@id\":\"https:\/\/feminem.org\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg\",\"datePublished\":\"2016-08-22T12:21:29+00:00\",\"dateModified\":\"2016-09-03T15:52:45+00:00\",\"author\":{\"@id\":\"https:\/\/feminem.org\/#\/schema\/person\/2bc2d9ed53bf497e09a7b63374b23eb1\"},\"breadcrumb\":{\"@id\":\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#primaryimage\",\"url\":\"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg\",\"contentUrl\":\"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg\",\"width\":400,\"height\":400},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/feminem.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It.\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/feminem.org\/#website\",\"url\":\"https:\/\/feminem.org\/\",\"name\":\"FemInEM\",\"description\":\"Females Working in Emergency Medicine\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/feminem.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/feminem.org\/#\/schema\/person\/2bc2d9ed53bf497e09a7b63374b23eb1\",\"name\":\"Erika Newton, MD MPH\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/feminem.org\/#\/schema\/person\/image\/3477a1c9bef1778afe7e47ed109f218b\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/aa2f28ed702a56ee3135bd1df44bb41d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/aa2f28ed702a56ee3135bd1df44bb41d?s=96&d=mm&r=g\",\"caption\":\"Erika Newton, MD MPH\"},\"description\":\"Erika has been on the Emergency Medicine faculty at Stony Brook since 2003. She completed her training in 1994, a member of Bellevue\/NYU\u2019s first entering class in EM. She has held faculty appointments at several medical schools, including Harvard and Tufts. In 1998, she sailed with her husband to Auckland, New Zealand on a 34-foot sloop, and stayed on to work as a consultant in Emergency Medicine for a year. Back in the U.S., she developed interests in medical ethics, serving as chair of Stony Brook Hospital's institutional ethics committee; in practice variation in medicine; and in the problem of nonbeneficial health care and the question of how medical care might better target the real needs of patients. She completed an MPH in 2012.\",\"url\":\"https:\/\/feminem.org\/author\/erika-newton-md-mph\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It. - FemInEM","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/","og_locale":"en_US","og_type":"article","og_title":"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It. - FemInEM","og_description":"Engaging patients in matters of their health and health care is important to me, but I never considered that I might have a special advantage in this area. Then one day, perusing abstracts in a recent issue of Academic Emergency...","og_url":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/","og_site_name":"FemInEM","article_publisher":"https:\/\/www.facebook.com\/groups\/1383586405303463\/","article_published_time":"2016-08-22T12:21:29+00:00","article_modified_time":"2016-09-03T15:52:45+00:00","og_image":[{"width":400,"height":400,"url":"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg","type":"image\/jpeg"}],"author":"Erika Newton, MD MPH","twitter_card":"summary_large_image","twitter_creator":"@feminemtweets","twitter_site":"@feminemtweets","twitter_misc":{"Written by":"Erika Newton, MD MPH","Est. reading time":"9 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/","url":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/","name":"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It. - FemInEM","isPartOf":{"@id":"https:\/\/feminem.org\/#website"},"primaryImageOfPage":{"@id":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#primaryimage"},"image":{"@id":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#primaryimage"},"thumbnailUrl":"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg","datePublished":"2016-08-22T12:21:29+00:00","dateModified":"2016-09-03T15:52:45+00:00","author":{"@id":"https:\/\/feminem.org\/#\/schema\/person\/2bc2d9ed53bf497e09a7b63374b23eb1"},"breadcrumb":{"@id":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#primaryimage","url":"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg","contentUrl":"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg","width":400,"height":400},{"@type":"BreadcrumbList","@id":"https:\/\/feminem.org\/2016\/08\/22\/female-decision-making\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/feminem.org\/"},{"@type":"ListItem","position":2,"name":"Patients Prefer an Active Role in Medical Decisions When the Provider is Female?\u00a0Just Go with It."}]},{"@type":"WebSite","@id":"https:\/\/feminem.org\/#website","url":"https:\/\/feminem.org\/","name":"FemInEM","description":"Females Working in Emergency Medicine","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/feminem.org\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/feminem.org\/#\/schema\/person\/2bc2d9ed53bf497e09a7b63374b23eb1","name":"Erika Newton, MD MPH","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/feminem.org\/#\/schema\/person\/image\/3477a1c9bef1778afe7e47ed109f218b","url":"https:\/\/secure.gravatar.com\/avatar\/aa2f28ed702a56ee3135bd1df44bb41d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/aa2f28ed702a56ee3135bd1df44bb41d?s=96&d=mm&r=g","caption":"Erika Newton, MD MPH"},"description":"Erika has been on the Emergency Medicine faculty at Stony Brook since 2003. She completed her training in 1994, a member of Bellevue\/NYU\u2019s first entering class in EM. She has held faculty appointments at several medical schools, including Harvard and Tufts. In 1998, she sailed with her husband to Auckland, New Zealand on a 34-foot sloop, and stayed on to work as a consultant in Emergency Medicine for a year. Back in the U.S., she developed interests in medical ethics, serving as chair of Stony Brook Hospital's institutional ethics committee; in practice variation in medicine; and in the problem of nonbeneficial health care and the question of how medical care might better target the real needs of patients. She completed an MPH in 2012.","url":"https:\/\/feminem.org\/author\/erika-newton-md-mph\/"}]}},"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/feminem.org\/wp-content\/uploads\/2016\/08\/shutterstock_440116279-e1471838324102.jpg","_links":{"self":[{"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/posts\/2743"}],"collection":[{"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/users\/72"}],"replies":[{"embeddable":true,"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/comments?post=2743"}],"version-history":[{"count":0,"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/posts\/2743\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/media\/2750"}],"wp:attachment":[{"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/media?parent=2743"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/categories?post=2743"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/tags?post=2743"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/feminem.org\/wp-json\/wp\/v2\/coauthors?post=2743"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}