A 31-y-old black man with neurofibromatosis, alcoholism and hypertension was admitted because of abdominal pain, hematemesis and cough. In the hospital he had prolonged fever and developed a multiorgan crisis. Despite thorough investigation, no infectious cause for fever was found. Urinary catecholamines and metabolites were markedly elevated. Computerized tomography revealed a mass abutting the left kidney. A diagnosis of pheochromocytoma was made, and as soon as treatment with phenoxybenzamine and propranolol was begun, the fever resolved. Serum interleukin-6 (IL-6) concentration was initially elevated, decreased after the start of adrenergic blockade, and gradually fell to an undetectable level after surgery. These observations suggest that interleukin-6 might have been causally related to the patient's fever and possibly the multiorgan crisis.

Background: Patient satisfaction surveys as a metric for quality-based financial incentives carry a risk of bias toward women and underrepresented physicians. Previous assessments in our department of medicine found that most women faculty were rated in the bottom quartile of patient satisfaction scores, whereas analysis of scores for underrepresented physicians had not been performed. To investigate, we compared patient satisfaction scores and relevant demographics of faculty physicians during 1 year when quality-related financial incentives were offered based on this metric.Methods: Patient satisfaction and communication scores collected during academic year 2015–2016 were obtained for 369 physicians (119 women and 250 men) at Indiana University Health system. Independent variables included physician gender, race, ethnicity, and subspecialty or division; 190 physicians constituted the study cohort for whom data were available for comparison. Statistical analyses were performed to determine if there were differences between gender and race in patient satisfaction scores (mean, median, t-tests, and Chi-square tests). A factorial analysis of variance model was performed to incorporate both main effects and to determine if there was a significant interaction between them.Results: Median and mean of scores were lower for women physicians and underrepresented physicians. Analysis demonstrated nonsignificant effect between gender-segregated cohorts. Racially underrepresented physicians had significantly lower mean scores than their white colleagues [F(4, 185)=2.46, p=0.046].Conclusion and Relevance: Our results indicate a significant difference in patient satisfaction scores between underrepresented and white physicians. These data may suggest a potential bias, among patients and institutional practices, ultimately leading to pay inequities through differences in financial incentives toward underrepresented physicians.

During the COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2, healthcare professionals across the world have been at high risk of transmission because of their direct contact with infected patients. In October 2020, the International Council of Nurses (ICN) confirmed that 1,500 nurses had died from COVID-19 in 44 countries and estimated that healthcare worker COVID-19 fatalities worldwide could be more than 20,000. To ensure protection of healthcare personnel, properly fitting personal protective equipment (PPE) must be worn. In a ‘one size fits all’ world, the differences between the fit of PPE for men and women can have devastating consequences. An N95 respirator mask is a component of PPE outlined by the Centers for Disease Control and Prevention (CDC) for protection against COVID-19; however, N95 masks do not offer protection if they do not fit properly. Fit testing is performed to ensure an adequate seal of the mask on the wearer. A single-institution retrospective review was performed on fit testing results for male versus female wearers in an attempt to elucidate a difference in failure rates. Females failed at a significantly higher rate than their male counterparts (6.67% female, 2.72% male; p=0.001), and the reason reported was often due to being ‘small-boned’ (p<0.0001). Sex-related differences in proper PPE fit are not new; however, the COVID-19 pandemic has made the situation more acute, and sex-specific N95 mask designs must be developed quickly, as the pandemic shows little signs of abating.

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