It has been well-documented that non-white patients are more likely to survive dangerous health conditions if they are treated by physicians of their race, which has spurred a push from hospitals to hire a more diverse team of physicians. A recent study in PNAS expanded these findings to gender, showing that among a sample of patients experiencing an acute myocardial infarction (AMI), female patients were more likely to survive when treated by a female ER physician.
The researchers used patient and physician data from Florida ED admissions between 1991 and 2010, because a patient admitted to the ER does not have a choice in which physician they see, resulting in a semi-random assignment of physician to patient. They divided the data into four groups: male doctors seeing male patients, male doctors seeing female patients, female doctors seeing male patients and female doctors seeing female patients, discarding all gender-neutral doctor names to avoid error. Survival rates after AMI were 2-3 times higher for female patients being treated by female physicians, even controlling for physician experience.
However, there were some attenuating factors. If a male doctor worked in a hospital with many female colleagues, or if he had treated a significantly higher number of female patients in the past, the difference in survival was improved. This may be because of knowledge “spillover” from his female colleagues or because hospitals with a commitment to even gender ratios may have policies that improve treatment gaps, or possibly mandate training to improve treatment of female patients.
This study is of significant import to us as future providers. For maximum beneficence, male providers should keep the results in mind and seek out hospitals with a commitment to unbiased hiring practices to improve their skills and the survival of their patients. Female providers should look out for female patients that are being treated by male colleagues and share knowledge when appropriate. Medical schools should emphasize the different presentations of conditions like AMIs in men and women to avoid maleficence. And when possible and appropriate, patients should be given the autonomy to choose their doctor.
I find this research extremely interesting, and it makes me think about other areas and specialties of medicine, particularly with OB/GYN specialists. I wonder how the effect of a male versus female doctor effects patients seeing a gynecologist, since it makes such difference in heart attack patients. I found an article from Huffpost discussing how there are more female than male gynecologists now than in recent years, and the percentage of female doctors in the field continue to increase, while the male percentage is decreasing. I wonder if having a female gynecologist has anything to do with a better experience and pregnancy compared to having a male doctor who is an OB/GYN.
ReplyDeleteThere is a statement in the article that reads "Why should there be a difference in terms of the gender of practitioner, and the quality of the care? I don't even know why that question exists. I think gender has nothing to do with capability, and nothing to do with quality of care." Obviously, gender can make a difference, and the autonomy of the patient should maybe be at the forefront of the conversation.
I find this research to be quite interesting as well, and I especially appreciate that you brought up the idea of autonomy in terms of choosing what doctor to be seen by. This is important because of the research you have presented here referring to survival rates based on the sex of the doctor, but it is also important because different people have varying levels of comfort towards doctors of a different sex. Some people prefer a male doctor, some prefer a female doctor, and a patient's comfort level is likely to impact their receptiveness to what the doctor has to say. I found an article in the Ovid journal that recorded whether people preferred to be seen by a female or male doctor. This paper was limited because only laceration repair patients were sampled, but they still observed an interesting pattern. More than 70% of the time, children preferred a female doctor; meanwhile, 60% of parents preferred male doctors (Waseem, & Ryan 2005). This difference could be the result of many different factors, but one possible factor is the generational difference. This article shows that many factors play into a person's preference of doctor. This reiterates the importance of autonomy to choose a doctor when possible, especially as the percentage of male to female doctors in the field changes, and as different generations begin to age because in order for physicians to provide the best care possible to their patients, their patients must feel comfortable with them.
ReplyDeleteReference
Waseem, M., & Ryan, M. (2005). “Doctor” or “doctora”: do patients care? Pediatric Emergency Care, 21(8), 515–517. Retrieved from http://dml.regis.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=16096596&site=ehost-live&scope=site
I think this is likewise critical for the provision of patient-centered care, which requires enormous humility on the provider's part. I remember many cases where, during a dangerous situation where a patient became assaulting, I knew that simply by being male or white that it would be harder for me to establish rapport with patients who were demographically dissimilar, or who had trauma at the hands of people who shared characteristics with me. Something the right thing to do is to ask a colleague for help, simply because the patient might like them better. I think this also gives more weight to the idea that we should have a body of physicians whose demographics actually match those of the patients they treat.
ReplyDeleteJust another way to think about why having a diverse team of providers is not only socially just, but is also pragmatically superior in terms of patient outcomes.
Arianna, thanks for sharing this. I had never really considered that there may be a correlation between gender and patient outcomes. I came across a similar article which analyzes this relationship. Rather than investigating survival rates of AMI in an ER setting specifically, the authors looked at Medicare patient’s readmission and mortality rates against physician gender. Similarly, the authors found that Medicare patients treated by female physicians saw lower rates of mortality and readmission than those treated by male physicians. The article admits several limitations, like not fully accounting for differences in the risk of death and readmission between patients. I agree that we need to look more carefully at this, so that we can seek to spread best practices among all doctors regardless of gender. Additionally, it would be interesting to see how transgender physicians fit into studies like this.
ReplyDeleteHere is the study I referenced. It’s worth a read!
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2593255
Wow, Natalie, great find! I wish that study had also investigated the relative gender compositions of the team working on each patient, because the truth is that care is no longer dictated by a single physician but by a team of docs, PAs, nurses and assistants. Follow-up work in this field is definitely warranted.
ReplyDeleteAriana,
ReplyDeleteYes! I think that physician gender does matter (for some patients) and evidence-based medicine agrees! We know that patient trust in the physician-patient relationship has direct impacts on healthcare outcomes of the patient [1]. For some patients, gender preference is significant in inducing trust in the patient-physician relationship. One example of this implication is observed in the context of cultural sensitivity. Some Indian cultures observe preference for female physicians in the care of female patients, and the availability of a female physician proved pivotal in the patient-physician relationship and resultant patient compliance and health outcomes [2]. Adherence to patient preference also aligns with protecting patient autonomy and should be a choice for the patient.
[1] https://academic.oup.com/fampra/article/19/5/476/539234
[2] https://www.aafp.org/afp/2010/0701/p28.html