By Robert H. Shmerling, M.D.
Harvard Health Blog
I’ve read medical research studies that surprised me. I’ve read medical news that inspired me to learn more. And, sure, there have been plenty of studies that went way over my head. But it’s rare that I’ve read a study that made me feel defensive. Until now.
Researchers publishing JAMA Internal Medicine reported that older adults admitted to the hospital fare better if under the care of a female physician rather than a male physician. More specifically, the patients in this study were less likely to end up back in the hospital, or die, in the 30 days after discharge if cared for by female physicians than similar patients cared for by male physicians.
How “good” was the study?
The study was large. Nearly 1.6 million hospital admissions among people covered by Medicare were analyzed for deaths within 30 days. Another 1.6 million admissions were analyzed for readmission within 30 days. When comparing care provided by male to female internists, the results clearly demonstrated small differences that consistently favored the female physicians:
–Deaths within 30 days of admission occurred in 11.07 percent of patients cared for by female physicians while 11.49 percent of patients cared for by male physicians died in that timeframe.
–Readmission to the hospital within 30 days of discharge occurred in 15.02 percent of patients with female physicians but in 15.57 percent of those cared for by male physicians.
–Even after accounting for several relevant factors, such as severity or type of patients’ illness, or type of medical training, age or experience of the physicians, the findings remained largely the same.
Although these differences may seem small, they could have a large impact on unnecessary suffering, premature death, and costs of care when considered over the millions of hospital admissions that occur each year.
Your reaction, please
When I surveyed the members of my household about these results, the reactions ranged from “Of course, everyone knows women are better at everything,” (my wife’s perspective) to, “There must be some other reason for these findings; the researchers must have missed something.” OK, that last one was from me. Did I mention I was feeling defensive?
But after reading the research report’s results carefully, it’s hard to come up with an alternative explanation for the study’s findings. And there is other research that suggests that female physicians outperform their male counterparts in certain aspects of medical care, such as communication skills.
So, what’s their secret?
And that brings us to this question. If female physicians are getting better results, how do they do it? Just what are the differences in the ways male and female physicians practice that lead to better outcomes for patients of women doctors?
The answer is important. Identifying the differences in how male and female physicians provide care could lead to improved care across the board, regardless of physician gender.
The study’s authors are appropriately cautious in their conclusions because a study of this type cannot determine why the results turned out as they did. But they did offer a few possibilities:
–Female physicians may follow clinical guidelines more often.
–Female physicians may communicate better, with less medical jargon.
–Male physicians may be less “deliberate” in addressing complicated patients’ problems (as suggested by past research).
I would add a couple of other possibilities:
–Perhaps female physicians listen more carefully.
–Female physicians may spend more time with their patients, and this could allow the doctor to get a better sense of the patient’s symptoms and help ensure that her recommendations are understood well by the patient.
There are more questions to answer
Beyond making us think about what female physicians are doing right, this study raises a number of other questions:
–Would the results be the same if other areas of medicine were similarly studied? This study excluded patients of care for by other types of doctors such as surgeons, obstetricians, and psychiatrists.
–Would physician gender matter if the patients were younger? The average age of patients in this Medicare-covered study population was nearly 81.
–How would the results be affected if outpatients were included?
How can we use this information to improve care of patients?
Undoubtedly, future research will try to tease out how female and male doctors practice differently. Then it will be important to figure out why these differences exist and which ones matter most. It’s probable that each gender has something to teach the other. One thing is certain: Accepting the possibility that female physicians may outperform male physicians in certain aspects of medical care, and then trying to understand why, is much more constructive than being defensive about it.
(Robert H. Shmerling, M.D., is a faculty editor at Harvard Health Publications.)