Patients Know Their Condition and Should Be Listened to by Physicians

The article quoted below gives evidence that on average the patients of female physicians have slightly better health outcomes than the patients of male physicians, and speculates that the reason is that on average, female physicians are somewhat better at listening than are male physicians. The article does not highlight an important implication of this speculation: that what the patient is saying is worth listening to, i.e., it has merit, often providing true and useful knowledge about their own condition. Patients actually know something. If so, this goes against the popular views that physicians should be paternalistic, and that the only actionable source of health knowledge is a randomized double-blind clinical trial.

(p. D4) Whether your doctor is male or female could be a matter of life or death, a new study suggests. The study, of more than 580,000 heart patients admitted over two decades to emergency rooms in Florida, found that mortality rates for both women and men were lower when the treating physician was female. And women who were treated by male doctors were the least likely to survive.

Earlier research supports the findings. In 2016, a Harvard study of more than 1.5 million hospitalized Medicare patients found that when patients were treated by female physicians, they were less likely to die or be readmitted to the hospital over a 30-day period than those cared for by male doctors. The difference in mortality was slight — about half a percentage point — but when applied to the entire Medicare population, it translates to 32,000 fewer deaths.

Other studies have also found meaningful differences in how women and men practice medicine. Researchers at Johns Hopkins Bloomberg School of Public Health analyzed a number of studies that focused on how doctors communicate. They found that female primary care doctors simply spent more time listening to patients than did their male colleagues. But listening comes with a cost. Doctors who were women spent, on average, two extra minutes, or about 10 percent more time per visit, creating scheduling delays and putting them an hour or more behind their male colleagues by the end of the day.

Dr. Nieca Goldberg, a cardiologist whose book “Women Are Not Small Men” helped start a national conversation about heart disease in women, said the research should not be used to disparage male doctors, but should instead empower patients to find doctors who listen.

. . .

Edna Haber, a retired mortgage company owner who lives in Westchester County in New York, said she has had wonderful male and female doctors, but her worst experiences have all involved male doctors.  . . .

Recently she decided to see Dr. Goldberg to discuss heart palpitations and feeling lightheaded. But a series of medical tests during the office visit found that her heart was normal. “I do believe that had I been with a male doctor, I think he just would have put his arm around me and said, ‘Listen, go home, relax, meditate, maybe take a tranquilizer,’ and that would have been the end of it.”

But Dr. Goldberg knew the patient had been concerned enough to see a doctor, so she suggested that she wear a heart monitor for a few days. Several days later, the technicians monitoring the feed noticed a pattern that ultimately showed Ms. Haber needed a pacemaker.

“She paid attention and treated me as if I was credible,” said Ms. Haber. “I wish all the women I know could understand how important it is to have a doctor who pays attention to them, whatever part of the body they are looking at. I think a lot of women are getting short shrift.”

For the full story see:

Tara Parker-Pope. “Should You Choose a Female Doctor?” The New York Times (Tuesday, August 21, 2018 [sic]): D4.

(Note: ellipses added.)

(Note: the online version of the story has the date Aug. 14, 2018 [sic], and has the same title as the print version.)

The “new” study mentioned above is:

Greenwood, Brad N., Seth Carnahanb, and Laura Huang. “Patient–Physician Gender Concordance and Increased Mortality among Female Heart Attack Patients.” PNAS 115, no. 34 (Aug. 21, 2018): 8569–74.

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