MedicalResearch.com Interview with:
Brad N. Greenwood PhD
Information & Decision Sciences
Carlson School of Management
University of Minnesota–Twin Cities, Minneapolis
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There has been growing work in medicine which suggests both that a) women are more skilled physicians across a variety of ailments and b) women are particularly challenging heart attack patients (for a variety of reasons ranging from delays in seeking treatment to atypical presentation). When you coupled this with the deep literatures in economics, sociology, and political science which suggests that advocatees experience better outcomes when they share traits with their advocates, it seemed plausible that there might be differences in outcomes.
The key finding is that gender concordance matters most for female patients: female patients are about 0.7-1.2% more likely to die if treated by a male doctor, relative to a female doctor. This number seems small. But, if the survival rate among the female heart attack patients treated by male doctor was the same as the survival rate among female heart attack patients treated by female doctors, about 1,500-3,000 fewer of the female heart attack patients in our sample would have passed away. Our sample covers the state of Florida from 1991-2010. Florida is about 10% of the US population.
MedicalResearch.com: What should readers take away from your report?
Response: We need to be careful here, since it is a secondary data study pinning down the exact mechanism is hard. There are several possible explanations, but each are speculative. For example, gender concordance often facilitates communication between the patient and the physician, meaning that men might not be getting the signals they need. Alternatively, women may feel more comfortable advocating for themselves with a female physician. Further, since heart disease is often cast as “male” condition, male physicians might not pick up on the atypical presentation symptoms women more often show (or at least not to the degree that female physicians do). But, like I mentioned, these are speculative and we need deeper work to dive in and figure out what’s going on.
The most important thing that readers might want to take from our study is the difference in heart attack symptoms across men and women. Readers should know that women may be experiencing a heart attack, despite not experiencing chest pain. Getting to an ER in a timely fashion is likely to matter more than the gender of one’s physician.
As for whether patients should ask for female doctors, which is where this usually goes next, I would hesitate to advocate doctor selection based on doctor gender. There are big distributions in what we observe in the data: some male doctors are better at treating female patients than some female doctors are. Patients should be sure that the doctor, regardless of gender, is taking seriously their concerns.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We outline these at length in the paper. I think this paper calls attention to the issue that the medical community has been grappling with, and making strides on, for a while: differences in patient presentation and making sure all patients get the care they need. I think what’s critical to emphasize is the importance of understanding the diversity of the patient community and ensuring that the physician pool is diverse as well. And this diversity will take a lot of shapes. Increasing the presence of women and minorities as colleagues. Increasing the diversity of perspectives (i.e. treating more than just the prototypical male patient) during medical education and continuing education. Increasing the diversity of patients entering the knowledge generating process (i.e. medical trials and the like). This way, every patient can get the care that they need. Like I said, the medical community has been making tremendous strides in this area, and we want to make sure they continue. I also think there are great opportunities to explore the patient care team (e.g. nurses, residents, interns, and other co-practicing physicians).
Disclosures: We have no conflicts to declare with this work.
Patient–physician gender concordance and increased mortality among female heart attack patients
Brad N. Greenwood, Seth Carnahan, Laura Huang
Proceedings of the National Academy of Sciences Aug 2018, 201800097; DOI:10.1073/pnas.1800097115
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