In a study that is sure to rile male doctors, Harvard researchers have found that female doctors who care for elderly hospitalized patients get better results. Patients cared for by women were less likely to die or return to the hospital after discharge.
But the latest work, published Monday in JAMA Internal Medicine, is the first to show a big difference in the result that matters most to patients: life or death.
The study's authors estimate "that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year."
"Of course! What did you expect?" replied the wife of Dr. Ashish Jha, the study's senior author, when he shared his team's findings with her. Jha said he expects a backlash over the study results. But his team's methodology, successfully put through multiple analyses, makes this work noteworthy, he added.
But tens of thousands of fewer deaths per year if we just went with female doctors?
Whoa! To us, a man and woman who met as we were getting our start in medicine, them's fightin' words.
An editorial about the study urges doctors to remedy the gender disparities in care and the pay gap that favors male physicians over women.
Since half the patients we treat are women and girls, it makes sense that at least half the physician corps should reflect the population. We've achieved that in medical school rolls, but overall only a third of practicing doctors are female. And many specialties, including orthopedics, cardiology and neurosurgery, are still dominated by men.
So why is there a gender-based difference in physicians' care? The authors admit that they are "unable to identify exactly why female physicians have better outcomes than male physicians."
We don't pretend to know for sure, but as married doctors, we have our hunches. We talked it over and here are our thoughts about the research.
Dr. Sarah-Anne Henning Schumann: The actual effect reported in the study is small, but multiplied over a huge population it does add up to something significant.
Dr. John Henning Schumann: I like the Big Data aspect of it. The authors said, "Let's look at more than a million Medicare patients over several years and see how they fared based on the gender of their doctor." While many people may want to tear this study apart, I think the findings make intuitive sense.
Sarah-Anne: I'm assuming the difference is because of the way that women, in general, communicate. It's about being better listeners, more nurturing and having emotional intelligence.
John: There are plenty of men who are good communicators.
Sarah-Anne: Yes, just as there are plenty of women who don't really have those qualities. For female doctors, having worked their way through pre-med, med school and residency, they can have some of that nurturing communication skill beaten out of them.
John: That happens to men, too!
Sarah-Anne: That's true. But this study shows us — just possibly — that if female doctors, on average, communicate better, their style might be more effective in treating disease and preventing death.
John: It's interesting to me because I think about some of my older patients, who much prefer that I tell them what to do rather than to discuss options and share decision-making.
Sarah-Anne: I think that traditionally men were the doctors. People often assume men are more intelligent and so would be more likely to take their advice.
John: That has to change, as we get closer to parity with women in the profession.
Sarah-Anne: My mother has had many experiences with male doctors where she feels they haven't listened to her. They aren't warm or kind, but she feels reassured anyway. She thinks they're smart, and what's most important to her is their knowledge and technical skill, not their bedside manner.
John: Mom always knows best, if that's what she values.
Sarah-Anne: Even in our family, we're both doctors. I'm a family doctor, trained to see adults and kids. You're an internist, trained to only see adults. And in both of our families, most of the time, our family members will reach out to you with their questions — even about kids. And my family, who attended my Harvard Medical School graduation, I'll remind you, seems to value your opinion more. They seem to be looking for opinions more from men. That's kind of an interesting thing.
John: I never really thought about that. I can see how that's totally male privilege. It has to be frustrating to be taken less seriously.
Sarah-Anne: I'm in a Facebook group of physicians who are moms. While it's not every doctor-mom in the country, there are over 60,000 of us in it. So many tell stories of being mistaken for nurses — and taking great offense at that. We have worked so hard to get where we are and want to be treated as equals to our male colleagues.
But I see the mix-up as a compliment rather than an insult. To be compared [to] a nurse says that patients are seeing me as someone who is caring for them and nurturing.
John: That's a smart way to reframe it. Our colleague Jill used to get angry when people assumed she was a nurse. Instead, she decided to embrace it and use it as a call to service. Now she asks patients if they need an extra blanket or something to drink. And she believes that she provides better, more empathic care.
Sarah-Anne: Everyone is going to want to know what is it about women that leads to these better outcomes. I think it's going to be hard to figure out exactly.
John: Do you think people that read or hear about this study will take home the message that they need to choose female doctors?
Sarah-Anne: Some will no doubt oversimplify it to that. What I take away is that if communication is the key, as I suspect, then we need to better select and train medical students and residents to exhibit these qualities.
John: Amen to that. What about equal pay for equal (or better!) outcomes? Paging Lilly Ledbetter!
Sarah-Anne: You're not really asking me that, are you?
Sarah-Anne Henning Schumann is a family doctor and serves as medical director of Community Health Connection, a federally qualified community health center in Tulsa, Okla.
John Henning Schumann is an internal medicine doctor and serves as president of the University of Oklahoma's Tulsa campus. He also hosts Studio Tulsa: Medical Monday on KWGS Public Radio Tulsa. He's on Twitter: @GlassHospital
ROBERT SIEGEL, HOST:
If you are older and hospitalized for an illness, does it matter whether you're treated by a male doctor or a female doctor? Well, a new study out in JAMA Internal Medicine - JAMA stands for the Journal of the American Medical Association - suggests that it could matter.
The study by researchers at Harvard School of Public Health looked at Medicare patients, average age about 80. And it found that patients treated by female doctors were less likely to die or to be readmitted within 30 days. In percentages, the differences look tiny, but the numbers matter. The researchers concluded that there would be 32,000 fewer deaths each year if male doctors performed as well as female doctors.
The study's authors say they were unable to identify exactly why this was the case. But for some hypotheses, we're joined now by a pair of doctors who have seen this study. John Schumann and Sarah-Anne Schumann join us both from Tulsa, Okla. Welcome to the program.
JOHN SCHUMANN: Nice to be here. Thank you.
SARAH-ANNE SCHUMANN: Thank you.
SIEGEL: And we should say, John, you're an internist. And Sarah-Anne, you're a family physician.
J. SCHUMANN: That's right.
SIEGEL: And you're also husband and wife.
J. SCHUMANN: We are - 18 years going strong.
SIEGEL: (Laughter) Well, Sarah-Anne, let me ask you. When you first heard about these findings that female doctors showed better outcomes than male doctors, was your initial response, this is nuts, or, this makes sense to me?
S. SCHUMANN: I thought it made perfect sense. I think this has really confirmed what a lot of us have suspected over many years, which is that in general, women tend to be better communicators. They generally are - have better emotional intelligence and often are able to see patients as people and not as just diseases. And again, this is a huge generalization.
SIEGEL: Well, John Schumann, did you think that this study suggests that there should be more medical education on at least how to be received as being more nurturing?
J. SCHUMANN: I do. I think that nowadays in the medical school community, we are looking at the applicants more holistically to try to find people who are of good character as well as high academic standing. How our patients gather their information, how they want their information and whether they look at us as an authority figure or as a partner in their care makes all the difference.
So if we have only one style, I think we run the risk of alienating certain patients that we have. Whereas if we're more emotionally intelligent and are able to read cues - you know, nonverbal language but, you know, obviously words as well - we are probably more able to deliver better care. And so I think we're only really in the infancy of being able to teach this much better in medical school. And it's a fierce struggle for time in the curriculum.
SIEGEL: Sarah-Anne, when we hear talk of communicating and of perhaps better communications accounting for some of this disparity, is there a specific kind of communication that you have in mind, a specific way of dealing with the patient in a hospital?
S. SCHUMANN: Well, one of the things I do think it is important for everyone to keep in mind - that these were hospitalized patients. So one element of communication I would, you know, again, hypothesize would be really important is for the doctors to be communicating with the nurses who are doing the discharge planning and the social workers and if there are people involved in the care after patients return home, you know, communicating with the family members of the patients to figure out how they will continue to get the care they need after they leave the hospital.
So it's not just that communication between the doctor and the patient while they're in the hospital but with the rest of the medical team and with the family members of the patients.
SIEGEL: Does it make sense to you that female doctors are more likely to be at the center of such a team than male doctors?
S. SCHUMANN: I think often - and again, these are huge generalizations. And I have to point out that my husband, John Schumann, is a great communicator, a great team member. You know, there are many, many male doctors who really have tremendous empathy and emotional intelligence.
But in general, I think there are more women that have these skills and who are comfortable sharing the responsibility for the care of the patient with the teams. And that goes back to the nurturing and the maternal instincts of women.
J. SCHUMANN: Thanks, Honey.
SIEGEL: (Laughter) Do you have anything else to say in response to that, John?
J. SCHUMANN: Well, you know, I would say that much of what I've learned about being not only a good doctor but a good person really comes from my wife because she just happens to be very gifted in terms of having emotional insight. And it's something she has perhaps unknowingly role modeled to me.
And it all I think in a way boils down to the Golden Rule, right? We want to treat others as the way we want to be treated. And I think it's easy for us doctors to often forget that.
SIEGEL: Well, thanks to both of you for talking with us today, and thanks for your contributions to the NPR health blog Shots.
J. SCHUMANN: Great to be with you, Robert.
S. SCHUMANN: Thank you so much for having us.
SIEGEL: John Schumann is an internist and president of the University of Oklahoma's Tulsa campus. Sarah-Anne Schumann is medical director of Community Health Connection, a community health center in Tulsa. Transcript provided by NPR, Copyright NPR.