Does Your Doctor’s Gender Affect Your Care?

My patient, a 40-year old woman named Sally, broke into a wide grin when she saw me enter the room. 

"Are you my doctor?" she asked. I nodded and started to introduce myself, but she cut me off. "I'm so glad that I have a woman doctor! I think women are much better than men."

That's in stark contrast to the previous patient I had seen just before Sally. Frank, a 72-year old man, looked at me askance and asked me if I was sure I wasn't his nurse. His wife explained (nicely) that they preferred a male doctor. 

These preferences don't always abide by gender or age divisions, either; plenty of female patients have said they prefer male doctors, and vice versa.

A new study from the University of Montreal finds that there may be real differences between the care provided between female and male doctors. Female doctors are more likely to follow evidence-based guidelines, and they score higher on care and quality, according to the study. Other research has found that female doctors tend to show greater empathy and are perceived as being better listeners. 

Some researchers have hypothesized that the differences are cultural and rooted in our upbringing. From an early age, girls tend to serve as confidantes to their friends, which may then result in greater attention to listening in the clinical context.

At the same time, I have worked with many men who display great empathy and care deeply about their patients. I also know of female doctors who don't hold up to the traditional gender stereotypes and don't like to spend time listening. 

In selecting a doctor, gender is one component. For some people (like Sally and Frank), it may matter a lot, in which case it should certainly help guide your choice of doctor. Other people just want to find someone who they can trust; they aren't as concerned whether their doctor is male or female.

So how can you identify a good doctor? Here are some characteristics to look for—regardless of gender:

Your doctor should listen to you: Research shows that 80 percent of diagnoses can be made just by listening to your story. Listening leads to better care, and your doctor should make an effort to hear you out and learn about you.

Your doctor should view your relationship as a partnership: Today's medical care is not about the doctor telling you what to do; rather, your doctor should involve you in your care as an equal partner. He or she should actively involve you in every step of the decision-making process about your treatment. 

Your doctor should be willing to ask for help: There is so much information on diagnostics and treatments—one person cannot possibly know everything. A good doctor is one who isn't afraid to admit that he or she doesn't know everything. Asking for help doesn't mean your doctor is incompetent; rather, it should increase your faith in his or her abilities and humility.

Your doctor needs to be available: It's unrealistic to expect that your doctor will be at your beck and call 24/7; however, before you leave your doctor's office, he or she should communicate to you how you can get help if necessary. Make sure you understand your follow-up plan. Are there any specific signs or symptoms you should watch out for? What should you do if something new or worse happens? 

You should feel comfortable with your doctor: This is perhaps the most important of all. If you do not feel at ease with your doctor, you might not share critical information, and important pieces of the puzzle might be missed. That's the most compelling argument for choosing a doctor of a particular gender—and only you can decide whether that's a characteristic that matters a lot to you.

One of my heroes, the Nobel prize-winner, humanist, and cardiologist Dr. Bernard Lown, talks about how a doctor is someone who should always make you feel better after having seen them. You go to your doctor because you want to feel better. You should find someone—female or male—who helps you accomplish this goal.

This article was previously published in Women's Health Magazine (posted here with their permission).

Male/Female, Same/Different

I’m an eighties baby and a proud member of Generation Y. A child of two working professionals who came of age in China’s Cultural Revolution, I grew up with a strong belief in gender equality. Feminism and women’s rights were concepts that I took for granted. Nobody ever told me that there were things I couldn’t do because I was a girl. Because of the battles fought by the generations ahead of me, I grew up sheltered, believing that gender differences and the professional challenges associated with them were relics of the past.

My early medical training helped to shield me from the realities of the world. I went to a very supportive medical school, where several of our Deans were women and had regular networking session for female medical students. These sessions were so popular that some men in my class tried to form a “male-only networking group”—an idea that somehow had a different connotation. I can’t recall a single incident of favoritism in my preclinical years. In my clinical years, the biggest challenge was getting visiting consultants and my patients to see me as the medical student—not the nursing student or candy striper. I learned to wear my white coat everywhere, and to laugh when someone would refer to me as “that nice nurse”, or, at one point, “that Oriental home health aide.”

It was in the U.K. that I had my first and most significant gender battle. After medical school, I won the Rhodes scholarship and studied at Oxford for two years. In my subject, economic history, we were required to take a beginning statistics class—something I wasn’t particularly thrilled to take, having taught stats on the graduate level before. Our class happened to have all men except for Jana, a Bulgarian girl who was a mathematician in her home country, and me.

After our first exam, the Professor stormed into the room. He gave us a lecture on academic honesty, and then pointed at Jana and me. “What can you say to explain yourself?” he yelled. “How dare you cheat on your exam?”

Apparently, the two of us had received high marks on the test. The 20-odd men, on the other hand, did not do particularly well. It was unacceptable to this Professor that the women—and two foreign women at that—had somehow outscored the men. The only explanation he could think of for this was that we had cheated.

The incident got resolved quickly through our department, though the Professor’s only slap on the hand was to mutter a begrudging “sorry” to the two of us. Though this experience was a very small part of my overall (very positive) educational experience, it gave me a great deal of respect for all the women who came before me, who had to face discrimination like this every time they went to class or work.

It also gave me additional perspective on other gendered experiences. In my residency, a group of female residents and young faculty attempted to form a women’s support network. Some of our colleagues, both male and female, questioned why it was really necessary to have a women’s group. In this day and age, aren’t issues that are relevant to women relevant to everyone else? Is there really anything to be gained from a network of high-achieving women?

I’m not sure that I would have known the answer to this before, but my answer now--as I am completing my medical training--is a resounding yes. Here are just a few of the reasons why:

1)    Mentorship. Studies have consistently shown that drive, intelligence, and passion are necessary but not sufficient for success; behind every star performer is a star mentor. Women can and should have male mentors, but female mentorship adds an additional critical dimension and nuance. For those of us in academic medicine, I am a believer that we all need not just research and professional mentors, but personal mentors, too.

2)    Practical aspects of work-life balance. It is almost a cliché to talk about work-life balance in a discussion of professional women’s issues. I’m embarrassed to admit that I used to roll my eyes every time we talked about it. Now that I’m married and thinking about starting a family, though, I seek out these discussions with women who have also “done it all”. I want to ask them how and what they did. How did they structure their initial career? What were challenges that they faced along the way, and what are the lessons they have to impart?

3)    Unique demands of our work. One of my classmates got fed up with all the talks on work-life balance and famously said that she wants to cut out the life and just talk about work. After all, isn’t work what men talk about? She’s not wrong; there are unique demands of our work, particularly for high-achieving women who wish to be "do it all" for our families and fo rour careers. It’s important to have the space for such discussions.

4)  Advocating for system-level change. Anne-Marie Slaughter wrote a provocative article in the Atlantic about how women can't have it all, and how it takes a village to really empower women. Gender equity is not an issue of the past; a recent Journal of the American Medical Association study showed that women physicians still consistently earn less than their male counterparts.

 

At this point, I have come full circle: from being a millennium child with little sense of gendered experiences, to a feminist with an understanding that being a professional woman continues to yield its separate challenges and requires active work. There are systems-level problems that require systems-level solutions, but it has to start with each one of us.

I would love to hear your thoughts on this and other matters. Portions of this article appeared in the Academy for Women in Academic Emergency Medicine awareness newsletter.