Female physicians tend to provide higher-quality medical care than males, according to Harvard research. And if male US doctors were as adept as females, at least 32,000 fewer Americans would die every year, reports The Atlantic.
At academic hospitals, male physicians receive more research funding and are more than twice as likely as female physicians to rise to the rank of full professor.
These disparities have historically been attributed to the effects of disproportionate domestic responsibilities – including maternity leave and subsequent part-time schedules. As physicians Rita Redberg and Anna Parks note, this can be perceived to “undermine the quality of female physicians’ work and explain male physicians’ higher salaries.”
But no – the report says that according to newly released research, female physicians actually tend to provide higher-quality medical care than males. If male physicians were as adept as females, some 32,000 fewer Americans would die every year – among Medicare patients alone.
The report says researchers from Harvard University reviewed the records of 1,583,028 hospital visits among Medicare patients. Within 30 days of arriving at the hospital, rates of death and re-admission were significantly lower when the patient’s doctor was female.
This was true for people with medical conditions of all sorts and severities. The report says the researchers tried to account for every variable; but ultimately all that was left was the finding that women are superior to men at treating these (65-and-older) patients in the hospital. The association held true even for patients who were randomly assigned to a physician when they arrived. People treated by a female had a 4% lower relative risk of dying and 5% lower relative risk of being admitted to the hospital again in the following month.
To explain the discrepancy, the researchers point to past studies that have shown female physicians are more likely to provide preventive care and psychosocial counselling. Female doctors are also more likely to adhere to clinical guidelines, the report says.
Though as Redberg and Parks note in an accompanying editorial, adherence to clinical guidelines “does not always equate with quality or value of care.” Instead they point to data that says female physicians “have a more patient-centred communication style, are more encouraging and reassuring, and have longer visits than male physicians.”
Still the implication is not that everyone should rush to choose a female physician, discarding males in droves. For one, this would be impractical since females make up only one-third of the American physician work force.
The report says in the journal article, the researchers conclude, rather: “Understanding exactly why these differences in care quality and practice patterns exist may provide valuable insights.”
And researcher Ashish Jha is quoted in the report as saying that the next step would be “to understand why female physicians have lower mortality so that all patients can have the best possible outcomes, irrespective of the gender of their physician.”
While gender differences in practice styles have been shown in past research, today’s study is the first to compare such meaningful outcomes as death and re-hospitalisation.
These are the results that many patients and doctors – and certainly hospitals and insurance corporations – care about most. In a profession increasingly conscious of bottom lines and quality outcomes, these numbers may be what it takes to spur equal (or better) compensation and opportunity for female physicians, the report says.
Abstract
Importance: Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown.
Objective: To determine whether mortality and readmission rates differ between patients treated by male or female physicians.
Design, Setting, and Participants: We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014. We examined the association between physician sex and 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects (effectively comparing female and male physicians within the same hospital). As a sensitivity analysis, we examined only physicians focusing on hospital care (hospitalists), among whom patients are plausibly quasi-randomized to physicians based on the physician’s specific work schedules. We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness.
Main Outcomes and Measures: Patients’ 30-day mortality and readmission rates.
Results: A total of 1 583 028 hospitalizations were used for analyses of 30-day mortality (mean [SD] patient age, 80.2 [8.5] years; 621 412 men and 961 616 women) and 1 540 797 were used for analyses of readmission (mean [SD] patient age, 80.1 [8.5] years; 602 115 men and 938 682 women). Patients treated by female physicians had lower 30-day mortality (adjusted mortality, 11.07% vs 11.49%; adjusted risk difference, –0.43%; 95% CI, –0.57% to –0.28%; P < .001; number needed to treat to prevent 1 death, 233) and lower 30-day readmissions (adjusted readmissions, 15.02% vs 15.57%; adjusted risk difference, –0.55%; 95% CI, –0.71% to –0.39%; P < .001; number needed to treat to prevent 1 readmission, 182) than patients cared for by male physicians, after accounting for potential confounders. Our findings were unaffected when restricting analyses to patients treated by hospitalists. Differences persisted across 8 common medical conditions and across patients’ severity of illness.
Conclusions and Relevance: Elderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists. These findings suggest that the differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.
Authors
Yusuke Tsugawa; Anupam B Jena; Jose F Figueroa; E John Orav; Daniel M Blumenthal; Ashish K Jha
Meanwhile, in a recently published article, a Henry Ford Hospital critical care medicine physician describes in candid detail about how her own near-death experience inspired an organisational campaign to help health professionals communicate more effectively and demonstrate more empathy to their patients.
Dr Rana Awdish, director of the hospital's Pulmonary Hypertension Programme, writes that as a patient "I learned that though we do many difficult, technical things so perfectly right, we fail our patients in many ways."
In 2008 Awdish nearly died when a tumour ruptured in her liver, leading to multisystem organ failure. The care team worked frantically to save her but could not save the baby she was carrying. Her recovery would include five major surgeries and multiple hospitalisations in intensive care. She also experienced something unexpected: a kind of casual indifference.
"I was privy to failures that I'd been blind to as a clinician," she says. "There were disturbing deficits in communication, dis-coordinated care, occasionally an apparently complete absence of empathy. I recognised myself in many of those failures."
Awdish says her patient experience inspired her to champion a shift in culture for helping health professionals talk more effectively with their patients at Henry Ford Hospital and throughout its parent organisation, the Detroit-based Henry Ford Health System. She used her experience to drive home the point to leaders and others that "everything matters, always. Every person, every time."
Henry Ford's Physician Communication and Peer Support curriculum, launched in 2013, is guided by empathy and compassion, beginning with an understanding of what matters most to patients and aligning them with patient values. It's geared for physicians, residents, fellows, nurses and other health professionals.
Courses include:
• CLEAR Conversations. CLEAR stands for Connect, Listen, Empathise, Align and Respect. A course in which health care workers test their communication skills in stimulated conversation exercises with Detroit-based improvisational actors who portray patients and family members. It teaches how to navigate difficult questions and respond to expressions of emotion. These exercises are videotaped, allowing for immediate feedback. A mobile app offers easy access to tips and videos for effective communication.
• A skilled communication workshop based on the 4 Habits of Effective Physician Communication model.
• Real-time shadowing. A trained observer shadows the provider during a series of patient interactions. Best practice behaviors and empathic communication skills are evaluated, and best practice feedback is shared during a one-on-one debriefing.
• New-hire orientation, during which employees are taught their value and purpose within the organization, not just to their job. Discussions emphasize learning to recognize avoidable and unavoidable forms of patient suffering. New employees are tasked with reducing avoidable suffering.
"My experience changed me," says Awdish, who also serves as medical director of Care Experience, which directs the patient communications initiative across the health system. "It changed my vision of what I wanted our organisation to be, to embody."
She says her experience is a teachable moment across the spectrum of health care as the focus shifts to respecting patients as more than just someone with an illness or disease.
"By focusing on our missteps, we can ensure that the path ahead is one of compassionate, coordinated care," Awdish says. "When we are ashamed, we can't tell our stories. In the wake of painful experience, we all seek meaning. It is the human thing to do, but it is also the job of great organisations. The stories we tell do more than restore our faith in ourselves. They have the power to transform."
[link url="https://www.theatlantic.com/health/archive/2016/12/female-doctors-superiority/511034/?utm_source=nextdraft&utm_medium=email"]The Atlantic report[/link]
[link url="http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2593255"]JAMA Internal Medicine abstract[/link]
[link url="http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2593252"]JAMA Internal Medicine editorial[/link]
[link url="https://www.sciencedaily.com/releases/2017/01/170104222357.htm"]Henry Ford Health System material[/link]
[link url="http://www.nejm.org/doi/10.1056/NEJMp1614078"]New England Journal of Medicine article[/link]