Women make better doctors

It’s official: women are better doctors than men! That’s at least according to a new study called "Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex", which finds a small but significant benefit to women being looked after by female doctors. It’s been published in Annals of Internal Medicine. F. Perry Wilson, from Yale School of Medicine - and author of How Medicine Works and When It Doesn't - has been taking a closer look at it for us….

Perry - This was a study that was trying to figure out if there is a benefit to being treated by a physician who matches your sex or is different from your sex. There have been studies in the past that have suggested that in particular women patients do a bit better when cared for by female physicians. And this was seeking to delve a little bit deeper into that.

Chris - This word 'better'. How do we get underneath that though? Because that can mean a range of different things. Are you cared for better because someone cares for you more? You feel better looked after? Do you get better faster? Do you die less often? What does that word better mean?

Perry - I agree. I think there's a lot of ‘better’ that would be very subjective. You know, it would just be up to how a patient feels after they're interacting with the doctor. But in the case of the study that we're talking about, better was quite literally defined as whether you were more likely to survive for 30 days after you were admitted to the hospital. Although it's probably not capturing everything about quality of care, it's nevertheless an outcome that many of us care very much about.

Chris - So who were the patients? Where did they get the data from?

Perry - These are patients who use the Medicare insurance system in the United States, which is available to everyone above age 65 in this country. And so they were slightly older patients. They were admitted to the hospital for an acute condition. So they were ill. It wasn't a scheduled admission to the hospital. And they were treated by what is known as a hospitalist physician. These are doctors who really just care for patients while they're in the hospital. They're not their GP or primary care providers, we might call them over here. And importantly for this study, patients in the United States don't really get to choose who their hospitalist is. It's just whoever is the next one available when they're admitted to the hospital. And that means that they can't really have a say in whether it is a female or a male hospitalist.

Chris - So there's an element of randomisation to this. Statisticians love this kind of thing because it means that you are taking one step closer to it being unbiased.

Perry - It wasn't truly randomised where a coin was flipped or a computer generated a random number and the patient was assigned based on that. But if you look at it, it does seem that the patients that were treated by male hospitalists and the patients that were treated by female hospitalists, they seem very similar. They're about the same age, about the same level of sickness. And so while not a truly randomised trial, it's better than a lot of the observational research that comes out.

Chris - So go on then, tell us what the outcomes were. When they broke this down by the sex of the patients and the sex of the doctors, what did they find?

Perry - So we're talking about a million patients, across around 50,000 doctors. And what they found, first of all, was that female patients tend to survive a bit better than male patients. The death rate at 30 days was around 8.2% for females, around 10% for male. That's independent of the sex of their physician. And this is not a surprise. We actually know from multiple studies that men do worse after a hospitalisation than women. It may be because they're a bit sicker when they come in, but that's not too much of a surprise. What was more of a surprise was that women who were cared for by female doctors were statistically likely to live longer, to be more likely to survive at 30 days than if they were treated by male doctors. That was not seen among male patients. So the sex of the doctor did not matter for men, but for women there was a small but statistically significant effect on the order of about 0.2% difference in survival at 30 days. But nevertheless, there it was. A suggestion that females being treated by females might lead to better outcomes.

Chris - If you delve into the data, are there any possible differences between the kinds of jobs that women doctors do and male doctors do that might account for that?

Perry - It's such a good question. Obviously, after you look at those results, the very next thing you want to ask is, 'okay, well why <laugh>?' Why did this happen? And one possibility, as you suggest, is that female hospital doctors do kind of different stuff than male hospital doctors. And one thing that did show up in the data is that they tend to see slightly less patients. That might suggest that, well, if you see less patients, maybe you have a little bit more time for each patient that you do see. And time is an important thing that we need when we're caring for patients to make sure that we're listening to them and making our diagnoses correct and not being too frazzled and whatnot. So that's certainly a possibility. There's also, of course, the more difficult things to measure. There have been studies in the past that suggest that female physicians are less likely to dismiss the concerns of female patients compared to male physicians. And so there might be an element here of women kind of understanding women and how they describe pain and how they describe symptoms that men don't understand as well. Very difficult to untangle though.

Chris - You are married to a doctor. I'm married to a doctor. We are both doctors. How do we survive with our egos intact?

Perry - <laugh> As male doctors? I think if you're married to a female doctor, you've probably already internalised the idea that they are better than we are. So I was okay with it.