Recently, one of my patients, an elderly man, stopped me as I got up from my stool to leave his room. I had just finished examining him, offering my assessment and plan, and apologizing for his long wait since I had been running late that day. He listened patiently then hopped down from the exam table just as I turned toward the door, the ties of his flimsy hospital gown flapping around his thin legs.
"Doctor," he said, "No need to apologize for being late." He smiled affably and added, "Truth be told, I prefer you lady doctors. You spend more time with patients. It's like you just know how to be a mother."
I smiled. My patient was satisfied and believed I had listened to him well. But, truth be told, I left his room somewhat taken aback, despite his good intentions. Did being a woman necessarily mean I gave better care? And was that care necessarily more patient-centered?
For two decades, spurred on by the rising number of women going to medical school (women currently make up almost half of each entering medical school class), researchers have been studying the influence of gender on physician style. While many of these investigators initially assumed that the long training process completed in lockstep with male peers would diminish gender differences, their findings over the years have indicated otherwise. Several studies have shown that female doctors tend to be more encouraging and reassuring, use shared decision-making, ask more psychosocial questions and spend more time — up to 10 percent more — with patients than male doctors do.
But research over the last few years has also found that the patient's gender determines how patients feel about their doctors, as much if not more than the physician's.
Gender is important in the patient-doctor relationship, but its influence can't be reduced to a simple statement like, "Women doctors are more sympathetic."
In one study, for example, Swiss and American researchers found that patients, depending on their gender, evaluated their male and female physicians' displays of concern for their patients differently. While male patients tended to be content regardless of physician gender and communication style, female patients were much more specific when it came to assessing their doctors. The female patients were most satisfied with their women doctors if those doctors expressed great concern and empathy and were extremely reassuring. But if the doctors were male, the female patients were dissatisfied with overt displays of caring and actually preferred less empathy and reassurance from the doctors.
"In any field that women have moved into as executives or managers, there's a Catch-22, double-blind ambivalence about how people are expected to behave," said Judith A. Hall, one of the study authors and a professor of psychology at Northeastern University in Boston. "We are just now uncovering how true it is in medicine."
Findings from other studies have also revealed that patients, regardless of gender, tend to be more assertive with women doctors, interrupting them and asking questions more frequently. While some experts have construed these interruptions as a sign of decreased respect, others contend that they in fact reflect a greater sense of comfort on the part of the patient. "Interruptions are not necessarily bad," Dr. Hall observed. "They can be a sign of empowerment and of participation. Patients feel like they are really talking."
But while the female doctor in the exam room tends to ignite such interactive conversations, it is the presence of a female patient that keeps those discussions going. According to another study published last year in The Journal of Women's Health, women patients were more likely to have discussions with doctors that focused on their illness experience and personal factors, regardless of the physician's gender.
"You can't necessarily say that women are better doctors," said Dr. Klea D. Bertakis, lead author of that study and a professor of family and community medicine at the University of California, Davis. "It's a matter of gender behaviors in the course of an encounter. Patients, as well as physicians, are bringing their specific backgrounds and experiences to that encounter; and we need to be aware of that."
Perhaps the most interesting finding in these studies of gender in the patient-doctor relationship involves male doctors who practice obstetrics and gynecology. While this group of male physicians has been shown to be significantly better than their female colleagues at showing empathy and talking to patients about their emotional concerns, many of their patients continue to have a strong preference for female doctors.
Patient-centered communication styles, it seems, may not be the only, nor even the most important, determinant of patient satisfaction.
But, as the obstetrics and gynecology example reveals, and contrary to my elderly patient's belief, the ability to have more patient-centered discussions is not limited to one sex. Or to those who might be mothers. Physician communication skills can be shaped with training; and medical schools across the country have taken advantage of that fact. More and more schools are offering courses that teach young doctors how to offer better counseling and prevention, provide shared decision-making and pay increased attention to how an illness and its treatment are affecting a patient, skills found in studies to be present more often in female physicians.
"But it's not about trying to become a woman," Dr. Bertakis reflected. "It's about learning behaviors."