Does gender matter when choosing a doctor?

Whether your doctor is male or female could be a matter of life or death, a new study suggests. The study, of more than 580,000 heart patients admitted over two decades to emergency rooms in Florida, found that mortality rates for both women and men were lower when the treating physician was female. And women who were treated by male doctors were the least likely to survive.

Earlier research supports the findings. In 2016, a Harvard study of more than 1.5 million hospitalized Medicare patients found that when patients were treated by female physicians, they were less likely to die or be readmitted to the hospital over a 30-day period than those cared for by male doctors. The difference in mortality was slight - about half a percentage point - but when applied to the entire Medicare population, it translates to 32,000 fewer deaths.

Other studies have also found meaningful differences in how women and men practice medicine. Researchers at Johns Hopkins Bloomberg School of Public Health analyzed a number of studies that focused on how doctors communicate. They found that female primary care doctors simply spent more time listening to patients than did their male colleagues. But listening comes with a cost. Doctors who were women spent, on average, two extra minutes, or about 10 percent more time per visit, creating scheduling delays and putting them an hour or more behind their male colleagues by the end of the day.

Dr. Nieca Goldberg, a cardiologist whose book ¡°Women Are Not Small Men¡± helped start a national conversation about heart disease in women, said the research should not be used to disparage male doctors, but should instead empower patients to find doctors who listen.

¡°All doctors, whether they are a man or a woman, really set out to save a person¡¯s life,¡± said Dr. Goldberg, who is the medical director of the Joan H. Tisch Center for Women¡¯s Health at NYU Langone. Communication is particularly important in heart patients because symptoms can be so different in men and women, she said. Chest pain, for instance, is less common in women who are having a heart attack, but doctors often ask patients about chest pain to rule out the diagnosis. ¡°I would just like to make sure that they spend time with women to really get to the fine point of a person¡¯s symptoms,¡± she said.

Dr. Goldberg said a new patient recently told her that she sought out a female doctor because her male physician wouldn¡¯t take the time to explain things to her and answer her questions. ¡°Patients not only want you to take care of them in terms of making the right diagnosis, they also want to feel heard, and a big part of health care is the communication piece,¡± she said.

The authors of the Florida study, published in the Proceedings of the National Academy of Sciences, urged caution in interpreting the results, and noted that one can only speculate about the reasons female patients had better survival when being treated by female doctors. It may be that women feel more comfortable talking to female physicians. Or it may be that doctors who are women are more focused on the unique symptoms of heart disease in women, or that they are, in fact, just better communicators and faster at picking up cues from patients compared to male doctors.

¡°I am hesitant to say that women should avoid male physicians or people should focus on getting a single type of physician, because that circumnavigates the issue,¡± said Brad Greenwood, the lead author and associate professor of information and decision sciences at the University of Minnesota¡¯s Carlson School of Management. ¡°Patients should, by all means, make sure that they are being taken seriously and being strong self-advocates.¡±

Dr. Don Barr, a professor at Stanford Medical School, said he often talks to his students about research into gender differences in how doctors communicate. Male doctors, he says, are notorious for interrupting patients in an effort to refocus the discussion. In one study, female primary care physicians waited an average of three minutes before interrupting a patient. Male doctors waited an average of 47 seconds.

Dr. Barr said he once conducted a personal experiment, deciding to let his next patient talk as long as he or she needed to without interruption. As it happened, the patient was a woman in her 70s who had been reluctant to seek care and was there only to appease friends and family. She talked of the weather, of a cough, of being uncertain about which drug to choose at the drugstore; her sister was a worrier, she told him. Despite frantic signals from his nurses that he was running behind schedule, Dr. Barr didn¡¯t interrupt. The woman spoke for 22 minutes.

In the end, the woman¡¯s diagnosis of lung cancer was bleak. Dr. Barr offered comfort, and the woman smiled at him. ¡°I¡¯ve had a good life. But I just wanted you to know ? this is the best doctor visit I¡¯ve ever had. You¡¯re the only one who ever listened.¡±

Dr. Barr wrote an essay about the experience that was published in the Annals of Internal Medicine, and says it made a lasting impression on him. While it¡¯s not practical to spend that much time with every patient, it made him more thoughtful about listening.

¡°Every patient I treated after that, I was more careful to be sure that they were given the opportunity to tell me their story,¡± he said. ¡°If I needed to guide the discussion, I tried to do it in a way that was more gentle. The fact that the doctor is hearing what you are saying and cares about you and understands what you are going through makes coping with the illness and the implications of the illness that much easier.¡±

Edna Haber, a retired mortgage company owner who lives in Westchester County in New York, said she has had wonderful male and female doctors, but her worst experiences have all involved male doctors. One male doctor was so dismissive of the medical history she gave him that she offered a copy of her medical record to prove her point and never went back. Another got angry when she seemed reluctant to take a medical test. It was just a scheduling issue, but ¡°he started to scream at me,¡± she said.

Recently she decided to see Dr. Goldberg to discuss heart palpitations and feeling lightheaded. But a series of medical tests during the office visit found that her heart was normal. ¡°I do believe that had I been with a male doctor, I think he just would have put his arm around me and said, ¡®Listen, go home, relax, meditate, maybe take a tranquilizer,¡¯ and that would have been the end of it.¡±

But Dr. Goldberg knew the patient had been concerned enough to see a doctor, so she suggested that she wear a heart monitor for a few days. Several days later, the technicians monitoring the feed noticed a pattern that ultimately showed Ms. Haber needed a pacemaker.

¡°She paid attention and treated me as if I was credible,¡± said Ms. Haber. ¡°I wish all the women I know could understand how important it is to have a doctor who pays attention to them, whatever part of the body they are looking at. I think a lot of women are getting short shrift.¡±