Jan 12, 2017

Dr. Jones: So you live longer if your doctor is female. That's what the research suggests. Well, let's look at this a little more carefully, okay? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Healthcare and full disclosure, I'm a female physician and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health," with Dr. Kirtly Jones, on The Scope.

Dr. Jones: It seems as if every major news outlet brought forth the research that people live longer if their doctor is female. Okay. That sets us up for some controversy and some potential bad feelings. But let's unpack the numbers and take a closer look.

The study was published in JAMA Internal Medicine. This is a well-respected journal and it looked at medical billings for hospitalizations around the country for people over 65 with a number of common medical problems such as pneumonia, heart failure, or urinary tract infections, to name a few. They analyzed over 1.5 million admissions between January 2011 and December of 2014. Wow, that's a lot of hospitalizations. But in fact, they just picked a random 20% of all the admissions in the US to study.

They specifically looked at the outcomes of death in the 30 days after admission or readmission to the hospital. Those are just the two things they looked at. And then, they looked at whether the physician who billed for the admission was a female or a male. It's amazing what you can find on the internet.

Of course, they had to look carefully to see if the patients of male physicians were sicker than those of women. They had to look at the age of the patients to see if they were older in the male doctor group than the female doctor group. Then, they looked at the doctors to see if the females were younger. And they were, on average, about five years. And if they had had more recently finished their training, which women physicians had by about five years. Then, they had to control for all these factors in their statistical analysis. They chose hospitals where the doctors who provided care tended to work on shifts, so the admitting doctor was not by the choice of the patient.

Well, it was pretty good study and with really big numbers. And the envelope, please. Patients who were cared for by female physicians were less likely to die in 20 days. Now the real numbers. Patients cared for by female physicians had an 11% chance of dying in the 30 days. You should know that the average age of these patients was 80. Compared to the rate of death within 30 days of 11.5% in those patients cared for by male physicians, that is one-half of 1% difference.

Now, because the number of patients is so large, one-half of 1% is statistically different. However, if you're thinking of changing your doctor, that's a pretty small difference for any one person. To save one death in 30 days, you had to have 233 people cared for by women for every one cared for by men.

Similar numbers were found in the rate of readmissions for hospitals, and the females compared to males was slightly less. Some people argue that the difference is very small for any individual patient. But if you look at hospital admissions for the elderly over the entire United States, there are over 10 million hospitalizations among Medicare patients annually. And one-half of 1% of 30-day mortality could add up to a lot.

So, what's this about? Physician sex doesn't make a difference in outcome. It isn't the extra x chromosome or the estrogen level that makes the difference. It must be some behaviors in female physicians that are just a little different than men. We call that a gender difference, not a sex difference. Sex is the chromosomes in the biology; gender is the behavior.

Studies have found that female physicians are little more likely to adhere to clinical guidelines in care and practice more evidence-based medicine. Women tend to use more patient-centered communication and provide more psychosocial counseling to their patients than males. It's hard to know exactly what is the difference in practice that accounts for this small difference in patient outcomes.

Of course, to me, it may all boil down to a factor that all women know. Women are more likely to stop and ask for directions, right? In fact, we are trying to teach more protocol-based and evidence-based medicine to all our medical student these days, men and women. And we are teaching patient-centered communications more.

So maybe our women and men graduating from medical school will be more comfortable asking for directions. And everyone, patients and doctors, will get where they're supposed to go.

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