Doctor’s Gender May Be Factor in Heart Diagnoses

By NICHOLAS BAKALAR
Conventional wisdom holds that coronary heart disease is an illness of older men, and that may be why doctors have difficulty diagnosing it in women. But do female doctors at least do a better job than male doctors? Apparently not, a new study finds.
The study, published online on Aug. 30 in Sociology of Health and Illness, did find significant differences in the ways male and female doctors diagnosed the illness. It reported that male doctors might be less biased by the gender and age of the patient being examined.
“We’re not trying to say that one group of doctors is better than another,” John B. McKinlay, the principal investigator said. “What we’re trying to do is for the first time describe and explain how much variability there is in doctors’ behavior when they look at exactly the same clinical presentation in different patients.”
The scientists videotaped professional actors portraying patients of varying gender, age, race and socioeconomic status who all had medically apparent symptoms of heart disease.
Then 112 male and female primary care doctors, half in Massachusetts and the rest in Britain, watched the videos. The physicians were asked to think of the patient as one of their own, make a diagnosis and suggest a treatment plan. Finally, they were asked to describe what factors they considered in arriving at their decisions.
Both male and female doctors picked up more psychological cues from female patients than from male patients. A characterization like “seemed very low" or “very depressed” was more likely to be made about a female patient than a male one.
Comments about a patient’s self-presentation like, “He doesn’t give a very cogent history,” or, “She’s a passive victim,” were more common among female doctors, and they made significantly more such observations of female patients.
Male doctors noticed fewer such cues in general, and only slightly more from male than female patients. This suggests that doctors, and especially female doctors, may be more sensitive to such information in patients of their own gender.
Even though older age is a significant risk factor for heart disease in both men and women, female doctors paid significantly less attention to female patients’ ages than those of males.
Dr. Alexandra J. Lansky, an associate professor of clinical medicine in cardiology at the Columbia University Medical Center who was not involved in the study, found the paper revealing.
“The old statement that female docs are better prepared to take care of female patients does not stand,” Dr. Lansky said. “Female docs are missing one big point that the male docs don’t miss, and that’s the age-related factor.”
Not all experts found the report convincing. “This study clearly says that female and male doctors approach the patient interview differently,” said Dr. Elizabeth A. Jackson, an assistant professor of medicine at the University of Michigan. “But they appear to have a similar knowledge base. This was not a real-life situation, and you can’t take conclusions from one study in isolation. I’d like to see if these results can be replicated.”
Dr. McKinlay, who is head of the New England Research Institutes in Watertown, Mass., said the study offered a new way to look at the disparities between men and women in treating coronary heart disease.
“A lot of the time,” he said, “health disparities have been explained by characteristics of the patient — race or economics, women versus men, older versus younger. But here the variability is explained by characteristics of the doctor.”