Calling Doctor Who

Even people who are not fans of the British science fiction series Doctor Who -- and, I must confess, I am not -- may have heard that, after 36 seasons over 54 years featuring 12 different Doctors, the series is finally having the Doctor transform into a woman.  Now, I recognize that the Doctor is neither a physician nor even from Earth, but I'm beginning to wonder if U.S. healthcare would be better if we could do the same.

Especially if you are a woman.

New research suggests that gender matters when it comes to treating heart attacks.  We've known for some time that women are less likely than men to survive heart attacks. but the new research found that the gender of the treating physician appears to play a role in survival as well.  Female heart attack patients had a higher mortality rate when treated by male physicians. 

Conversely, though, male and female patients had similar outcomes when treated by female physicians.  In addition, male doctors' performance improved when there were more female doctors around -- when the proportion of female physicians rises by 5%, female survival rates rise 0.4%. 

The researchers looked at emergency room records in Florida between 1991 and 2010, including all those admitted with a heart attack.  Their conclusion was blunt:

These results suggest a reason why gender inequality in heart attack mortality persists: Most physicians are male, and male physicians appear to have trouble treating female patients.

One author, Professor Seth Carnahan, speculated to Marketwatch:  "Female doctors may be more keen to remember and pay attention to the sex differences in symptoms."  Professor Laura Huang, another co-author, described the impact more starkly: "But even here [heart attack treatment], we see a glass ceiling on life."

Let that one sink in. 

This is not, let's remember, the first evidence of women physicians performing better than their male counterparts.  A 2016 study found lower mortality rates generally for patients of female physicians, and a 2017 follow-up study found they had lower readmission rates as well.  Lead author Ashish Jha got lots of headlines for his quote: "If male physicians had the same outcomes as female physicians, we’d have 32,000 fewer deaths in the Medicare population."

Despite this kind of evidence, on average, U.S. female doctors still make $105,000 less than male doctors, some 28% lower.  The gaps exist even when controlling for specialty. 

It's not just that female physicians may perform better than male ones; it is also that female patients generally may get worse care.  In its article on the Florida study, The Atlantic reminded us of related gender-based findings:

• Women are more likely to delay getting treatment for suspected heart attacks.  
• Women's symptoms are less likely to be identified as heart attacks.  
• Women with suspected heart attacks were less likely to get diagnostic tests for them.  

All that is alarming enough, but, as co-author Professor Brad Greenwood told The Atlantic, when treated by male physicians, "the penalty for being female is greater."

Again, let that one sink in.

Dr. Jha, who was not part of the study, diplomatically put his finger on what needs to happen, saying::

What is convincing is that we have to do better in terms of caring for women with cardiovascular disease—all of us. And male physicians could learn a thing or two from our female colleagues about how to achieve better outcomes.

Sadly, this issue is not limited to cardiovascular disease. 

USA Today recently ran an expose about maternal health in hospitals, asserting: "Every year, thousands of women suffer life-altering injuries or die during childbirth because hospitals and medical workers skip safety practices known to head off disaster."  According to them, 50,000 injuries and 700 deaths annually could be cut in half by following such practices.

In a similar study, NPR and ProPublica found that the U.S. has a higher maternal death rate than any other developed country, and that for every death, another 70 almost die.  The rate of the latter has almost tripled since 1993, according to CDC statistics.  This is third world stuff.

Source: The Lancet, Credit: Rob Weychert/ProPublica

It almost seems ironic to note that the risk of pregnant women having having a heart attack increased 25% from 2002 to 2014. 

Let's not even get into the attacks on Planned Parenthood, the limits on birth control and abortion, or the fact that in 2018 we still don't have a comfortable way to get a mammogram.  All in all, when it comes to women's heath, there may not only be a glass ceiling but also a ragged floor.

Suzannah Weiss, writing in Bustle, took a different tact on the issue.  Instead of more statistics about gender disparities, she requested that women report "the most ridiculous things doctors have told them."  She quickly garnered over 500 responses, and boiled them down into 32 examples (I should note that several of the examples feature female physicians). 

As a man, the examples are eye-opening to me, but I suspect most women would recognize many of them, and have some of their own to add.  My favorite: "If you were a man, I would send you to the ER for pelvic pain. But you should just drink some chamomile tea and calm down."

Good thing she wasn't having a heart attack. 

Of course, we don't just do a bad job delivering care to women.  I could also talk about racial/ethnic disparities, socioeconomic disparities, or geographic disparities.  Health and health care are anything but equal in the U.S.

We're not going to be like Doctor Who and turn our doctors into women, but we are making progress.  Women make up  slightly over half of entrants to medical school, and now account for just over a third of all active U.S. physicians (which is still well below the OECD average of 46%).  That's progress, but one that will have a long tail.

Our health shouldn't depend on whether we get care from a female doctor or a male one.  It shouldn't matter if we are female or male.  It shouldn't matter if we are "minority" or not, rich or poor, live in New Mexico or New York. 

But it does.  When are we going to finally do something about it?