If you're a woman having a heart attack, insist on a female physician

August 06, 2018

If you're a woman and having a heart attack (what's called in medical parlance an "acute myocardial infarction" or AMI), do your best to make sure you're treated by a female physician. It's literally a matter of life or death.

That's the takeaway of new research by Harvard Business School associate professor Laura Huang (lhuang@hbs.edu) and her coauthors, Brad Greenwood of the University of Minnesota-Twin Cities (wood@umn.edu) and Seth Carnahan of Washington University in St. Louis (seth.carnahan@wustl.edu), in an article to be published next week online in the Proceedings of the National Academy of Sciences (PNAS).

According to their findings in "Patient-Physician Gender Concordance and Increased Mortality Among Female Heart Attack Patients," of more than 500,000 heart attack patients admitted to hospital emergency departments in Florida between 1991 and 2010, female patients treated by male physicians were less likely to survive than patients of either gender treated by female physicians or male patients treated by male physicians. In addition, they found that survival rates among female patients treated by male physicians improved with an increase in the percentage of female physicians in the emergency department and an increase in the number of female patients previously treated by the physician.

"These results," they write, "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. The fact that gender concordance (that is, men treating men or women treating women) correlates with whether a patient survives a heart attack has implications for theory and practice:

• Medical practitioners should be aware of the possible challenges male providers face when treating female AMI patients--for example, a propensity among women to delay seeking treatment and the presentation of symptoms that differ from those of men.
  
  
• Although mortality rates for female patients treated by male physicians decrease as the male physician treats more female patients, this decrease may come at the expense of earlier female patients. Given the cost of male physicians' learning on the job, it may be more effective to increase the presence of female physicians within the emergency department.
  
  
• All this underscores the need to update the training physicians receive to ensure that heart disease is not simply cast as a "male" condition, which is often taken as conventional wisdom in both the media and the medical community.
  
  

Huang and her colleagues conclude that there is still work to be done to understand the precise mechanism as to why gender concordance appears critical, particularly for female patients. "Such research might include experimental interventions, or tests of more targeted training, to examine how exposing male physicians more thoroughly to the presentation of female patients might impact outcomes," they say.

Another variable they cite, omitted in this study, is the previous finding by other researchers that female physicians tend to perform better than male physicians across a wide variety of ailments. "If female patients tend to be more challenging for male and female doctors to diagnose and treat, the patterns we document may reflect the fact that the most skillful physicians (i.e., female physicians) provide the highest return to their skills when treating the most challenging patients (i.e., female patients)."

"Finally," they write, "interesting opportunities for research exist in an examination of the role played by residents, nurses, and other physicians who may be present or provide information to the supervising physician...future work that considers these supporting figures would advance our understanding of how coordination between [all] healthcare providers might influence the relationship between physician-patient gender concordance and patient survival."

Harvard Business School

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