Do women make better doctors?

I smiled. My patient was satisfied. But,truth be told,I left his room somewhat taken aback,despite his good intentions. Did being a woman necessarily mean I gave better care? And was that care necessarily more patient-centered?

For two decades,spurred on by the rising number of women going to medical school women currently make up almost half of each entering medical school class,researchers have been studying the influence of gender on physician style. While many of these investigators initially assumed that the long training process completed in lockstep with male peers would diminish gender differences,their findings over the years have indicated otherwise. Several studies have shown that female doctors tend to be more encouraging and reassuring,use shared decision-making,ask more psychosocial questions and spend more time up to 10 per cent more with patients than male doctors do. But research over the last few years has also found that the patients gender determines how patients feel about their doctors,as much if not more than the physicians.

Gender is important in the patient-doctor relationship,but its influence cant be reduced to a simple statement like,Women doctors are more sympathetic.

In one study,for example,Swiss and American researchers found that patients,depending on their gender,evaluated their male and female physicians displays of concern for their patients differently. While male patients tended to be content regardless of the physicians gender and communication style,female patients were much more specific when it came to assessing their doctors. They were most satisfied with women doctors if those doctors expressed great concern and empathy and were extremely reassuring. But if the doctors were male,the female patients were dissatisfied with overt displays of caring and actually preferred less empathy.

In any field that women have moved into as executives or managers,theres a Catch-22,double-blind ambivalence about how people are expected to behave, said Judith A Hall,one of the study authors and a professor of psychology at Northeastern University in Boston. We are now uncovering how true it is in medicine. Findings from other studies have also revealed that patients,regardless of gender,tend to be more assertive with women doctors,interrupting them and asking questions more frequently. While some experts have construed these as a sign of decreased respect,others contend that they in fact reflect a greater sense of comfort on the part of the patient. They can be a sign of empowerment and of participation, Hall observed. But while a female doctor in the exam room tends to ignite such conversations,it is the presence of a female patient that keeps those discussions going. According to another study published last year in The Journal of Womens Health,women patients were more likely to have discussions with doctors ,regardless of the physicians gender.

You cant necessarily say that women are better doctors, said Dr Klea D Bertakis,lead author of that study and a professor of family and community medicine at the University of California. Its a matter of gender behaviours in the course of an encounter. Patients,as well as physicians,are bringing their specific backgrounds and experiences to that encounter; and we need to be aware of that.

Perhaps the most interesting finding involves male doctors who practice obstetrics and gynecology. While this group has been shown to be significantly better than their female colleagues at showing empathy and talking to patients,many of their patients continue to have a strong preference for female doctors. Patient-centered communication styles,it seems,may not be the only,nor even the most important,determinant of patient satisfaction. But,as the obstetrics and gynecology example reveals,and contrary to my patients belief,the ability to have more patient-centered discussions is not limited to one sex.

Physician communication skills can be shaped with training and medical schools have taken advantage of that fact. More and more schools are offering courses that teach how to offer better counselling,provide shared decision-making and pay increased attention skills found to be present more often in female physicians.

But its not about trying to become a woman, Bertakis reflected. Its about learning behaviours.