Nicholas Bakalar
iht.com
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," said John McKinlay, head of the New England Research Institutes in Watertown, Massachusetts, and the principal investigator. "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.
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.
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.
Not all experts found the report convincing. "This study clearly says that female and male doctors approach the patient interview differently," said Dr. Elizabeth 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."
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