Women with heart disease often fare better with a female physician

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By Linda Carroll

(Reuters Health) - Female physicians have better patient outcomes, in part because outcomes for female patients with a male doctor are worse than for male patients, according to a new systematic review that concludes better training and more female cardiologists are needed.

When researchers analyzed 13 studies of physician-patient gender relationship and outcomes, among their findings was that mortality among women with heart disease treated by a male physician was higher than among those treated by a female physician. In addition, female diabetes patients were less likely to receive intense treatment than male patients, particularly when treated by a male primary care provider, according to the results published in the Journal of the American College of Cardiology.

"This is an area that is ripe for future exploration with randomized science done in a controlled fashion," said senior study author Dr. Malissa Wood, co-director of the Corrigan Women's Heart Program at the Massachusetts General Hospital in Boston. "But I think (right now) there is an indication that there might be a benefit for women of having gender concordance with their physician."

Ultimately, there would be less of a problem if the demographics of cardiologists mirrored that of the general population, Dr. Wood said. Currently, "women account for more than 50% of patients while just 15% of practicing cardiologists are female," Dr. Wood said. "We need to be creative in finding ways to attract more women and underrepresented minorities - such as Hispanics and Blacks - into the cardiology workforce. There is still a staggering preponderance of white men who are cardiologists."

In the meantime, the culture of cardiology needs to be changed so that it is more family and female friendly, Dr. Wood said. That should include changing the field so that it allows physicians to have a better work-life balance, she added.

To explore whether physician gender might play a role in the quality of care that women receive, Dr. Wood and her colleagues reviewed studies published in English between 2009 and 2019 that examined patient-provider gender concordance. Of 872 studies screened, 13 met their criteria, with eight examining outcomes and five looking at patient preferences.

Among the eight that looked at outcomes, six found that patient-provider concordance influenced clinical outcomes. Of the five studies that examined patient preferences, two found an association between gender concordance and patient behavior.

In a study of 157,458 adult diabetes patients treated by primary care physicians at Kaiser Permanente Northern California, for example, researchers found that female patients were much less likely to receive treatment intensification for suboptimal risk factor control compared to male patients, particularly when they were treated by a male physician.

A study that looked at patients admitted to Florida hospitals for acute myocardial infarction between 1991 and 2010 found that mortality rates were highest among female patients treated by male physicians, whereas mortality rates were similar between men and women if the treating physician was female. In fact, the researchers found that patient-provider concordance was associated with a 5.4% reduced probability of death relative to a baseline mortality rate of 11.9%.

Overall, the review reveals that available data on the impact of patient-physician gender concordance on patient outcomes and preferences are limited and mixed, the authors note, adding that there are no data available from randomized controlled studies.

"This is an important area and the emerging evidence we do have is summarized in this paper," said Dr. Erin Michos, an associate professor of medicine in the division of cardiology and director of women's cardiovascular health at the Johns Hopkins School of Medicine, in Baltimore. "A pivotal one that was reviewed in the paper found that after an acute heart attack at medical centers in Florida, women patients treated by male physicians had worse outcomes than those treated by female physicians."

Interestingly, if the male physician treating the woman had more female colleagues or more female patients in his practice, then the outcomes for women were better, Dr. Michos noted. "That suggests that when male physicians have more exposure to women colleagues and patients, the outcomes may be improved."

Dr. Michos suspects that part of the explanation for the differences in outcomes could come down to communication styles. "Women tend to spend a little more time with patients on average and to be more patient listeners," she said. "They also tend to follow guidelines a little more."

Another factor could be that some male doctors may fail to recognize early cardiovascular symptoms in women, such as pain in the neck, arm, back and jaw, indigestion, fatigue and shortness of breath, Dr. Michos said. "Because women can present a little differently their symptoms can be blown off," she added.

Achieving parity in the number of male and female cardiologists "is not going to happen overnight," Dr. Michos said. "In meantime I think we need to focus on both male and female physicians providing the highest quality of care regardless of whether the patient is a man or a woman."

SOURCE: https://bit.ly/3dP5X0v Journal of the American College of Cardiology, online February 22, 2021.

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