In late 2016, a landmark paper was published in The Journal of the American Medical Association.(1)
A study of around 1,600,000 urgent medical admissions of older people, for a variety of different diagnoses, found that when the caring physician was a woman, mortality rate was lower and fewer of the patients who were discharged were readmitted in the following month.
While the differences were not large, if extrapolated, the authors suggest that 32,000 fewer patients would die annually in the USA if male physicians could achieve the same outcomes as female physicians.
A bra-burning moment indeed! Vindication perhaps for the era when I entered medical school (which a peer from those days says we should celebrate because it is, heaven forbid, nearly 50 years ago) when far fewer women were admitted than men. Fifty years later, while there is now gender equality in medical admissions, women still on average earn less than men and are under-represented in certain specialties, particularly surgery.
However, this is not a feminist rant, rather I would like to look at those qualities women bring into medicine which may be contributing to this difference, which is not only in morbidity and well-being in the community as we see from studies in general practice, but to mortality in an acute hospital setting. This paper suggests that female physicians are at least as competent and capable as their male counterparts, but what do they bring that makes this difference?
This particular paper does not explore the reasons for these differences. However previous studies have shown that women are more likely to practise good communication, take more time over their consultations, follow guidelines and provide psychosocial counselling. Love and compassion have always been difficult to quantify and hold little place in the world of evidence based medicine, despite a sense by most in the caring professions that they are of vital importance.
This is not about valuing women over men, but exploring the qualities we all have, that can be brought to the practice of medicine, for the great benefit of all.
The particular qualities that women bring into medicine are by no means gender specific. Many men in Medicine are deeply caring, good communicators and thorough in their approaches and some women, of course, are not! Is it possible that some of these qualities have not been as valued by the profession and certainly not by management who give precedence to technical skills, controlling waiting lists and time limited medicine? Does this attitude still serve us in 2017? This way of practising medicine is destructive for us as physicians and is not healing for our patients.
Moves towards patient centred care and the Medical Home will only ever be effective if we are able to take more time over consultations, are highly skilled communicators, take a broad holistic view of health and take into account psychosocial determinants of health as well as following guidelines and pathways.
I feel for a long time the women in Medicine have felt unable to bring those qualities they really value into medical practice, because they have needed to be able to prove their worth in a male dominated profession. Now this can change.
I feel we could all, men and women, change the face of Medicine if we made those healing qualities foundational not only to our work with patients, but to our relationships with one another. If our hospitals and clinics were more supportive to both clinicians and patients, surely, like this paper suggests, the outcomes could be better and we as physicians could feel we are practising the kind of medicine we may have always dreamed of practising.