August 15, 2018

'A glass ceiling on life': Women who suffer heart attacks are likelier to die if their doctor is male, study finds

Daily Briefing

    Read Advisory Board's take on this story.

    When a woman has a heart attack, she's more likely to survive if her emergency doctor is a female, according to recent study published in the Proceedings of the National Academy of Sciences of the United States.

    Study details

    For the study, researchers analyzed medical records of more than 500,000 hearts attack patients who had been admitted to EDs in Florida from 1991 to 2010. The researchers compared the survival rates of male and female patients who had been treated by either a male or female physician.

    Findings

    The researchers found that female patients are, in general, less likely to survive a heart attack than male patients—and their odds are especially poor if treated by a male physician.

    For example, the researchers found that 12.6% of men died when treated by male physicians, compared with about 13.3% of women—a gender gap of 0.7%. By comparison, when patients were treated by female physicians, 11.8% of men died compared with 12% of women—a gender gap of 0.2%.

    The researchers said the survival gap remained even after accounting for factors such as the hospital; the patient's age, ethnicity, and other diseases; and the physician's years of experience.

    The researchers wrote, "These results 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."

    Why female heart attack patients may fare worse

    The researchers and other experts say there are several reasons female heart attack patients fare worse in general—and may fare particularly poorly with male physicians.

    For instance, women tend to present with symptoms of indigestion, or discomfort in the arms, neck, jaw, back, and stomach, rather than with the classic gripping chest pains seen in men. But because most research on heart attacks has been done on men, these more commonly female symptoms are often considered "atypical."  As such, women experiencing such symptoms often delay seeking medical care, and those who do seek care are more often dismissed and less likely to be offered diagnostic tests.

    According to the researchers, female physicians might be more apt to quickly recognize these gender-specific symptoms.  Further, previous research suggests patients can better communicate their symptoms when they share a gender with their physician.

    Do differences in communication styles contribute to the survival gap?

    Nieca Goldberg, a spokesperson for the American Heart Association, who is also the director of the NYU Center for Women's Health in New York City, suggested that female doctors' communication styles may also contribute to the survival gap. She said, "There may be some unconscious bias, or that women physicians spend more time with their patients. This needs to be studied."

    A meta-analysis out of Johns Hopkins Bloomberg School of Public Health, for example, found that female primary care doctors spent an average of two minutes per visit, or 10% more time, with patients than their male colleagues.

    Don Barr, a professor at Stanford Medical School, said he often discusses research findings with his students about how gender differences impact how doctors communicate. He said that male doctors more readily interrupt patients; one study found that male doctors waited an average of 47 seconds before interrupting a patient, while female doctors waited an average of three minutes.

    Discussion

    Ashish Jha, senior associate dean at the Harvard T. H. Chan School of Public Health, said, "[W]e have to do better in terms of caring for women with cardiovascular disease—all of us. And male physicians could learn a thing or two from our female colleagues about how to achieve better outcomes."

    Laura Huang, one of the study's authors and an associate professor of business administration at Harvard Business School, said, "There are inequalities in a lot of different contexts, but when someone is suffering from a heart attack, you might expect that there would be no gender differences because every physician will go in trying to save their patient's life. But even here, we see a glass ceiling on life" (Yong, The Atlantic, 8/6; Knowles, Becker's Clinical Leadership & Infection Control, 8/6; Mozles, CBS News, 8/7; Harvard Business School release, 8/6; Parker-Pope, New York Times, 8/14).

    Advisory Board's take

    Megan Tooley, Practice Manager, Cardiovascular Roundtable

    Over the past year, we've seen increasing attention paid to gender biases in health care—and specifically in the cardiovascular space. Perhaps this has been inspired by the broader #MeToo movement, or perhaps it's due to a younger generation of female doctors who are unwilling to submit to a problematic status quo.

    Whatever the reason, the media coverage has inspired providers and patients to have important conversations that are, quite honestly, long overdue.

    There are many ways in which gender bias surfaces in cardiovascular care. For example, recent research has suggested women are less likely to seek care for heart attack symptoms than men, while other research has shown that those women who do seek medical care are more likely to have their symptoms dismissed as not heart-related.

    “We have to first address the barriers that can lead women to be underrepresented in certain clinical trials.”

    To solve this problem, we have to first address the barriers that can lead women to be underrepresented in certain clinical trials. Clearly, if women aren't included in the research that informs clinical recommendations, the resulting guidelines aren't going to incorporate their physiological differences.

    Patients aren't the only ones who must deal with gender bias. A recent four-part series in JAMA: Cardiology highlighted discrimination against female cardiologists, documenting wage disparities, sexual harassment, and bias in the workplace. While cardiology is certainly not the only specialty to face these challenges, lower representation of women in the cardiovascular service line has exacerbated the challenges.

    “Providers can address gender inequalities by providing individualized, patient-centered care—for all patients, not just women.”

    There are some positive trends. For example, the percentage of cardiology research that cites a woman as the lead author has increased in recent years—from 11% in 1996 to 21% in 2016. But there's still obviously a lot of work to be done.

    While solving these problems requires systemic change, individual providers can address gender inequalities by providing individualized, patient-centered care—for all patients, not just women. Taking into account clinical differences and risk factors due to gender and race, as well as behavioral health differences and sociodemographic factors, can enable more tailored care plans and better treatment for every patient.

    I'm glad that we're starting to have these conversations.

    We've compiled all of our resources about reducing cardiovascular care variation just for our members. To view and download these resources, including case studies from leading cardiovascular programs, make sure you view our resource page.

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