Saturday, November 21, 2009

I’ve Got to Crow: Notes from the Empty Nest

One of the great advantages of now having self propelling children is that I can go to conferences that rekindle my interest in more general professional topics. I just attended a meeting sponsored by the Society for Women’s Health Research on the topic of adherence to medication—what in the not so distant past was called compliance. Improving adherence to medical advice offers great promise as a strategy for reducing health care costs. And I was delighted to find that women physicians already excel in this area.

At the meeting I learned about a big review article (Roter, Hall and Aoki, Physician Gender Effects in Medical Communication: A Meta-analytic Review, JAMA 288:6 756-64)that showed that women physicians, at least those in primary care, spend more time with patients (10% longer visits—an average of only 2 minutes more per encounter). The researchers found women were better at enlisting patients as partners in their care, asking about the social context of illness, and focusing on emotion. I remember, still indignantly, being scolded by a resident for spending too much time “chatting” with patients on rounds. This study—a meta-analysis, please note-- firmly laid that shibboleth to rest. The extra time we spend with patients is not merely social conversation. Women use time with patients well, conveying medical information as thoroughly as male physicians. While the effect on medical outcomes was not reported, other people at the meeting provided compelling data that communication promotes adherence, and adherence promotes health and lowers costs.

These data are something we can all be proud of. I confess I would love to go back to my obnoxious resident and say it out loud: “So there !”

7 comments:

  1. Very interesting. Will have to check out the Roter article, thanks. But that extra time has got to come from somewhere, possibly at the expense of something or someone else.

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  2. I've heard of this data and it's not surprising to me - I hear Carol Gilligan's work echoed in this research. We relate differently. I do think it ultimately translates to the bond between physician and patient.

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  3. Interesting, especially as I was opening the AM mail: I just got a solicitation from an insurance company which touted the fact that "practices ... which include mostly female physician have fewer liability claims" - may be related to this extra time.

    Thanks for helping to validate the additional time I spend with my patients :)

    A

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  4. Which all suggests that the extra time we spend is saved in the long run by having to spend less time defending ourselves in court

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  6. I've been reprimanded for the same. I know that you have to balance talking to people with time constraints, but as a female I seem to get many more patients trying to talk to me about things, including grabbing my hand as the team leaves the room and so on. Nice to get some validation about it.

    I think some of it has to do with the fact that they assume that I am a nurse not a doctor (being female), particularly when on an all male team. A lot of people tend to think that nurses are nicer, more caring and have more time for patients than doctors. I guess some of that has to do with differences between the professions, but possibly also that nurses were traditionally female. Possibly anyway.

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  7. Great website.

    Started my own site last week and I'm checking out other med blogs. How could I not look at yours? Everyone had a mom...I try to teach my residents that compassion and kindness go just as far as a good medical font of knowledge.

    Well done, I will be following.

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