Male Patients Are Likelier To Bail On Female Doctors. The Question Is Why

Old joke: Man comes in to see the doctor and says, "Doc, my friend has a problem." The doctor replies, "Well, drop your pants and let's take a look at your friend."

A little uncomfortable, right? Does it get even more uncomfortable if you imagine the doctor as a woman?

If so, maybe that's part of what is at work in the graph below. Athenahealth, an electronic medical records software company that can mine data from doctor's office visits, finds a striking gap when it comes to new male patients who see female doctors.

In a data dive that looked at more than 2 million visits to primary care doctors, athenahealth found that men with commercial insurance were quite a bit less likely to return to a new female doctor than a male one. They came back about 40 percent of the time if the doctor was a woman, compared to a roughly 50 percent return rate if the doctor was a man.

Women patients showed a far smaller gender gap, of just 3 percent.

The male patients' tendency to bail was so striking that athenahealth headlined its recent post on the findings, "Are Male Patients Comfortable With Female Doctors?"

The deluge of responses to that post suggest that "one particular tripwire for at least some male patients" is discomfort about intimate medical exams, says Josh Gray, athenahealth's vice president of research. The responses indicate they may feel particularly uncomfortable if there is more than one female medical staffer in the room during the exam, he adds.

Example: One commenter writes that:

Men that might be willing to have an intimate exam or procedure with a female physician are not necessarily comfortable with her bringing in a female nurse or other female staff member (as an assistant or chaperone for example). That can take what was a tolerable situation and make it unacceptable to them. Most men are too embarrassed to speak up and instead find it easier to just not go back to that doctor.

Another commenter responds:

Yes! You nailed it! I am a 40 year old male. While I am willing to (not happy to, but willing to) have a female physician perform an intimate exam on me, I am absolutely not comfortable with any other female staff in the room for any reason while I am fully exposed. The presence of another fully clothed woman in the room to 'observe' turns what would be a tolerable situation into an intolerable situation for me.

Other factors could be at work in this gender gap as well. Research finds that in general, male and female doctors tend to have somewhat different communication styles, values and behaviors, says Northeastern University psychology professor Judith Hall, who has studied gender differences in medicine.

"Women physicians have a kind of a laundry list of skills and attributes that are different statistically from male doctors," she says. "This includes being a good listener, showing empathy, being supportive, being able to talk about emotions and psychosocial issues."

Women doctors are also likelier to engage in "status leveling," Hall says, "which is not lording it over the patient as a dominant authority figure, but rather trying to establish a more level playing field, so that there can be more mutual participation — because patient participation is considered one of the main things to be strived for in medical care."

Doesn't sound so bad. And let's not forget the recent finding that elderly patients of women doctors tend to live longer and do better in the hospital. Other studies have been similarly reassuring about female doctors.

So what's making men run? Professor Hall and colleagues have examined the research on the effects of physician gender on patient satisfaction, and found that overall, female doctors' patients are only slightly more satisfied — but not nearly as satisfied as the differences in quality of care would suggest that they should be.

"When it comes to putting it all together in an overall evaluation of competence, or satisfaction as a general construct, they're reluctant to really endorse [female doctors] fully," Hall says.

One theory as to why, she says, is that patients may see many aspects of good care by a woman doctor as simply part and parcel of being a woman.

"I think the most fascinating reason is that when a patient sees a female doctor doing all these really good, patient-centered things, they don't represent it in their minds as, 'Oh, this is a great doctor,' " she says. "They represent it as being, 'This is what women do. It's how women act. And she's being a good woman. She's conforming to my expectations.' "

Whereas, she adds, "If the male physician shows all those patient-centered skills and behaviors, it stands out. It's really connected in the patient's mind to, 'Wow, this is a great doctor.' So there's a kind of an uneven reward that patients will give back to physicians," an unconscious double standard.

Age could play a role as well, Hall says; the great influx of women into medicine is a fairly recent phenomenon, so women doctors tend to be younger, and their youth could cause added discomfort or doubt in some men.

Athenahealth, which analyzed the data, does not offer a theory on what's at work, but plans to continue exploring how gender plays out in medicine, including patient retention and doctor burnout.

The responses to its post, and to a query about physician gender on Quora, suggest that reactions to a doctor's gender vary widely, from men who actively prefer female physicians to men who avoid them.

There does, however, seem to be widespread discomfort with chaperones -- the additional medical staffers brought in to prevent impropriety during intimate exams.

One commenter on the athenahealth post writes that bringing in a chaperone without the patient's express permission amounts to disrespect for a man's modesty:

The patient "ambush" is quite typical; even when an appointment is made with a male physician, it is not unusual for a female chaperone, female scribe or both to suddenly walk into the exam room with the hapless male patient sitting there in a state of undress. Informed consent is just that: "informed" consent. Give the male patient a chance to say no, or request a male instead of a female. I would suggest that the return rate would be much higher in the long run.

Readers, experiences? Theories?