The message came through the patient portal: “I want to take my dad to a different doctor. Could you recommend an older male doctor with a strong authoritative presence?”
Were it not for the gendered request, I would have dispensed with this message in a few easy clicks. “No problem!” He had a difficult issue, a spinal fracture in an elderly, curmudgeonly, and sometimes confused man. Like others with this problem, he had not been compliant with wearing his brace. His daughter was his attentive and exhausted caregiver, but he wasn’t listening to her and she was frustrated. I guess she thought he needed things mansplained. Or graysplained? Though I am one of the more senior neurosurgeons in town, I am not male, and I do not have gray hair. (Thanks for the great genes, Mom!)
If not gray hair, my years in neurosurgery have at least given me a thick skin. I can plow past the stray unintentional disrespect: “Will I talk to the surgeon?” “I am the surgeon.” If patients seem uneasy, I encourage them to get second opinions. It does not hurt my feelings. A patient should feel comfortable with the person who will see their insides. The sexist request for a second opinion bothered me, though. And it bothered me that it bothered me.
Is it wrong to want a doctor who looks like you? I want to believe the man who wanted an older male doctor was being sexist. I want to be terribly offended. But the woman who chose me because I am a woman, is she sexist too? What about the Black patient who left my practice for a Black doctor? Racist? It is distasteful even to suggest. Perhaps I am unfairly labeling my patient as sexist when many patients seek physicians who look like them.
A couple of recent studies have shown that people are more satisfied with doctors who look like them, either choosing a PCP that is same-gender or ranking their same-race/ethnicity PCP higher on patient satisfaction surveys. For women and minorities, choosing doctors who look like them may actually impact the quality of medical care they receive. A study in 2018 revealed lower mortality for female heart attack patients treated by female cardiologists. Female patients in another study had better postoperative outcomes with female surgeons than with male surgeons. Black infants in a study on infant mortality in Florida had a lower mortality rate when they received care from Black pediatricians. Maybe my patient wanting the older male doctor should know that a study of hospitalized Medicare patients showed lower mortality rates in female and male patients treated by female hospitalists.
Perhaps, then, it is more important for women and minority patients to have doctors who look like them. In the past, women and marginalized populations had no choice but to see physicians who did not look like them. My first ob/gyn was a gray-haired white man. While he was friendly, respectful, and knowledgeable, I had few other choices at that time. Despite the increasing diversity among medical school graduates, patients may still have difficulty finding diverse medical and surgical subspecialists. If only two oncologists practice in a community, a patient may have to travel hours to see one who resembles him. Surprisingly, it was because of increased diversity in this community that my patient could not find the older male neurosurgeon he sought. Usually in the majority, he was seeing health care from a different perspective.
While I respect the physician-patient concordance data, I did not go into neurosurgery to only take care of short white women. I have had many wonderful curmudgeonly male patients and enjoy caring for all kinds of people. I felt conflicted by my patient’s request and conflicted by the data because I do not want to practice in a world of silos where female patients see female doctors, Asian patients see Asian doctors, and cat-lovers see cat-loving doctors. Are we championing patient choice because the data show it might improve their outcomes or are we encouraging divisive behavior? For now, I am erring on the side of patient choice because of the studies, but the line seems blurry and turning a blind eye to sexist or racist or other-ing attitudes seems wrong.
What did I do for this patient? Did I don a gray wig and lay down the law in my deepest voice? Did I bring him in for a lecture on gender bias and improved outcomes with female doctors? No, I took a deep breath and let it go. Just as he can choose whether to wear his brace, he can choose which doctor he wishes to see. I am sure the daughter was trying to do her best for dear old Dad, despite delivering what seemed like yet another sexist jab. These million tiny arrows of unintended disrespect may eventually pierce my impenetrably thick skin, but not today. I instructed them to call his PCP for a referral to a doctor who looks like him. I’ll do my best to connect with the next patient so he can appreciate the skills and not focus so much on the package.
How have you approached conversations where a patient has asked for another clinician? Share in the comments.
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