We've seen studies recently about women getting substandard medical care and experiencing worse medical outcomes from hospital stays than men. At the heart of the debate around this gender gap are difficult questions about what factors prevent the optimal care of women: Is it the doctors and the healthcare system or the women and their families? Although a new study, which turns its lens on the doctors, hardly resolves such chicken-and-egg conundrums, it points to research that might reveal the tiny fissures in our system that can grow into cracks.
The study looked at whether women with breast cancer received radiation after their lumpectomies -- a treatment now considered a standard of quality cancer care. Of nearly 30,000 women with breast cancer ages 65 and older, nearly 25 percent didn't receive postoperative radiation, and so the researchers analyzed data for possible influencing factors. Earlier studies had shown that older women, women from rural areas and black women were less likely to receive radiology treatments, and this study found similar patterns. But this study, published in the Journal of the National Cancer Institute, also analyzed data on the 4,453 surgeons who treated the women.
The researchers found that the surgeons of patients who ended up receiving radiology were more likely to have certain attributes, like being experienced or trained in the U.S. That certainly made sense to me. (Both experienced doctors and those trained in the U.S. may be more likely to be aware of protocols than greenhorns who got their degree out of the country.) But the likelihood of receiving radiology was also associated with having a female surgeon.
Since the study did not, as the abstract put it, "differentiate between lack of referral or patient refusal as the reason for not receiving radiotherapy," the researchers are only suggesting that the findings beg for more investigation. But from this ignorant laywoman's perspective, there are many ways to interpret this data -- are male doctors too quick to downplay the importance of the treatment if the woman seems especially put out by the idea of more treatment? Do female doctors communicate differently with their patients? Do female patients listen to male and female doctors differently? Does the fact that both female doctors and their patients are women, and therefore share the risk of breast cancer, subtly influence the course of treatment? Whatever the case, it's going to make me a bit more conscious about what might be going on, unconsciously, with my mostly male doctors.