Women are stupid.


Thats what one male patient blurted to Dr. Janice Christensen, a cardiologist with Spokane Cardiology PSC, years ago when she was practicing medicine in Arizona. Women doctors here say such attitudes are diminishing, though, as the number of female physicians continues to rise, influencing patient perceptions and the field of medicine.


National studies and local physicians agree that female and male doctors differ in ways other than their gender. Women doctors often spend more time with patients, are gentler and more expressive, and are better listeners than their male counterparts, the American Medical Association (AMA) says in a recent analysis of 26 studies.


Nearly half of next years incoming medical students are women, and, by 2010, some 30 percent of all practicing physicians are to be women, up from 12 percent in 1980, the AMA says. The increasing number of female doctors is affecting patients experiences, and its influencing physicians schedules, since fewer women than men are willing to maintain the grueling schedules that doctors in the U.S. endure.


In the Spokane area, of the 1,019 physicians who belong to the Spokane County Medical Society, which accounts for about 98 percent of the doctors here, 203 are women and 816 are men, the society says. Figures arent available locally or nationally that provide a gender breakdown of part-time and full-time physicians.


A lot of patients now are able to choose who they go toincluding whether to see a male or a female doctor, says Dr. Renu Sinha, a general surgeon in the Spokane Valley with Inland Surgical Associates. She contends, Female patients tend to go to female physicians for certain things, and now even the male patients tend to like the more friendly, caring atmosphere provided by women doctors.


Analysis backs womens experiences


The AMA analysis, published last August, found that women physicians disclose more about themselves in conversations with patients, demonstrate warmer nonverbal communication, and get patients to talk in a more open and intimate way than male doctors. To make patients feel more comfortable, women often downplay their role in doctor-patient relationships, while male doctors tend to assert their status as physicians more than women, the review found.


The AMA article, however, adds, There is far more common ground than difference in communication behaviors of male and female physicians. In contrast to higher levels of psychosocial and socio-emotional exchange between women doctors and their patients, there is little evidence that physician gender is a factor in discussions of diagnosis, prognosis, and medical treatment, the studies say. Some patient behaviors, such as negative comments and patient questions, were found to be little or no different in the studies whether a patient was seeing a male or female doctor.


The AMA analysis suggests that patients react differently to different physician behaviors. Even though male and female physicians evaluated in the studies provided the same amount of biomedical information to patients, patients of female doctors provided more biomedical information to them in return than the patients of the male physicians provided to them. Although patients might not be aware of the difference, female doctors here, including Sinha, say theyve seen the patient-doctor relationship expand during their careers.


The older men at first were more embarrassed, she says, recalling a patient who exclaimed, You mean Ive got to take my clothes off?


Sinha, who completed her training during the 1980s, says, in general, women patients are more accepting of female doctors. She says she suspects thats because for many years women usually had no choice but to see male doctors, and became comfortable being examined by them. Younger men dont seem to have a problem seeing female physicians, and increasingly older men sometimes prefer women doctors, she says.


They can chat longer with female physicians, Sinha says.


Dr. Deborah Vermaire, an anesthesiologist at Deaconess Medical Center, is the only female in her group of 17 doctors. She says she didnt feel like she was in the minority 10 years ago in medical school at the University of Louisville, where 40 percent of the students were female, but when she entered her specialty and began clinical rotations, it felt like a mans world.


Vermaire says many of her patients comment that theyve never had a female anesthesiologist before, but no one responds negatively.


Taking their time


Theres a big difference between a female and a male physicians approach to patients, Vermaire claims.


Women tend to be more personable, and were probably not as gruff and hard as some of our male counterparts, she says. We spend more time getting to know patients.


Vermaire also claims that women doctors ask more questions about patients families and personal lives, and they touch patients more than men do.


Several patients have commented on her demeanor, she says. They say things like, Thanks for taking the time.


Vermaires observation is backed by the AMA analysis, which found that female physicians spend an average of two minutes, or 10 percent, more time with patients per visit. By the end of a busy day, female physicians are often an hour behind male colleagues, the article says.


Dr. Steven Silverstein, a urologist at Deaconess, who is married to a female physician, Dr. Pamela Silverstein, argues that the style of patient care depends more upon personality than gender.


If you compare men and women, its a spectrum for both sexes, he says. For medical-legal purposes, male physicians are more obligated to be chaperoned and have more restrictions on the amount of physical contact with patients. Otherwise, Silverstein says, from his perspective, theres not a lot of difference in how female and male physicians communicate with female patients.


Women seek life balance


The AMA analysis shows that having more females in medicine is changing the field in other ways. More women doctors than males prefer part-time work or job sharing, says Evelyn Torkelson, vice president of physician recruitment and outreach services at Deaconess. This means more doctors must be employed to fill the needs of hospitals and clinics.


Women often ask, If Im going to have a family, I want to work part time. What are my options? Torkelson says. They really look at the long-term options.


Vermaire says male doctors sometimes make negative comments about women physicians who work part time.


While Sinha was in training, it wasnt acceptable to go home for your kids birthday. Family came second, she says. Never would you do anything for your family when a patient needed you, but we need balance. You cannot take care of your patients if youre not taking care of yourself.


Since 1995, Sinha has been in faculty practice with the medical school at University of Arizona in Tucson, where she lived before moving to Spokane a year ago. She continues to teach there. As associate director of residency at the medical school, she says she encouraged staff members to balance work and familya sentiment shed never heard from the male clinicians before her. Still, convincing medical students to accept a balanced approach to training proved difficult, she says.


They all wanted to do that, but they were afraid, she says.


Of course, not all female doctors seek part-time work. Christensen, of Spokane Cardiology, works full time while her husband, an architect, works from home and provides the primary care for the couples two children, ages 10 and 5. Christensen has been practicing medicine for five years and puts in anywhere from 30 to 80 hours a week at work. She says that while working part time was considered heresy in years past, the medical profession is more accepting of womens contributions to the field now. For that to continue, though, female physicians should insist on equality, she says.


If I were talking to girls considering going into a medical career, I could say more positive things about it than when I was going into medical school, she says. Women physicians have to take the risk to sometimes leave a practice and choose another practice where theyre listened to, where their participation is valued.


Silverstein says male doctors have welcomed the opening up of the field to women. Its a real positive thing, he says.


The major changes to the field, he quipped, are that with more women present, theres a little more sensibility and a lot less football talk.