Do Women Prefer Female Obstetricians?
September 1, 2002 4 minutes read
Abstract & Commentary
Synopsis: One third of postpartum women delivered in a tertiary hospital in the Northeast prefer female obstetricians.
Source: Howell EA, et al. Obstet Gynecol. 2002;99: 1031-1039.
In recent years, many medical professionals have come to believe that female patients prefer to see female physicians. As Howell and colleagues point out in their brief review of the literature, there is little literature to review. Most studies have focused on one type of patient (obstetrical, primary care, postmenopausal, or some other group) or a specific type of physician (OB/GYN, or family physician, etc). Howell et al recruited 67 postpartum patients who agreed to undergo an interview. The interview was carried out using a nonstandardized instrument. They state that they used open-ended questions. The responses were "collected, transcribed, and printed" and were then analyzed.
Fifty-eight percent of the patients stated that they had no preference for physician gender. Thirty-four percent preferred a female obstetrician. Howell et al state that "a theme emerged" showing that as long as the patient felt a "connection" to their obstetrician, gender did not matter, but only provided vague information supporting this contention.
Howell et al acknowledge that their results differ from 2 other recent studies. They believe that this might be due to the nature of the patient population that they studied.
Comment by Kenneth L. Noller, MD
I chose this paper to review, not because it is a good paper (in fact it really is not) but because it gives me an opportunity to ventilate on a subject that is discussed nearly continuously by OB/GYNs. As Howell et al point out, the published data supporting the fact that women prefer to see women physicians are rather scanty. Nonetheless, anyone who has practiced OB/GYN in the last decade has to be aware that a majority of women calling for first time appointments in gynecology, or as new obstetrical patients with no previous OB/GYN experience, request a female physician. If they are told there is no female physician available, many will accept a male. That does not mean that they had no preference. Indeed, that is the most important problem with this current study. The women were all interviewed postpartum—ie, after they already had a prolonged experience with an obstetrician. Some probably had a female obstetrician providing most of their care, but were delivered by a male, some had prenatal care by a female and delivery by a female, and every variation of the combination of prenatal care/delivery/ and physician gender. Howell et al did not report how many women saw men or women for their prenatal care—only who delivered them.
The authors work at a tertiary care hospital and the women they sampled are a poor representation of the general female population. Likewise, after the stresses of labor and delivery, if everything turned out fine (and the infants born to these mothers had high Apgar scores) they perhaps cared little whether their care provider was male or female. In fact, even those who had chosen a female obstetrician and were delivered by her might have seen a male partner during the postpartum stay, were happy with him and thus would answer the questions as indicating no preference. The bottom line is, the population Howell et al chose to study is so poorly representative of women who are calling to make their first appointment with a gynecologist (the most important statistic) that it is meaningless.
For those of us who are at academic institutions where many medical students must be trained, there is great fear that we may never be able to train male medical students adequately in the proper examination of female patients. When asked if they will allow a male medical student to examine them, the rate of refusal among women is extremely high. The problem occurs in OB/GYN rotations, family medicine, and internal medicine.
This is also a great example of a study where the conclusion placed in the abstract does not at all match the study population. In the conclusion section of the abstract Howell et al state that "a majority of women did not prefer a female obstetrician." That is not consistent with their study population. They should have said: "Immediately postpartum women still hospitalized who delivered at a tertiary care center in the northeastern United States did not prefer a female obstetrician." Even that statement is not completely correct since it also should mention that a majority of the women were white, the majority had 2 children, that a female physician performed the interview, and that the study instrument (questionnaire) had not been standardized. Far too often I see this mistake made. I do know that editors constantly try to shorten manuscripts and that may lead to conclusions that are too brief and not exactly accurate. But it is still the authors’ responsibility to make certain that the information is not misleading.
A number of physicians seem to want to believe that the fact that most women would prefer to see a female physician (particularly if a pelvic examination is going to be performed) as something "bad." I think that is terribly unfair. There is nothing good or bad about that fact, and most patients will accept either gender if no one else is available. Additionally, if someone has special expertise in a particular field it matters little whether that physician is male or female, or the gender of the patient. Well-trained, thoughtful, compassionate physicians will always be busy regardless of their specialty or their gender.
Dr. Noller is Professor and Chairman Department of OB/GYN Tufts University School of Massachusetts.
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