Patients' Prejudice

Discussions about the shortage of doctors and the poor distribution of them invariably get around to un used woman power. Then accusatory fingers are pointed at medical schools and the profession's elders for having long discouraged women from en tering the field. However, this kind of discrimination has begun to fade (see box opposite), giving rise to a new question: Will patients welcome an increasing number of female physicians? A large part of the public apparently will not.

A startling degree of bias was turned up last year by Dr. Edgar Engleman, who studied the attitudes of 500 patients in three New York City hospitals." Eighty-four percent of the men and 75% of the women questioned said that they preferred a male doctor. Though better than half agreed that woman physicians were more considerate than male colleagues in dealing with poor patients and nearly 40% said that they considered women friendlier than men, only one-quarter of the patients thought that they would be more comfortable confiding in a woman.

Ethnic Factors. Heed advice from a woman doctor? Many said no. Twenty percent, which Engleman calls "a significant number," would not take drugs prescribed by a woman, and 48% said that they would seriously question a woman's recommendation to enter a hospital for treatment or tests. The study also turned up some contrasts in attitudes that seem to be linked to educational, ethnic and age factors. Among those with less than an eighth-grade education, 85% preferred a male doctor, compared with 73% among the college-educated. One notable disparity: 54% of the Puerto Rican patients thought women were less competent physicians than men, but only 20% of the blacks agreed. Engleman offers a cultural explanation:

"People from a Spanish background have a masculine-dominated culture, but in black American culture it is often the woman who is more educated and esteemed."

More predictable was the finding that people under 30 of all back grounds were far more receptive to being treated by a woman than were older people. This, Engleman suspects, is because younger patients are closer to the time when they were cared for by their mothers and perhaps by woman pediatricians. Also, the young generally have less rigid attitudes toward sex and the sexes.

Engleman, 26, now an intern at the University of California in San Francisco, believes that his study actually shows prejudice against women, not just woman doctors. To support that conclusion, he cites typical responses. One patient who had never even met a female physician said: "A male knows more and takes his work more seriously. He puts his mind to it. A woman has home problems." Another rationalized: "No, I've never seen a woman doctor, but I resent them anyway. How can they be doctors and raise a family? Chances are they don't do either very well." Others were more blindly biased. "I don't think female doctors have any feelings at all," said one, and another epitomized prejudice with the statement "I hate them all. I don't know why."

Woman doctors, of course, do not need a poll to tell them that they face such attitudes. They improvise a variety of defenses and responses. Faced with the frequency of men's reluctance to submit to genital examinations, for instance, some woman doctors simply discourage adult males from becoming their patients. Others, like Anitha Mitchell, a black resident in internal medicine at the University of California in Los Angeles, "just try to be as businesslike as possible."

Manhattan Psychiatrist Helen Edey observes that young woman interns and residents are frequently mistaken for nurses. She overcame the problem by ignoring it: "You can do the same things whether the patient calls you nurse or doctor." Leona Miller, now a diabetes specialist in Los Angeles, remembers the sincere but puzzled thank-you from a woman whose husband had been saved by a trio of woman physicians. "To think," the woman said, "that you three nurses took care of him and that a doctor never saw him."

Catch-22. In two areas there is no lack of demand for women. In pediatrics, seemingly viewed almost as an extension of motherhood, supply has responded to demand and fully one-fifth of all pediatricians are women. Obstetrics and gynecology, the second specialty, is medicine's catch-22. The Engleman study and others show clearly that women prefer female obstetrician-gynecologists, but only a scant 6.8% of doctors in women's medicine are women.

Why this paradox? Obstetrics and gynecology are considered a surgical specialty, and surgery is the most rigidly disciplined major branch of medicine. It requires more apprenticeship training than most other branches, and many senior man doctors do not want to "waste" the education on a woman who might later practice only part time for family reasons. Cardiovascular Surgeon Nina Braunwald of the University of California at San Diego, one of the few who made it, sees another reason: "Surgery is a closed field, and the male ego would like to keep it so." Because department heads in the surgical specialties would rather not take a chance on a woman, the female residents are usually chosen last. In many hospitals, if a woman resident takes a six-month maternity leave, she has no job guarantee, though men are given two years of military leave with job security.

Standing Up. Anesthesiologist Barbara Lipton encountered a typical response while interning at Yale--New Haven Hospital. She held retractors for a neurosurgeon during a particularly long operation. The surgeon, duly impressed with her perseverance, sent her a Christmas greeting: "To one of the boys." Says Pediatrician-Hematologist Darleen Powars: "There are hundreds of ways to discourage woman surgeons. There's no place for a woman resident to sleep. And if you want to urinate some other way than standing up, you have a problem."

Now things are gradually changing, even in surgery. "When I started medical school in 1948," Nina Braunwald recalls, "a woman would think about surgery 116 times and probably decide against it. Today she'll think about it 100 times and feel that there is some possibility of success." Like most women in medicine, Dr. Braunwald finds that acceptance by male colleagues varies. "The more intelligent a male doctor is," she says, "the less he minds."

In self-defense, many woman physicians say that they offer patients qualities that men do not. Family Practitioner Constance Louise Holt of Washington, D.C., feels that "women understand the non-medical problems that bring patients to doctors' offices." Mary Allen Engle, chief of pediatric cardiology at New York Hospital, also points out that being a mother has helped her in treating children. Her specialty--caring for those with congenital heart disease--is a relatively new field that was begun by another woman doctor, Helen Taussig, who was Dr. Engle's mentor in the 1940s. Until then, says Dr. Engle, "these kids were being written off. Now we can do something to help, and this is very gratifying."

The Engle prescription for how a female doctor gets ahead is succinct: "By being more qualified than a man." That statement may sound like feminine chauvinism, but patients who balk at being cared for by a woman might consider what they are missing. To get her degree, to complete her residency, to earn specialty certification, the typical woman doctor of today had to show more determination and skill than her male counterpart.

*Then a student at Columbia University College of Physicians and Surgeons, Engleman arranged to have each person interviewed at length on his or her feelings toward man and woman physicians. Though all clinic patrons, the patients included college-educated middle-class people as well as the poor. These findings are excerpted from Engleman's unpublished study.

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