Solving the chicken or egg problem
When it comes to empathy, female doctors are better than males, and this probably makes them better doctors. Our research published this week found that female doctors are better at empathy than males. The study included results from 64 individual surveys in 15 countries. In the surveys patients were asked things like whether their doctors listened carefully, whether they felt understood, and whether their doctors came up with a helpful plan. Studies with mostly female doctors scored an average of 43 (out of a maximum of 50 points), while studies with males scored just 35.
This is important because better empathy can reduce patient pain and anxiety, while increasing satisfaction. Empathy is also required to be a good doctor. Unfriendly doctors are less likely to get enough information from patients to make the right diagnoses, or prescribe the right treatments. One study even showed that unempathetic doctors could cause harm by scaring patients away from medical care when they need it.
We also found that female doctors spent more time with their patients. This raises a chicken or egg question: are female doctors better at empathy because they spend more time with patients? Or did they take more time because they were better at empathy? It is important to answer this if we want to improve male doctor empathy. If spending more time is key, all we have to do is let under-performing men spend a few more minutes with patients. This could be hard because many doctors complain—for good reason—that paperwork imposed from above stands in the way of adequate empathy (I’ll leave the problem with bureaucratic paperwork for another newsletter). But if female doctors spend more time with their patients because they are empathic, then more time alone won’t help male doctors improve.
The chicken or egg problem is common in a lot of medical research. It was made famous in the 1950s when the first studies linking smoking with lung cancer were published. At that time, 
some people actually asked whether smoking caused cancer or cancer caused people to smoke. The distinguished medical statistician Ronald Fisher was one of the people asking these (to us now, silly) questions. Fortunately, Fisher’s views were discredited because of his links to the tobacco industry and the fact that he was a heavy smoker himself. The chicken or egg problem was solved in the smoking and lung cancer case by doing more research. We learned that some bad things in the smoke (especially tar) did something bad to the lungs that caused cancerous tumors to grow. This additional information made it clear that smoking produced higher rates of cancer. Chicken or egg problem solved (for this case).
In the same way, we need more science to solve the chicken or egg problem with empathy and time spent with patients. Our research so far is starting to give us answers:
- Doctors who are good at empathy ask general questions about patients as whole people, have good body language (look at the patient instead of a computer screen), communicate that they understand patients, and come up with a plan of action based on that understanding. This probably takes additional time, but may not.
- Empathy and time spent with patients could be inseparable, the way flour and water can’t be separated after you combine them in baked bread. Empathic doctors are probably happy to spend more time with their patients, and more time allows them to express empathy.
Still, we don’t yet know the answer to the chicken or egg problem when it comes to time with patients and empathy. Yet in the midst of all the controversy surrounding chickens, eggs, time, and empathy, one thing is certain: if you’re looking for a doctor who is good at empathy, you’re probably much better off with a female than a male.
Jeremy Howick is the author of a new book, Doctor You in which he discusses his research on empathy (and other fun things). You can find out more about him on Twitter @jeremyhowick and www.jeremyhowick.com.
This was published as a TheConversation blog.