Recently, I was talking to an acquaintance of mine who’d just had a baby, when she made an offhand remark about her lactation consultant: She was upset, she confided, that the consultant had the audacity to offer breastfeeding advice when she herself had never nursed a child.
It’s not the first time I’d come across the sentiment. In a recent medical-odyssey essay about finding a diagnosis for her painful uterine condition, the author wrote about feeling indignant that “a person with a penis, who had never personally experienced a period,” told her that maybe she just didn’t realize what periods felt like.
Studies show women largely prefer seeing women doctors, especially when it comes to their reproductive health care. In some cases, that may be because they’re just more comfortable with a person of the same gender examining their private areas, but others are clearly looking for a doctor that knows what it’s like to be a woman.
Which raises the question: Can we really expect medical professionals not only have professional skill and experience in their field, but personal familiarity with it, too?
When you expand this logic out to other areas of medicine, it starts to seem almost silly: Would you prefer an oncologist who has endured cancer? A dermatologist with acne? A gastroenterologist with irritable bowel syndrome? From a patient’s point of view, why does a medical professional’s personal experience matter? And also: How is their personal history even any of my business?
And let’s assume they did have that personal experience, but it didn’t go the way you, as the patient, may have wanted. Like, say a lactation consultant did have kids, and had tried to breastfeed — but maybe she had a lot of difficulty and started supplementing with formula. There’s a chance her story could make her more sympathetic in the eyes of her patients — more capable of understanding their struggle because she’s been there, too. On the other hand, though, some might consider her incapable of doling out advice because she struggled with the same thing she teaches other people to do.
Centuries ago, personal experience was indeed a substitute for women’s health expertise: “It was often the norm for a woman’s sexual organs to be examined by midwives, nurses or other females who previously had had similar problems to the patient’s,” gynecologist Jaques Balayla wrote in the McGill Journal of Medicine. But “by the early 1800s, with the advent of modern medical degrees and physical examinations, the pelvic exam began to be performed by male physicians, as women were not allowed to enroll in medical school.” Perhaps women seeking care from women is a pushback against the patriarchal takeover of gynecology and childbirth, which has historically been a typically women-only endeavor.
Physician Abigail Zuger tackled this topic from the doctor’s point of view in her New York Times article, “When Doctors Treat Patients Like Themselves,” asking: “Is health care more effective when patient and doctor are the same—the same sex, class, race, tax bracket, sore feet and cholesterol level? Or does essential objectivity require some differences?” From the patient’s point of view, she noted, there’s no single right answer:
Anecdotes abound. One woman loves her gynecologist because she “knows just how I feel.” Another hates the same gynecologist because she “thinks she knows everything.” (The subject of discord was menstrual cramps, the doctor uttering the fatal phrase “They’re just not all that bad.” That was it for the second patient: off to a man whose reactions would presumably be governed by sympathetic imagination, not personal experience.)
Much of the research on why women want to be treated by women doctors concludes that the preference is mainly based on the belief that women are better communicators. A 2012 review paper published in the journal Patient Education and Counseling analyzed ten years’ worth of research on patients’ preferences regarding their doctor’s gender, concluding: “Preference for a female gynecologist-obstetrician might be explained by a more patient-centered communication style used by female gynecologists-obstetricians. Using a patient-centered communication style increases patient satisfaction.”
So a better question might be: When we ask for sameness or lived experience from medical providers, what is it that we’re really asking for? In light of the pervasive gender bias in medicine — among other things, women wait longer in emergency rooms, and are more likely to receive sedatives for pain rather than pain medication — maybe women are simply hoping to be believed about their symptoms, to be taken seriously and treated accordingly.
Whether shared experience really accomplishes that, though, is still up for debate, and may be too complicated for an across-the-board conclusion. There isn’t much research on whether women patients have better outcomes with women doctors (although a small 2016 study suggested that older patients of both sexes did fare better when treated by women).
There is some evidence to suggest that racial minorities benefit from seeing doctors who are also racial minorities: One recent study in the Journal of Pain and Symptom Management found that black patients receive less empathy from white doctors than from black doctors, likely one reason why black intensive-care patients die at higher rates than their white counterparts.
Other racial and ethnic minority groups, as well as people with disabilities, or poor, old, overweight and LGBT people also face bias and discrimination at the doctor’s office. In fact, the Institute of Medicine recently identified 13 groups that experience bias in medical care, advising doctors treating members of these groups to “communicate with the patient in a way that connects your humanness with the patient’s humanness … [S]eeing a patient as individual human being helps reduce the power of stereotypes and promotes trust in both individuals.”
But focusing on a common humanity isn’t really the same thing as focusing on shared personal experiences — and some research suggests that striving for this more specific common ground can actually backfire. In a 2015 study in the Journal of Personality and Social Psychology, a team of Harvard researchers found that people who endured certain life challenges in the past were actually less likely to show compassion for someone facing the same struggle. “The intuition [is] that shared experience breeds empathy,” the authors wrote. “Our recent research suggests that this instinct is very often wrong.”
So sympathetic imagination, to borrow Zuger’s phrasing, may be the more powerful force after all. In his paper, Balayla argued that “men might even have a heightened sensitivity about the distress that a gynecological exam can cause as they themselves have never undergone one. Something as routine as a Pap smear can be a really difficult experience for some women, and some men might go more out of their way to be gentle and explain what they’re doing than female gynecologists, who may feel it’s not that big of a deal because they’ve been through the process themselves.”
Sensitivity isn’t the same as common ground, but that might not be a bad thing. In the title essay of her book The Empathy Exams, author Leslie Jamison recalled an encounter with one of her doctors: “I remember feeling grateful for the calmness in his voice and not offended by it. Why? Maybe it was just because he was a man. I didn’t need him to be my mother—even for a day—I only needed him to know what he was doing … His calmness didn’t make me feel abandoned, it made me feel secure. It offered assurance rather than empathy.
“Empathy is a kind of care,” she wrote, “but it’s not the only kind of care, and it’s not always enough.”