Apr 25th 2018

Female doctors show more empathy, but at a cost to their mental well-being

 

Female doctors show more empathy than male doctors. They ask their patients more questions, including questions about emotions and feelings, and they spend more time talking to patients than their male colleagues do. Some have suggested that this might make women better doctors. It may also take a terrible toll on their mental health.

Studies indicate that female doctors are at greater risk of burnout than male doctors, and that this might be linked to differences to do with empathy. Burnout is bad for doctors and their patients. People with burnout feel exhausted, emotionally depleted, cynical and detached. They are also less satisfied with their work.

Doctors who develop burnout make more errors, are less likely to answer patients’ questions or fully discuss their treatment options. Interestingly, as people develop burnout, they show reduced empathy for others (so-called compassion fatigue). Compassion fatigue has been called the cost of caring because it is more commonly seen in health professionals such as nurses, psychotherapists and doctors.

One theory about why compassion fatigue sets in is that high empathy causes greater levels of emotional arousal and distress, so the reduction of empathy is simply a survival mechanism to cope with experiencing long periods or extreme emotional stress. This theory has been used to explain why medical students and doctors report lower levels of empathy as they progress through medical school and their post-graduate medical training. It might also explain why doctors’ brains show a reduced response to witnessing people experience pain, compared with people who aren’t doctors.

Men and women burn out differently

As well as the differences in risk of burnout, the way female doctors burn out appears to be different to the ways male doctors burn out. Identifying and understanding these differences might be important for recognising when doctors are developing burnout and getting help and support for them in time.

A four-year study of Dutch GPs found that, for female doctors, burnout begins with emotional exhaustion (feeling emotionally depleted), and then progresses to feeling increased depersonalisation (feeling detached or cynical about people and work). Finally, they tend to feel less work-related personal accomplishment and have reduced self-belief in their competence at work. This last component of burnout, reduced personal accomplishment, involves evaluating one’s work negatively and is likely to compound the problem as it increases stress and emotional exhaustion.

Conversely, male GPs report depersonalisation first rather than emotional exhaustion. Also, males did not report a reduced sense of personal accomplishment at work, even though this is one of the three traditional components of burnout. This means that, as they burn out, male doctors feel growing depersonalisation and emotional exhaustion but they often still feel effective, capable and competent at work - which is typically not the case for female doctors.

High suicide rates

In 2005, Eva Schernhammer of Harvard Medical School argued that there are stark differences in the psychological demands on female doctors, compared with males. Her review of 25 studies found that the female doctor suicide rate was about 130% higher than women in the general population.

In contrast, the suicide rate among male doctors is 40% higher than the suicide rate of males in the general population. Schernhammer concluded that the stress and burnout experienced by female doctors combines with other risk factors to contribute to high rates of psychiatric illness and suicide, compared with male doctors.

The additional risks include greater demands and expectations related to their family life, trying to succeed in a historically male-dominated profession, and experiencing sexual harassment at work. The influence of gender expectations on women’s suicide has a long history of being overlooked or ignored.

Gender expectations

When female doctors deliver more empathetic care, it may reflect our social expectations of gender roles rather than something innate. These include the idea that women are better at empathising than men, and that women are nurturing or caring. Studies also show that patients have different expectations of female doctors than they do of male doctors. For example, patients assume female doctors are more compassionate.

The idea that men are less likely to be caring and empathetic has possible benefits for male doctors. When male doctors show empathy, it can be an unexpected bonus for the patient, and so the doctor might seem better than anticipated. For example, male medical students with a good bedside manner are rated as more competent than female medical students who have a similarly good bedside manner. It seems that the females are simply expected to be more patient-centered and empathetic.

The disadvantages of these expectations for female doctors is that they are expected to do more “emotion work” than males. A study of more than 7,000 doctors found that female doctors were more likely to feel emotionally exhausted by work. They also felt that their work negatively affected their personal life, and they felt less valued by patients, colleagues and superiors, compared with male doctors.

Different expectations of doctors’ empathy based on their gender makes the job and workplace conditions unequal for doctors. And this appears to be a global phenomenon. Female doctors in Finland, South Africa and China all report higher levels of emotional exhaustion than male doctors. These results support the idea that female doctors’ jobs can be emotionally depleting for them and contributes to their increased risk of burnout.

We need to recognise that doctors face different expectations about empathetic care, depending on their gender. The emotional demands on female doctors puts them at increased risk of poor mental health. Regardless of gender, medical students and doctors should be provided with training that helps them navigate and sensitively address unequal experiences and expectations of delivering empathetic care.

 

Rajvinder Samra, Lecturer in Health, The Open University

This article was originally published on The Conversation. Read the original article.

Browse articles by author

More Essays

Jul 4th 2020
EXTRACT: "--- Nobody is more dangerous than he who imagines himself pure in heart, for his purity, by definition, is unassailable. --- Author James Baldwin’s words, written in the America of the late 1950s."
Jun 29th 2020
EXTRACT: "Numerous studies have shown that children who grow up in more deprived neighbourhoods tend to have worse physical health as adults compared to those raised in more affluent areas. This is the case even when researchers take into account family income and education, and whether or not parents have major illnesses. In order to address this health disparity, researchers need to understand how those living in disadvantaged neighbourhoods end up with worse health outcomes. Our team’s latest study has highlighted one potential way your childhood neighbourhood may influence your health for years to come. It might do so through changing how the activity of your genes is regulated."
Jun 29th 2020
EXTRACT: "Ruth Poniarski is a painter and the author of Journey of the Self: Memoir of an Artist (Warren Publishing, 2020), in which she tells the story of her decade long struggle with mental illness, a “spiraling malady” which led her into a “pattern of psychosis”. I recently had the opportunity to talk with Poniarski about her life and work, and how she eventually overcame her demons."
Jun 27th 2020
EXTRACT: "I know I’m good in a couple of things, really good in a few things, and that’s enough. My confidence is big enough that I can really let people grow next to me, it’s no problem. I need experts around me. It’s really very important that you are empathetic, that you try to understand the people around you, and that you give real support to the people around you."
Jun 27th 2020
An essay about the "the enormously influential 1940 'Head of Christ' painting by evangelical Warner E. Sallman" pictured below.
Jun 17th 2020
EXTRACT: "The diverse, non-human life forms that live in our guts – known as our microbiome – are crucial to our health. A disrupted balance of these contribute to a range of disorders and diseases, including obesity, diabetes, inflammatory bowel disease. It could even affect our mental health..... It’s well known that the microbes living in our guts are altered through diet. For example, including dietary fibre and dairy products in our diets encourages the growth of beneficial bacteria. But mounting evidence suggests that exercise can also modify the types of bacteria that reside within our guts."
Jun 13th 2020
EXTRACT: "Bonhoeffer’s life holds an important lesson for us today, regardless of our religious affiliation or lack thereof. And simply put it is this: you are called upon; you are called on behalf of your neighbor. When you are called to be responsible that is not an obligation which you can decline, discharge or acquit yourself of – it is an infinite responsibility, a “forever commitment” as Charles Blow recently put it. And we all must be prepared to make any sacrifice necessary when we are called."
Jun 11th 2020
EXTRACT: "People differ substantially in how much they’re affected by experiences in their lives. Some people seem to be more affected by daily stress, or the loss of someone close to them. On the other hand, some people seem to get through the same experiences relatively unscathed. Similarly, some people benefit strongly from counselling, or having a support system of close family and friends. Others seem better able to manage on their own. But understanding why some people are more sensitive than others isn’t just a question of how they were raised, and the experiences they’ve been through. In fact, previous research has found that some people in general seem more sensitive to what they experience – and some are generally less sensitive."
Jun 7th 2020
EXTRACT: " The root causes of anthropogenic climate change – which has led to the endangering of countless species across the globe – cannot be adequately grasped in isolation from the technological application of modern science. While Swedish activist Greta Thunberg was certainly justified in calling upon American legislators to “unite behind the science,” neither can we overlook the culpability of science in bringing about the environmental crisis. "
May 23rd 2020
EXTRACT: "The QAnon movement began in 2017 after someone known only as Q posted a series of conspiracy theories about Trump on the internet forum 4chan. QAnon followers believe global elites are seeking to bring down Trump, whom they see as the world’s only hope to defeat the “deep state.” OKM is part of a network of independent congregations (or ekklesia) called Home Congregations Worldwide (HCW). The organization’s spiritual adviser is Mark Taylor, a self-proclaimed “Trump Prophet” and QAnon influencer with a large social media following on Twitter and YouTube."
May 23rd 2020
EXTRACT: "The aim of my research for the Understanding Unbelief programme was to investigate the worldviews of non-believers, since little is known about the diversity of these non-religious beliefs, and what psychological functions they serve. I wanted to explore the idea that while non-believers may not hold religious beliefs, they still hold distinct ontological, epistemological and ethical beliefs about reality, and the idea that these secular beliefs and worldviews provide the non-religious with equivalent sources of meaning, or similar coping mechanisms, as the supernatural beliefs of religious individuals."
May 22nd 2020
EXTRACT: "Psalm 91, for example, reassures believers that God will protect them from “the pestilence that walketh in darkness… A thousand shall fall at thy side, and ten thousand at thy right hand; but it shall not come nigh thee”.............Luther was a devout believer but insisted that religious faith had to be joined with practical, physical defences against sickness. It was a good Christian’s duty to work to keep themselves and others safe, rather than relying solely on the protection of God. "
May 22nd 2020
EXTRACT: "Evidence from this study shows clearly that eating foods rich in flavonoids over your lifetime is significantly linked to reducing Alzheimer’s disease risk. However, their consumption will be even more beneficial alongside other lifestyle changes, such as quitting smoking, managing a healthy weight and exercising."
May 5th 2020
EXTRACT: "It’s possible that the answers to questions like, “how do I live a virtuous life?” or “how do we build a good society?” are not the same as they were a few weeks ago."
May 2nd 2020
EXTRACT: "Strangely, those with strong beliefs tend to be admired. The human mind hates uncertainty, so it is comforting to be told what to think, and to form settled opinions. But it is not rational. As the philosopher Bertrand Russell wrote: “The fundamental cause of the trouble is that in the modern world the stupid are cocksure while the intelligent are full of doubt.”
Apr 21st 2020
Extract: "Humans, Boccaccio seems to be saying, can think of themselves as upstanding and moral – but unawares, they may show indifference to others. We see this in the 10 storytellers themselves: They make a pact to live virtuously in their well-appointed retreats. Yet while they pamper themselves, they indulge in some stories that illustrate brutality, betrayal and exploitation. Boccaccio wanted to challenge his readers, and make them think about their responsibilities to others. “The Decameron” raises the questions: How do the rich relate to the poor during times of widespread suffering? What is the value of a life? In our own pandemic, with millions unemployed due to a virus that has killed thousands, these issues are strikingly relevant.
Apr 20th 2020
Extract: "If we do not seize this crisis as a moment for transformation, then we will have lost the war. If doing so requires reviving notions of collective guilt and responsibility – including the admittedly uncomfortable view that every one of us is infinitely responsible, then so be it; as long we do not morally cop out by blaming some group as the true bearers of sin, guilt, and God’s heavy judgment. A pandemic clarifies the nature of action: that with our every act we answer to each other. In that light, we have a duty to seize this public crisis as an opportunity to reframe our mutual responsibility to one another and the world."
Apr 16th 2020
EXTRACT: "Death is the common experience which can make all members of the human race feel their common bonds and their common humanity."
Apr 7th 2020
EXTRACT: "A crisis such as this one demands that we exercise what the philosopher Immanuel Kant called the ‘public use of reason’ – as opposed to merely the ‘private use of reason’ where, briefly put, the expert, the specialist is tasked with resolving a defined problem. The private use of reason is sufficient when we are dealing with a problem that can be solved by simply applying the appropriate expertise...............The public use of reason asks: how we are defining the problem? Is our definition – our conceptualization of the problem – perhaps part of the problem itself? Is this pandemic solely a problem of public health, or is it also a problem of extreme economic inequality? ..............Since this crisis began, the greatest failure of the administration is not the denial, the lies, the lack of preparedness, but the inability to rally and unify the nation against this common threat, the lack of genuine leadership – Trump’s utter inability to bring the nation together."
Apr 5th 2020
EXTRACT: "Rarely has an architectural experiment aroused such extremes of ire and admiration. One side is convinced the house is a masterpiece. The other expresses brutal condemnation of the entire project (leaky roof, danger of flooding, too-hot, too-cold interiors depending on the American Midwest weather).........Farnsworth encapsulated her personal ambiguity in her comment to a Newsweek interviewer: “This handsome pavilion I own is almost totally unworkable.” She told one journalist, “ … all I got was this glib, false sophistication. The conception of a house as a glass cage suspended in air is ridiculous.”