Do patients talk differently to male and female physicians?: A meta-analytic review

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Abstract

A meta-analytic review was undertaken of seven observational studies which investigated the relation between physician gender and patient communication in medical visits. In five of the studies the physicians were in general practice, internal medicine, or family practice and were seeing general medical patients, and in two of the studies the physicians were in obstetrics–gynecology and were seeing women for obstetrical or gynecological care. Significant findings revealed that, overall, patients spoke more to female physicians than to male physicians, disclosed more biomedical and psychosocial information, and made more positive statements to female physicians. Patients also were rated as more assertive toward female physicians and tended to interrupt them more. Several results were weaker, or even reversed, in the two obstetrics–gynecology studies. Partnership statements were made significantly more often to female than male physicians in general medical visits but not in obstetrical-gynecological visits.

Introduction

Speculation that physicians’ communication may be a quality of care pathway has grown over the past decade and has enhanced the centrality of communication to research and training efforts [1], [2], [3]. Within the context of gender, disparities in patient referrals for major diagnostic and therapeutic interventions, as well as preventive services, have drawn attention to possible differences in the content of medical recommendations made to male versus female patients [4], [5]. More recently, however, quality of care markers have been broadened from the content of recommendations to the dynamics of the therapeutic relationship. In this regard, debate on whether female physicians provide a more intense therapeutic milieu with their patients than male physicians—one that would allow for more open exchange and collaboration, and ultimately more comprehensive diagnosis and treatment—has gained attention [6], [7], [8]. Much of our own investigation and interest in this area has been devoted to understanding how male and female physicians communicate, especially when with patients of the same or different gender [9], [10], [11].

One might argue that the traditional focus on physician communication fails to appreciate the influence of patients in shaping the doctor-patient relationship. In fact, discussions of gender effects in medical communication have virtually ignored the question of how patients behave toward male versus female physicians. We believe this is an important question, however, because it shifts a largely physician-centric view of communication to one that better appreciates the reciprocal and dynamic elements of both patient and physician in the medical interchange.

In the present article we address how patients behave toward male and female physicians based on the limited amount of published evidence that we were able to locate. In spite of the relatively small database, some clear findings emerge.

There are good reasons to expect that patients may behave differently toward male versus female physicians. First, there is evidence from non-clinical studies that people treat men and women differently in conversation; for example, people gaze and smile more at women than at men, approach women more closely, and self-disclose more to women [12], [13], [14]. Thus, women seem to be a different kind of stimulus than men are in social interaction and this may apply in the clinical situation as well.

Second, to the extent that male and female physicians communicate differently, one would expect reciprocal behavior patterns in patients [15], [16]. Behaviors such as gazing, smiling, posture, a variety of speech behaviors, and the emotional tone of one’s communication are typically reciprocated or matched in social interactions [14], [17], [18], [19]. For example, if your doctor’s voice sounds angry or anxious, yours will tend to sound that way too [17], and if someone smiles at you, you are likely to smile back [13], [20]. The reciprocation of affectively toned verbal and nonverbal behaviors is one of the chief mechanisms underlying the operation of interpersonal expectancy effects (self-fulfilling prophecies) in interpersonal interaction [21], [22]. Therefore, behavioral differences between male and female physicians could produce corresponding gender differences in patients’ behavior directed back at them.

It happens that there are, indeed, behavioral differences between male and female physicians. In a meta-analysis based on studies using objective observations, Roter et al. [11] determined that female physicians conducted longer visits than male physicians and engaged in significantly more active partnership behaviors, positive talk, psychosocial information giving and question asking, and emotionally focused talk. Female physicians also displayed more positive nonverbal behaviors than male physicians. These effects were especially notable in studies of general medicine practice (internal medicine and family practice) and were, interestingly, sometimes reversed in direction in the two available studies of physicians specializing in obstetrics–gynecology.

In the main, the differences between the communication styles of male and female physicians correspond well with gender differences in communication that are extensively documented in non-clinical populations. Compared to men, women have been shown to be more emotionally expressive in both words and nonverbal behavior, to engage in more positive and engaged nonverbal behaviors (such as smiling, nodding, and gazing at a partner in conversation), to engage in more self-disclosure, and to be more egalitarian in interpersonal relations [12], [14], [23], [24]. Thus, it appears that the selection and socialization processes impinging on male and female physicians are not strong enough to erase the pervasive effects of gender-role socialization. Because the communication behaviors exhibited more often by female physicians appear to be associated with positive patient effects in the form of satisfaction and clinical outcomes [25], [26], it has been speculated that female physicians create a more favorable therapeutic milieu than do male physicians [6]. By examining how patients behave with female versus male physicians, we can help to flesh out our understanding of how those milieus might differ. The reciprocity principle would lead us to expect that patients treat their male and female physicians in much the same way as they are treated by them, which is to say that patient behavior toward male versus female physicians should parallel how male and female physicians themselves behave.

Section snippets

Search procedure and criteria for study inclusion

To be included in the review, a study had to meet the following criteria: (1) involve physicians, physicians in training (interns or residents), or medical students; (2) measure communication using neutral observers (including simulated patients as observers), audiotape, or videotape; (3) test for an association between physician gender and at least one patient communication variable; (4) deal with non-psychiatric medical visits; and, (5) be published in an English-language book or journal.

Results

Altogether, seven studies reported quantitative results on the relation of physician gender to patient communication (A1–A7). An additional study [31] indicated that patient behavior was objectively measured and showed no physician effects; however, it was unclear exactly which patient behaviors were being referred to so this study is not included in the summaries that follow.

Discussion

Although based on a limited dataset, the present quantitative summary was able to detect several significant trends in the behavior of patients toward their male versus female physicians. Female physicians received more positive statements in all kinds of visits, but they received more talk overall, more biomedical and psychosocial information, and more partnership behaviors to a greater extent (or only) in routine medical visits as opposed to visits to obstetricians-gynecologists. Findings for

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