Article

Roter DL, Hall JA, Aoki YPhysician gender effects in medical communication: a meta-analytic review. JAMA 288: 756-764

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2002; 288(6):756-64. DOI: 10.1001/jama.288.6.756
Source: PubMed

ABSTRACT

Physician gender has been viewed as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians facilitate more open and equal exchange and a different therapeutic milieu from that of male physicians. However, studies in this area are generally based on small samples, with conflicting results.
To systematically review and quantify the effect of physician gender on communication during medical visits.
Online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and Bioethics); a hand search was conducted of reprint files and the reference sections of review articles and other publications.
Studies using a communication data source, such as audiotape, videotape, or direct observation, and large national or regional studies in which physician report was used to establish length of visit, were identified through bibliographic and computerized searches. Twenty-three observational studies and 3 large physician-report studies reported in 29 publications met inclusion criteria and were rated.
The Cohen d was computed based on 2 reviewers' (J.A.H. and Y.A.) independent extraction of quantitative information from the publications. Study heterogeneity was tested using Q statistics and pooled effect sizes were computed using the appropriate effects model. The characteristics of the study populations were also extracted.
Female physicians engage in significantly more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. There were no gender differences evident in the amount, quality, or manner of biomedical information giving or social conversation. Medical visits with female physicians are, on average, 2 minutes (10%) longer than those with male physicians. Obstetrics and gynecology may present a different pattern than that of primary care, with male physicians demonstrating higher levels of emotionally focused talk than their female colleagues.
Female primary care physicians engage in more communication that can be considered patient centered and have longer visits than their male colleagues. Limited studies exist outside of primary care, and gender-related practice patterns in some subspecialties may differ from those evident in primary care.

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    • "And it is the GPs' job to respond to whatever does come through. Good communication skills and appropriate body language and demeanour are regarded as important aspects of professional competence, required for both effective medical care for individual patients and an orderly and efficient work flow (Roter et al. 2002, West 1984). Far from violence being a 'tool of [their] trade', GPs are expected to maintain a professional demeanour of emotional neutrality towards all their patients, and may be held to account for any failures to manage patients' or their own emotions, such as anger and fear, within consultations. "
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    ABSTRACT: This article focuses on the extent to which violence against family doctors in England is experienced in gendered terms. It draws on data from two studies: a postal survey of 1,300 general practitioners (GPs) (62% response rate) and in-depth interviews with 26 doctors who have been assaulted or threatened; and 13 focus groups with primary care teams and 19 in-depth interviews with GPs who had expressed an interest in the topic of violence against doctors. Most GPs, regardless of gender, reported receiving verbal abuse over the last two years, often interpreted as a consequence of declining deference to professionals, while actual physical assaults and threats were much rarer and more likely to be reported by men. Overall, women GPs were much more likely to express concern about violence and to take personal precautions, although younger male GPs working in inner-city practices also had high levels of concern. The study shows how some aspects of family doctors' work has been organised on gendered lines and how these contribute to the differences in experience of violence. We suggest that the increasing proportion of women among family doctors may have implications for these, often tacit, organisational routines.
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    • "This difference occurs for partnership and psychosocial orientation, positivity in verbal and nonverbal communication , accurate interpersonal perception, empathy, focus on feelings, verbal and nonverbal encouragement, good listening , expressions of respect or praise, and a focus on prevention (Hall, Irish, Roter, et al., 1994; Hall, Roter, Blanch, & Frankel, 2009; Lurie et al., 1993; Meeuwesen, Schaap, & Van der Staak, 1991; Mendez, Shymansky, & Wolraich, 1986; Roter, Hall, & Aoki, 2002; Roter, Lipkin, & Korsgaard, 1991; Wasserman et al., 1984; Zandbelt et al., 2006). Female physicians spend more time with patients than male physicians do (Roter et al., 2002), and they have more humanistic and patient-centered attitudes about patient care (Krupat et al., 2000). Furthermore, patients generally prefer a patient-centered style (Swenson et al., 2004). "
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    ABSTRACT: Previous research suggests that female physicians may not receive appropriate credit in patients' eyes for their patient-centered skills compared to their male counterparts. An experiment was conducted to determine whether a performance of higher (versus lower) verbal patient-centeredness would result in a greater difference in analogue patient satisfaction for male than female physicians. Two male and two female actors portrayed physicians speaking to a patient using high or low patient-centered scripts while not varying their nonverbal cues. One hundred ninety-two students served as analogue patients by assuming the patient role while watching one of the videos and rating their satisfaction and other evaluative responses to the physician. Greater verbal patient-centeredness had a stronger positive effect on satisfaction and evaluations for male than for female physicians. This pattern is consistent with the hypothesis that the different associations between patient-centeredness and patients' satisfaction for male versus female physicians occur because of the overlap between stereotypical female behavior and behaviors that comprise patient-centered medical care. If this is the case, high verbal patient-centered behavior by female physicians is not recognized as a marker of clinical competence, as it is for male physicians, but is rather seen as expected female behavior.
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    • "Several studies have shown that there is no significant evidence of interaction between the genders of the examinee and the SP [5]. However, some studies have shown that female SPs generated lower [7] [8] or higher scores [9] [10] [11] than male SPs do. Furthermore , a recent study showed that the sex of SPs might influence examinees' performance on the OSCE test, irrespective of the sex of the examinee [12]. "
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    ABSTRACT: Opinions on the interaction between the genders of standardized patients and examinees are controversial. Our study sought to determine the influence of gender on communication skills assessment in Eastern country. We recruited year 5 medical students from a medical college in Taiwan. They were assigned to obtain informed consent from either male or female age-matched standardized patients. Their performance was rated by standardized checklist rating scores and global rating scores. Either male or female examiners rated their performance. A total of 253 medical students (166 male students and 87 female students) were recruited. The checklist rating scores for students interacting with male standardized patients were significantly lower than the scores for interactions with female standardized patients (male examiners, P=0.006; female examiners, P=0.001). For male students, the checklist rating scores were significantly lower for male standardized patients than for female standardized patients (male examiners, P=0.006; female examiners, P=0.008). For male standardized patients, male students had significantly lower checklist rating scores than female students when rated by male examiners (P=0.044). The global rating scores were similar except when female students interacted with male and female SPs and when rated by female examiners (P=0.004). The gender of standardized patients influences communication skills assessment. In terms of checklist rating scores, female standardized patients seem preferable to minimize potential gender effects. In the best interest of students, global rating score may be preferable to checklist rating score, especially for male examinees. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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