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Interactions between patients and physicians: Why should we care about gender Issues?
Abstract
This article presents the major findings of research on medical interactions from a gender perspective. Male and female physicians give the same amount of medical informations to their patients, but male physicians discuss less the psychosocial aspects of the illness. Male physicians ask less medical and psychosocial questions, and patients provide them with less information. Female physicians adopt more partnership-behaviors and display more affiliative nonverbal behaviors. Patients behave less dominantly with male than with female physicians. Finally, male patients are given less signs of empathy and receive less information, whatever the gender of the physician.
Empathy is a powerful and necessary skill for understanding another person's subjective experience. In this study we wanted to explore psychiatrists' attitudes towards PTSD, general empathy, possible differences related to age, sex and regional location in Croatia.
205 psychiatrists from different Croatian regions participated in this study. To define psychiatrists' attitudes towards PTSD patients a questionnaire was devised. It contained 14 items related to psychiatrists' ability to live through emotional and social conditions of PTSD patients. BarOn Emotional Quotient-Inventory Empathy Subscale was used to measure the empathy among the subjects.
This study has found statistically significant differences regarding gender in measured variables of the designed questionnaire. Male participants believed they were able to understand war veterans' feeling's and relate to traumatic experience while female participants stated that they had the ability to understand the trivial triggers for suicidal intentions. Regional differences were found in the understanding of war traumatic experience and social deviations occurring in PTSD. Older psychiatrists stated their incomprehension of the social difficulties the PTSD patients were facing. The years of experience in the psychiatric field were associated with inability to understand the patients' feelings'. Differences in empathy among the subjects were not found.
The understanding of the empathic process in the therapeutic approach towards PTSD explored in this study was associated with basic variables such as gender and age but the construct of empathy itself is more complex and related with variables not assessed in this study, so our findings are preliminary and further research is needed.
In this article, we examined the effect of gender concordance on physicians' perception of their patients and of their medical condition, analyzing a data set of 8,258 visit questionnaires from the New Zealand National Primary Care Medical Care Survey conducted in 2001 2002. Multivariate analysis indicated that the concordant female patient/female physician dyad had a positive independent association with physicians' reporting high rapport and a negative independent association with reporting uncertainty about the diagnosis. The discordant female patient/male physician dyad had a positive independent association with physicians' perceptions of uncertainty of diagnosis and hidden agenda, and a negative independent association with rating the patient's condition of high severity. The findings suggest a need to raise male physicians' awareness to possible biases when treating female patients. The findings also suggest the need to empower female patients to take an active partnership role to improve their communication with male physicians.
This pair of studies sought to apply the explanatory calculus of expectancy theory to examine patient compliance and satisfaction with physicians’ instructions. Study 1 analyzed the differential expectations of patients based on gender of the physician. Results indicated that female physicians are expected to use instrumentally unaggressive strategies while male physicians are expected to use strategies that fall in the mid-range of a verbal aggression continuum. There were no differences in expectations based on the gender of patients. The second study manipulated physician communication and physician gender to predict an interaction such that when male physicians deviate from moderately aggressive, direction-giving strategies, using either more affiliative tactics or more instrumentally aggressive strategies, compliance increases. It was also predicted that affective satisfaction with male physicians would increase with increased use of affiliative, nonaggressive compliance-gaining messages. Based on expectancy theory, an inverse linear relationship between the use of instrumental verbal aggression and compliance and affective satisfaction was predicted for female physicians. Results supported the posited interaction. Implications for further refinement of expectancy theory are discussed, and practical implications for physician-patient communication in clinical situations are offered.
Patients' preferences for physicians of a particular sex tend to skew sex distributions of clinical populations in training and practice settings. A study was developed to explore these preferences and potential reasons for them. Of 185 adult patients surveyed at four family practice residency clinics, 45% expressed a preference for sex of physician; 43% of women and 12% of men preferred a female physician, while 31% of men and 9% of women preferred a male physician. Patients who stated no overall preference often expressed one in specific clinical situations, eg, anal or genital examinations. Patients who preferred female physicians reported humane behaviors as more characteristic of female physicians, and those who preferred male physicians reported humane behaviors as more characteristic of men; patients who had no overall sex preference did not sex stereotype physicians on these behaviors (F = 59.34, P less than .01). Patients who preferred male physicians reported technical competence behaviors as more characteristic of male physicians; others did not sex stereotype physicians on these behaviors (F = 15.4, P less than .01). Patients rated humaneness and comprehensiveness as being of high priority, but no relationship was found between priorities for aspects of care and preferences for sex of physician. Areas for future investigation include assessing preferences in other populations and exploring sex differences in physician behavior during office encounters and correlating these differences with patient satisfaction.
The role of common sense models of heart disease in the attribution of cardiac-related symptoms was examined in a sample of healthy young adults (N = 224). Participants were less likely to attribute symptoms to possible cardiac causes for female victims reporting stressful life events (M = 5.14) than for female victims without such stressors (M = 6.82) or for male victims with (M = 6.23) or without (M = 6.48) concurrent stressors. Cardiac attributions remained lowest for female/high-stress victims in additional samples of undergraduates (N = 194), community-residing adults (N = 48), and physicians (N = 45), although this outcome sometimes appeared to reflect additive, rather than interactive, effects. Two final experiments with undergraduate samples (Ns = 48 and 60, respectively) indicated that stereotypes associating heart disease with male gender may account for gender disparities in the attribution of cardiac-related symptoms.
Much research on gender differences in medicine has centered on women as better communicators, more egalitarian, more patient-centered, and more involved with psychosocial problems, preventive care, and female-specific problems. Hardly any research has examined the interaction between the doctor's gender and the patient's gender. The authors examined students' perceptions and comfort levels regarding patients' gender during consultation.
This cross-sectional study used a questionnaire to survey final-year medical students at one school in 1999. It tested students' patient-centeredness, "patient-care" values, and degree of comfort in performing certain intimate physical examinations.
Women students were more patient-centered than were men students. Both genders were more attuned to the concerns of patients of their own gender, were more comfortable with personal rather than sexual issues, and were more uncomfortable with performing more intimate examinations upon the opposite gender. Using comparable case studies, it was also shown that the female student-female patient dyad had significantly greater "patient-care" values than did the male student-male patient dyad.
Medical students did not behave in a gender-neutral way in the consultation. There is a powerful interaction between a student's gender and a patient's gender. This warrants further investigation in the real clinical situation because it has implications on the outcomes of the consultation.
Patient and physician gender may impact the process of medical care and its outcomes. Our objective was to investigate the influence of patient gender on what takes place during initial primary care visits while controlling for other variables previously demonstrated to affect the physician-patient interaction, such as physician gender and specialty, patient health status, pain, depression, obesity, age, education, and income.
New patients (315 women, 194 men) were randomized for care by 105 primary care physicians. Sociodemographic information, self-reported health status and pain measures, a depression evaluation, screening for alcoholism, history of tobacco use, and measured body mass index (BMI) were collected during a previsit interview. The entire medical visit was videotaped, and then analyzed using the Davis Observation Code (DOC) system.
There was no significant difference in the visit length or work intensity (number of behavioral codes) for female patients compared with male patients; however, women's visits had more discussions regarding the results of the therapeutic interventions, more preventive services, less physical examination, and fewer discussions about tobacco, alcohol, and other substance abuse.
There are significant differences in the process of care between female and male patients. Physicians may be making medical decisions based on gender-related considerations. Strategies for implementing knowledge about these gender differences are crucial for the delivery of gender-sensitive care.