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Sheppard M, Johnson S, Quiroz V, Ward J. Differences in history-taking skills between male and female chiropractic student interns. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:151-156. [PMID: 37655805 PMCID: PMC11095650 DOI: 10.7899/jce-22-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 01/06/2023] [Accepted: 07/03/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE The purpose of this study was to determine if there was a difference in history-taking skills between male and female chiropractic student interns. METHODS This study included 2040 patient histories collected by student interns over a 3-year period. Students were assessed by chiropractic college clinicians on reasoning (ability to derive clinically relevant information using a mnemonic for taking a history), communication, and professionalism using a modified Dreyfus model scoring system on a 1-4 scale (1 = novice, 4 = proficient). Ordinal dependent variables were scores for reasoning, communication, and professionalism. The categorical independent variable was sex of the student intern (male or female). A Mann-Whitney U test was used to compare for differences in nonparametric dependent variables by the sex of the students. RESULTS The Mann-Whitney U test revealed that communication scores were greater for female chiropractic interns compared with male chiropractic interns (p < .001, with a small effect size (r = -.08). There was no statistically significant effect for sex on reasoning (p = .263) or professionalism (p = .098). CONCLUSION Female chiropractic student interns scored higher than male interns on communication skills during a history-taking patient encounter. This supports the trend seen among female medical school students and physicians that women score higher than men on communication-related assessments.
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AlFaifi JJ, Alrehaili RA, Alshammari SD, Alqurashi JHM, Alasmari HMA, Alhallafi AFS. Levels of Surgical Patients' Education Related to Surgical Interventions Among Patients in Saudi Arabia. Cureus 2023; 15:e42715. [PMID: 37654936 PMCID: PMC10466169 DOI: 10.7759/cureus.42715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Patient education and counseling should simplify and clarify the condition, surgery, postoperative care, and potential complications. This study aimed to determine the levels of surgical patients' education regarding surgical interventions among patients in Saudi Arabia. METHOD This was an online survey study that was conducted between January and May 2023 to determine the levels of surgical patients' education regarding surgical interventions among patients in Saudi Arabia. The study population was patients who underwent surgeries (elective and emergency) living in Saudi Arabia. The questionnaire tool used in this study was developed based on an extensive literature review in the field of patients' education regarding surgical interventions. Binary logistic regression analysis was used to identify predictors of satisfaction with the callouts and the surgeon-consultant's communication quality. RESULTS A total of 1360 participants were involved in this study. Around 40.5% of the participants reported that they met the surgeon after diagnosing and recommending the issue. Almost 70.0% of research participants reported that the consultant surgeon personally explained a diagnosis or strategy to attain it and the surgical technique, method, and purpose before signing the informed consent. The majority of study participants reported that the consulting surgeon or a member of his surgical team explained the stages of reaching a diagnosis and the steps he/she will take to diagnose their condition (83.2%), discussed the diagnosis with them and how certain they are of the diagnosis (88.1%), described the surgery clearly and simply (85.5%), informed them of alternatives to surgical intervention (63.1%), and discussed the entire postoperative treatment plan (81.8%), informed them of possible postoperative complications (79.6%), used additional callout during the discussion (81.3%), and spoke to them after the surgery and before they left the hospital (69.2%). After a conversation with their doctors, 36.3% of study participants said they did not require an outside source to understand the diagnosis, operation, probable problems, treatment plan, and follow-up. Discussion "Just talk," sketching, and pictograms were the most popular callouts during patient education, with 78.3%, 22.3%, and 17.9%, respectively. Saudi participants were more likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05). At the same time, participants who live in the Southern area were less likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05). CONCLUSION This study highlights the crucial role of surgeons in preoperative patient education as well as the significance of surgical team participation in this process. In order to increase patient knowledge, facilitate treatment decisions, and assure informed consent, it is necessary to establish guidelines and roles to improve surgeon-patient communication, increase patient and surgeon awareness, nurture patient concern expression, and encourage non-medical patient participation.
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Affiliation(s)
- Jubran Jaber AlFaifi
- Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Responding to patient requests for women obstetrician-gynecologists. Am J Obstet Gynecol 2022; 226:678-682. [PMID: 34762865 DOI: 10.1016/j.ajog.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022]
Abstract
Patients may request care from a woman obstetrician-gynecologist for various reasons, including privacy concerns, religious or cultural reasons, and in some cases, a history of abuse. They should be given the opportunity to voice their reasons for requesting a woman obstetrician-gynecologist but should not be compelled to do so. Respect for patient autonomy is a compelling reason to consider honoring a patient's gender-based request. When a patient requests a woman obstetrician-gynecologist, efforts should be made to accommodate the request if possible. However, medical professionals and institutions are not ethically obligated to have a woman obstetrician-gynecologist on call or to make one available at all times. If it is not feasible for a woman obstetrician-gynecologist to provide care because of staffing or other system constraints or patient safety concerns, accommodation is not required, and physicians do not have an overriding responsibility to ensure that patients receive gender-concordant care. Patients have the right to decline care and may choose to seek care elsewhere if their requested healthcare provider type is not available. Institutions and medical clinics should have policies and procedures in place for managing patient requests for women obstetrician-gynecologists, and patients should be made aware of these policies preemptively. These policies and procedures should include information about whom to contact for assistance and how to document the encounter. They should also be accessible and familiar to physicians and trainees. Care should be taken to ensure that adequate educational opportunities in obstetrics and gynecology are available for all medical trainees, regardless of gender.
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Rossi E. The Social Construction of Gender in Medical Interactions: A Case for the Perpetuation of Stereotypes? HEALTH COMMUNICATION 2021; 36:1125-1135. [PMID: 32172595 DOI: 10.1080/10410236.2020.1735698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper focuses on the ways in which gender, conceived as the product of an ongoing social and cultural construction in and through communication processes, is accomplished during medical encounters and through the narratives produced within these interactions. The main objective is to examine: (1) when and by what devices gender becomes interactionally relevant; (2) the participants' narratives on 'gender issues'; (3) the interplay between the narratives produced and the forms of communication created, also considering which form may be more effective in challenging gender stereotypes and bias. Data are drawn from a corpus of self-administered audio-recorded interactions between a female gynecologist/midwife and pregnant patients. The consultations (half of them mediated, half not) took place in a city of North Italy; the patients (sometimes accompanied by the husband) are migrant women from North and West Africa. The main results show that: (1) at each stage of the examinations, an orientation to gender emerges, mainly through questions that display categorizations, category-bound activities, and cultural assumptions about gender: when referred to the patient, these devices often reproduce the traditional cultural model of femininity and, connected to this, the 'normal' (heterosexual and stable) intimate relationship as socially expected; (2) medical dialogue as patient-centered approach is the most recurrent form of interaction and often leads to a co-construction of narratives in which personal uniqueness is more relevant than gender roles, expectations, and stereotyped representations; when husbands are involved, however, the interactions seem to shift toward doctor-centered forms of communication, and this usually leads to asymmetrical and directive constructions of narratives about differentiated and traditional gender roles.
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Affiliation(s)
- Elisa Rossi
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia
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Mishra A, Read SH, Rochon PA. Influence of Physician Sex and Gender on Prescribing Practices Among Older Adults. J Am Geriatr Soc 2020; 68:2764-2767. [PMID: 33047303 DOI: 10.1111/jgs.16851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 01/24/2023]
Abstract
Although prescribing is the most common intervention provided by physicians, limited research has examined the role of physician sex and gender on prescribing practices. In this article, we briefly summarize research relating to differences in prescribing behaviors based on physician sex and gender. To identify articles, PubMed was searched for studies from the last 20 years reporting on prescribing differences by physician sex or gender for the general population and specifically for older adults. We describe major themes emerging from the studies, illustrate findings from key studies, and note the major gaps in the literature, notably the lack of evidence on prescribing for older adults. Given the paucity of research in this area, we also explore evidence on the impact of physician sex and gender on other aspects of healthcare delivery, such as communication within the patient-physician relationship, and consider how these findings may also apply to prescribing behaviors. In general, we note that female physicians have been observed to engage in more careful and conservative healthcare provision including prescribing. A careful and conservative approach to prescribing may reduce the incidence of adverse drug events in older adults and be linked to a more patient-centered approach to care. To what extent these differences in prescribing are important for patient health outcomes is unknown, and further research is required to identify optimal prescribing practices that minimize harms.
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Affiliation(s)
- Anamika Mishra
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Western University, London, Ontario, Canada
| | - Stephanie H Read
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Paula A Rochon
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hajebrahimi S, Janati A, Arab-Zozani M, Sokhanvar M, Haghgoshayie E, Siraneh Y, Bahadori M, Hasanpoor E. Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-05-2019-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeVisit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries.Design/methodology/approachMEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0.FindingsOf 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8,I2=81.27,p=0.891) and patients’ gender (Q=55.98, df=11,I2=80.35,p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5,I2=87.88,p=0.170).Originality/valueIn this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.
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Bateman LB, White ML, Tofil NM, Clair JM, Needham BL. A Qualitative Examination of Physician Gender and Parental Status in Pediatric End-of-Life Communication. HEALTH COMMUNICATION 2017; 32:903-909. [PMID: 27436067 DOI: 10.1080/10410236.2016.1196412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this study we utilized the framework of patient-centered communication to explore the influence of physician gender and physician parental status on (1) physician-parent communication and (2) care of pediatric patients at the end of life (EOL). The findings presented here emerged from a larger qualitative study that explored physician narratives surrounding pediatric EOL communication. The current study includes 17 pediatric critical care and pediatric emergency medicine physician participants who completed narrative interviews between March and October 2012 to discuss how their backgrounds influenced their approaches to pediatric EOL communication. Between April and June of 2013, participants completed a second round of narrative interviews to discuss topics generated out of the first round of interviews. We used grounded theory to inform the design and analysis of the study. Findings indicated that physician gender is related to pediatric EOL communication and care in two primary ways: (1) the level of physician emotional distress and (2) the way physicians perceive the influence of gender on communication. Additionally, parental status emerged as an important theme as it related to EOL decision-making and communication, emotional distress, and empathy. Although physicians reported experiencing more emotional distress related to interacting with patients at the EOL after they became parents, they also felt that they were better able to show empathy to parents of their patients.
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Affiliation(s)
- Lori Brand Bateman
- a Division of Preventive Medicine , University of Alabama at Birmingham School of Medicine
| | - Marjorie Lee White
- b Department of Pediatrics , University of Alabama at Birmingham School of Medicine
| | - Nancy M Tofil
- b Department of Pediatrics , University of Alabama at Birmingham School of Medicine
| | | | - Belinda L Needham
- d Department of Epidemiology , University of Michigan School of Public Health
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Jefferson L, Bloor K, Hewitt C. The effect of physician gender on length of patient consultations: observational findings from the UK hospital setting and synthesis with existing studies. J R Soc Med 2015; 108:136-41. [PMID: 25567769 DOI: 10.1177/0141076814558522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the effect of physician gender on consultation length in UK hospital outpatient clinics and compare this, through meta-analysis, with previous studies outside the UK. DESIGN Observational data on clinic times were analysed and findings were combined in a meta-analysis with existing studies investigating the effect of physician gender on consultation length. SETTING UK hospital practice. PARTICIPANTS A total of 174 observations of outpatient consultations with 10 hospital specialists (consultants) from different specialties in two UK hospital trusts. MAIN OUTCOME MEASURES Clinic times were recorded and analysis of consultation length was undertaken with physician gender as a covariate. Data were then synthesised through meta-analysis with 10 existing studies in this field. RESULTS No statistically significant difference was found in the length of consultations for male and female doctors in these UK hospital settings. When pooled with existing studies, consultations with women doctors were found to be approximately two minutes longer than with men (p = 0.01). CONCLUSIONS Findings from this analysis of clinic consultations in the UK National Health Service do not support previous studies, which were undertaken predominantly in North America and primary care settings. Overall, meta-analysis suggests doctors' gender may influence consultation length. Gender differences in communication should be considered in training clinicians and in overall clinical practice.
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Affiliation(s)
- Laura Jefferson
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, YO10 5DD, UK
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Jefferson L, Bloor K, Spilsbury K. Exploring gender differences in the working lives of UK hospital consultants. J R Soc Med 2015; 108:184-91. [PMID: 25567767 DOI: 10.1177/0141076814558523] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Internationally, increasing numbers of women are practising medicine. Gender differences in doctors' working hours, specialty choices and communication styles are well documented, but studies often neglect contextual factors such as the role of socialised gender expectations on behaviours in the workplace and the medical profession. These may be important as recent studies have reported gender differences in doctors' activity rates that cannot be explained by specialty or contracted hours, suggesting other sources of variation. This study sought to explore the working lives of hospital doctors and how their work is negotiated according to gender and context. DESIGN Gender differences in the day-to-day work of hospital specialists (consultants) in the NHS were investigated using a qualitative approach, including observation and interview methods. Data were analysed inductively using qualitative observation and interview methods. SETTING Two NHS hospital trusts in England. PARTICIPANTS Data were collected from 13 participants working in a variety of specialties and in a range of clinical and non-clinical settings. MAIN OUTCOME MEASURES Various behaviours, attitudes and experiences were explored, such as doctor-patient communication, interactions with colleagues and workload. RESULTS Influences at both individual and situational levels, appear to affect differentially the work of male and female doctors. Female consultants described awareness of the impact of behaviours on relationships with colleagues, and their interactions appeared to be more carefully performed. Nurses and other colleagues tend to demonstrate less cooperation with female consultants. Gender differences also exist in patient communication, feelings of work-family conflict and barriers to career progression. CONCLUSIONS These variations in hospital consultants' work may have implications for both the quantity and quality of care provided by male and female consultants. This is timely and of importance to the medical workforce as the gender composition approaches parity.
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Affiliation(s)
- Laura Jefferson
- Department of Health Sciences, University of York, York Trials Unit, University of York, York YO10 5DD, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York Trials Unit, University of York, York YO10 5DD, UK
| | - Karen Spilsbury
- Department of Health Sciences, University of York, York Trials Unit, University of York, York YO10 5DD, UK
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Levinson W, Hudak P, Tricco AC. A systematic review of surgeon-patient communication: strengths and opportunities for improvement. PATIENT EDUCATION AND COUNSELING 2013; 93:3-17. [PMID: 23867446 DOI: 10.1016/j.pec.2013.03.023] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/06/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Effective communication is critical to patient satisfaction, outcomes of care and malpractice prevention. Surgeons need particularly effective communication skills to discuss complicated procedures and help patients make informed choices. We conducted a systematic review of the literature on surgeon-patient communication. METHODS Searches were conducted in MEDLINE, PsycINFO, and Sociological Abstract. Two reviewers screened citations and full-text articles. Quality was appraised using the Critical Appraisal Skills Program tool. Studies were categorized into content of communication, patient satisfaction, relationship of communication to malpractice, and duration of visits. RESULTS 2794 citations and 74 full-text articles, 21 studies and 13 companion reports were included. Surgeons spent the majority of their time educating patients and helping them to make choices. Surgeons were generally thorough in providing details about surgical conditions and treatments. Surgeons often did not explore the emotions or concerns of patients. Potential areas of improvement included discussing some elements of informed decision making, and expressing empathy. CONCLUSION Surgeons can enhance their communication skills, particularly in areas of relative deficiency. Studies in primary care demonstrate communication programs are effective in teaching these skills. PRACTICE IMPLICATIONS These can be adapted to surgical training and ultimately lead to improved outcomes and satisfaction with care.
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Affiliation(s)
- Wendy Levinson
- Department of Medicine, University of Toronto, Toronto, Canada.
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Ports KA, Reddy DM, Barnack-Tavlaris JL. Sex differences in health care provider communication during genital herpes care and patients' health outcomes. JOURNAL OF HEALTH COMMUNICATION 2013; 18:1436-1448. [PMID: 24015854 DOI: 10.1080/10810730.2013.798377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.
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Affiliation(s)
- Katie A Ports
- a Department of Social and Behavioral Health , Virginia Commonwealth University , Richmond , Virginia , USA
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Jefferson L, Bloor K, Birks Y, Hewitt C, Bland M. Effect of physicians’ gender on communication and consultation length: a systematic review and meta-analysis. J Health Serv Res Policy 2013; 18:242-8. [DOI: 10.1177/1355819613486465] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Physician gender may be a source of differences in communication between physicians and their patients, which may in turn contribute to patient satisfaction and other outcomes. Our aim was to review systematically research on gender differences in the length, style and content of communication with patients. Methods Seven electronic databases were searched from inception to September 2010 with no language restrictions (included MEDLINE; PsychINFO; EMBASE; CINAHL; Health Management Information Consortium; Web of Science; and ASSIA). ‘Grey’ literature was also searched. Data extraction and quality assessment was carried out in accordance with Cochrane Collaboration guidelines by at least two reviewers. The review uses mainly narrative synthesis due to the heterogeneous nature of the studies, with only data on consultation length being pooled in a random effects generic inverse variance meta-analysis. Results Searches yielded 6412 articles, of which 33 studies fulfilled the inclusion criteria. Studies were heterogenous and of mixed quality. Conflicting results are reported for many communication variables. There is some evidence that female physicians adopt a more partnership building style and spend on average 2.24 min longer with patients per consultation (95% CI 0.62–3.86) than their male colleagues. Conclusions Greater patient engagement by female doctors may reflect a more patient-centred approach, but their longer consultation times will limit the number of consultations they can provide. This has implications for planning and managing services.
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Affiliation(s)
- Laura Jefferson
- Research Fellow, Department of Health Sciences, University of York, UK
| | - Karen Bloor
- Professor of Health Economics and Policy, Department of Health Sciences, University of York, UK
| | - Yvonne Birks
- Senior Research Fellow, Department of Health Sciences, University of York, UK
| | - Catherine Hewitt
- Senior Research Fellow, Department of Health Sciences, University of York, UK
| | - Martin Bland
- Professor of Health Statistics, Department of Health Sciences, University of York, UK
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Schweizer A, Bruchez C, Santiago-Delefosse M. Integrating sexuality into gynaecological consultations: gynaecologists' perspectives. CULTURE, HEALTH & SEXUALITY 2012; 15:175-190. [PMID: 23210486 DOI: 10.1080/13691058.2012.746396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There are currently few studies exploring doctors' personal perspectives on integrating sexuality into medical consultations. This study focuses on the views of gynaecologists on introducing, or not introducing, sexuality into their work. A total of 30 semi-structured interviews were conducted with gynaecologists in the French-speaking part of Switzerland. The thematic content analysis and computer-assisted lexical analysis (Alceste) on the interview transcripts highlighted four categories: perceptions and description of sexuality, patient's sexological history, training in sexology and perceived difficulties. It is observed that, above all, the 'medical dimension' characterises gynaecologists' perceptions. Of greater interest is our observation of disparities in gynaecologists' discussion of their practice, which is often the product of lay knowledge based on common sense and/or personal experience. Finally, the decision to integrate questions relating to sexuality seems to depend on non-medical factors such as the personal experience, interest or gender of the doctor.
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Affiliation(s)
- Angélick Schweizer
- Research Centre for Health Psychology, University of Lausanne, Lausanne, Switzerland.
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Janssen SM, Lagro-Janssen ALM. Physician's gender, communication style, patient preferences and patient satisfaction in gynecology and obstetrics: a systematic review. PATIENT EDUCATION AND COUNSELING 2012; 89:221-6. [PMID: 22819711 DOI: 10.1016/j.pec.2012.06.034] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 06/24/2012] [Accepted: 06/25/2012] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Review of studies published in the last 10 years about women seeking gynecological- or obstetrical care and physician's gender in relation to patient preferences, differences in communication style and patient satisfaction. METHODS Studies were identified by searching the online databases PubMed, PsycINFO, Embase and the Cochrane Library. The search strategies 'gender'; 'obstetrics' and 'gynecology' were combined with 'communication'; 'physician-patient relations'; 'patient preference' and 'patient satisfaction'. RESULTS After screening title and abstract, evaluating full text and quality assessment, 9 articles were included in this review. Most patients preferred a female rather than a male gynecologist-obstetrician. This was partly explained by a more patient-centered communication style used by female gynecologists-obstetricians. Also experience and clinical competence were important factors in choosing a gynecologist-obstetrician. It was not clear whether patient's age or ethnicity influenced patients gender preference. Patient satisfaction increased when gynecologists-obstetricians used a patient-centered communication style. CONCLUSION 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. PRACTICE IMPLICATIONS To increase patient satisfaction, gynecologists-obstetricians should learn to integrate patient-centered communication style into the consultation.
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Affiliation(s)
- Sabine M Janssen
- Department of Primary Care and Community Care, Radboud University Nijmegen, Nijmegen, Netherlands
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Ueeck BA, Assael LA. Perioperative management of the female and gravid patient. Oral Maxillofac Surg Clin North Am 2009; 18:195-202, vi. [PMID: 18088823 DOI: 10.1016/j.coms.2005.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Care of female and gravid patients requires a detailed understanding of the unique issues inherent to quality treatment. Increasingly important data continue to accumulate about significant differences in the physiology of men and women and the way they express disease. Furthermore, the gravid patient requires specific alterations and considerations in clinical care that not only affect the mother but also the fetus. This article focuses on key elements that the treating surgeon should consider.
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Affiliation(s)
- Brett A Ueeck
- Department of Oral and Maxillofacial Surgery, Oregon Health and Sciences University, 611 SW Campus Drive, Portland, OR 97239, USA.
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Sandhu H, Adams A, Singleton L, Clark-Carter D, Kidd J. The impact of gender dyads on doctor-patient communication: a systematic review. PATIENT EDUCATION AND COUNSELING 2009; 76:348-355. [PMID: 19647969 DOI: 10.1016/j.pec.2009.07.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 07/07/2009] [Accepted: 07/08/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Systematic review of evidence about the impact of gender dyads on clinician-patient communication. METHODS Search of Medline, CINAHL and PsychINFO (1960-2007) and the British Library of grey literature, and hand searching of Patient Education and Counselling and Social Science and Medicine (2005-2007), returning 648 articles. Ten studies met all inclusion criteria. RESULTS Gender dyads influenced the patient agendas elicited, talk content, communication style, non-verbal communication, the exhibition of power, and consultation length. Consultation length was studied and affected by gender dyads more frequently than any other phenomenon. Distinctive differences between the dyads were identified, largely as expected, but with some surprises. For example, female/female dyads were the most patient-centred, and had longer consultations containing the most talk. However they also contained the most bio-medical talk. CONCLUSION The evidence base is small, and a more rigorous approach to reporting quality indicators is needed. However, observed dyad differences may provide different opportunities for effective communication and clinical outcomes for patients. Further research with a primary focus on gender dyad effects is needed to test this. PRACTICE IMPLICATIONS Findings have implications for policy, healthcare organisations, and individual doctors alike, raising awareness about workforce issues and communication skills training needs in particular.
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Affiliation(s)
- Harbinder Sandhu
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
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Christen RN, Alder J, Bitzer J. Gender differences in physicians' communicative skills and their influence on patient satisfaction in gynaecological outpatient consultations. Soc Sci Med 2008; 66:1474-83. [DOI: 10.1016/j.socscimed.2007.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Indexed: 10/22/2022]
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Bensing JM, Tromp F, van Dulmen S, van den Brink-Muinen A, Verheul W, Schellevis F. De zakelijke huisarts en de niet-mondige patiënt: veranderingen in communicatie. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/bf03086628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Schnatz PF, Murphy JL, O’Sullivan DM, Sorosky JI. Patient choice: comparing criteria for selecting an obstetrician-gynecologist based on image, gender, and professional attributes. Am J Obstet Gynecol 2007; 197:548.e1-7. [PMID: 17980206 DOI: 10.1016/j.ajog.2007.07.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 05/30/2007] [Accepted: 07/23/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to compare gender, humanistic qualities or technical competence (HQTC), and age when an obstetrician-gynecologist is selected. STUDY DESIGN Participants saw photographs (2 women, 2 men) without descriptors then the same photographs with descriptors. To test whether HQTC were more important than gender, the men in the photographs were given HQTC descriptors. Female patients, visitors, and staff at Hartford Hospital along with community and outpatient sites were recruited. Demographic information was collected. RESULTS From 901 participants, 83% chose a woman, 59% of whom selected gender or age as the reason. Single and younger patients were more likely to choose female and younger providers, respectively. With descriptors, 62% of the women chose a male provider. A significant number chose a different gender provider (P < .001) and made their selection for a different reason (P < .001). CONCLUSION More women chose a female provider when no additional information is known. A significant number changed their selection when male providers were described with HQTC.
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Alder J, Christen R, Zemp E, Bitzer J. Communication skills training in obstetrics and gynaecology: whom should we train? A randomized controlled trial. Arch Gynecol Obstet 2007; 276:605-12. [PMID: 17576587 DOI: 10.1007/s00404-007-0399-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 05/29/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether patient-physician communication in obstetrics and gynaecology can be improved by a training program and to investigate if physicians with poorer performance before the training show greater improvement in communication skills scores over the course of the study. DESIGN Intervention study with randomisation in training (n = 16) and control group (n = 16) and patient satisfaction and communication skills of physicians as outcome variables. Physicians' communication skills were assessed by independent raters using a standardised evaluation instrument (adapted version of the MAAS-R) to analyse video recorded interviews before and after the training. Patient satisfaction was assessed with a patient satisfaction questionnaire. RESULTS Using general linear model (GLM) for repeated measures no group x time interaction nor time effects were found for physicians' communication skills. No group x time interaction was found for patients' satisfaction scores; however the significant time effect was mostly attributable to positive changes in patients' rating of the training group. Physicians with poorer performance at the beginning showed greater improvements over the course of the study, especially in the training group. CONCLUSIONS In this randomized controlled trial marginal intervention effects for the improvement of communication skills and only partial changes in patient satisfaction scores from pre to post training were shown. However, physicians with poorer performance at the beginning showed greater improvements, suggesting that competence levels were already relatively high at the beginning of the study. Also, formation of communication training groups should be based on specific skill deficits rather than being implemented unspecifically for an entire team of physicians.
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Affiliation(s)
- Judith Alder
- University Women's Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Cox ED, Smith MA, Brown RL, Fitzpatrick MA. Effect of gender and visit length on participation in pediatric visits. PATIENT EDUCATION AND COUNSELING 2007; 65:320-8. [PMID: 17011738 DOI: 10.1016/j.pec.2006.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 07/27/2006] [Accepted: 08/26/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To examine the effect of child, physician and parent genders as well as visit length on participation. METHODS We analyzed videotapes and sociodemographics from 100 pediatric visits. Using the Roter Interaction Analysis System, coded utterances were aggregated to reflect key visit tasks: information giving, information gathering and relationship building. Negative binomial models were used to analyze how participation was associated with participants' genders and visit length. RESULTS After adjustment, girls did twice as much relationship building as boys (incidence rate ratio = 2.33, 95% confidence interval = 1.01-5.36) and their physicians did 34% more information gathering (1.34, 1.16-1.55). Female physicians did 29% less information giving (0.71, 0.54-0.94). Having the father accompany the child reduced child relationship building 76% (0.24, 0.08-0.69) and reduced physician information giving 14% (0.86, 0.75-0.995), compared to having mother accompany. After adjusting for participants' genders, longer visits were associated with more participation for all participants. CONCLUSION Child participation was impacted by child gender and by the accompanying parent's gender as well as the visit length. PRACTICE IMPLICATIONS Because gender-based patterns of participation are evident in childhood, interventions to facilitate participation might begin early in life. To improve participation, interventions might include advocating for policies to support longer visit lengths.
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Affiliation(s)
- Elizabeth D Cox
- Center for Women's Health Research, University of Wisconsin School of Medicine and Public Health, WI, United States
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Tschudin S, Sibil T, Alder J, Judith A, Bitzer J, Johannes B, Merki GS, Susanne MG. Contraceptive counseling by gynecologists--which issues are discussed and does gender play a role? J Psychosom Obstet Gynaecol 2007; 28:13-9. [PMID: 17454510 DOI: 10.1080/01674820601096120] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Explorative pilot study with the aim of gaining insight into the contraceptive counseling practices and possible gender differences of a selected group of male and female gynecologists. DESIGN Semi-structured telephone-interviews of 48 gynecologists concerning the content and strategies of their contraceptive counseling with special focus on aspects relevant to patient adherence. RESULTS Male and female gynecologists inform equally frequently about various methods and reproductive health aspects such as risks, the advantages and disadvantages of the methods and side effects. Male physicians speak more often about the efficiency and benefits of the methods, while their female colleagues emphasize STI and emergency contraception. Sexual health aspects were seldom mentioned as issues of discussion. For the choice of a contraceptive method efficiency was considered very important by 100%, reversibility by 83%, side effects by 85% and convenience by 79%. Naturalness and costs were more often quoted as important by female, and benefits by male gynecologists. Side effects are considered the most important factor for patient adherence by 60%, counseling and information is predominantly cited by female, and patient's character and personality by male doctors. CONCLUSIONS While contraceptive counseling by practising gynecologists includes basic information about available methods and their efficiency, as well as some reproductive health issues, sexual health issues are often neglected. Gender differences occasionally influence the choice of the topics as well as the attitude towards the patient.
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Kilminster S, Downes J, Gough B, Murdoch-Eaton D, Roberts T. Women in medicine--is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine. MEDICAL EDUCATION 2007; 41:39-49. [PMID: 17209891 DOI: 10.1111/j.1365-2929.2006.02645.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession. AIMS The purpose of this review was to explore the evidence, issues and explanations to understand the effects of the changing composition of the medical profession. CONCLUSIONS This review identified evidence that delineates some of the effects of gender on the culture, practice and organisation of medicine. There are problems with some of the research methodologies and we identify areas for further research. To understand the effects of the changing gender composition of medicine it will be necessary to use more sophisticated research designs to explore the structural, economic, historical and social contexts that interact to produce medical culture. This will provide a basis for exploring the impact and implications of these changes and has immediate relevance for workforce planning and understanding both the changing nature of health professions' education and health care delivery.
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Affiliation(s)
- Sue Kilminster
- Medical Education Unit, School of Medicine, University of Leeds, Leeds, UK.
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Bensing JM, Tromp F, van Dulmen S, van den Brink-Muinen A, Verheul W, Schellevis FG. Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients. BMC FAMILY PRACTICE 2006; 7:62. [PMID: 17064407 PMCID: PMC1630692 DOI: 10.1186/1471-2296-7-62] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 10/25/2006] [Indexed: 12/30/2022]
Abstract
Background Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002. Methods A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques. Results No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier. Conclusion The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries.
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Affiliation(s)
- Jozien M Bensing
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
- Utrecht University, Department of Health Psychology, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Fred Tromp
- Utrecht Medical Center St. Radboud, Department of Postgraduate Training for General Practice, PO Box 9120, 6500 HB Nijmegen, The Netherlands
| | - Sandra van Dulmen
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Atie van den Brink-Muinen
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
| | - William Verheul
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
| | - François G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
- VU, University Medical Centre, Department of General Practice, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands
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El-Kak F, Jurdi R, Kaddour A, Zurayk H. Gender and sexual health in clinical practice in Lebanon. Int J Gynaecol Obstet 2005; 87:260-6. [PMID: 15548405 PMCID: PMC1457111 DOI: 10.1016/j.ijgo.2004.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 08/09/2004] [Accepted: 08/13/2004] [Indexed: 10/26/2022]
Abstract
This study examines the readiness of obstetricians/gynecologists (Ob/Gyns) in Lebanon to provide sexual consultation, their degree of comfort when discussing issues of sexual health, and their attitudes regarding assessment, treatment, and referral. Data on these concepts were collected through face-to-face interviews with 286 randomly selected Ob/Gyns. Most Ob/Gyns reported feeling comfortable discussing sexuality during consultations, which they attributed much more to professional experience than to training. Most Ob/Gyns reported giving proper time for management of sexual health issues and follow-up, as these issues are brought up frequently by their women clients. However, results suggest that only one-third (31%) of Lebanese Ob/Gyns nearly always take the initiative in asking patients about their sexual health. Moreover, almost 45% of participating Ob/Gyns did not recognize a strong relationship between reproductive health and sexual functioning. Gender was not found to be an important predictor for any of the indicators measured in the present study. Ob/Gyns in Lebanon are significant consultants on various sexual issues, and they need better postgraduate training, continuing medical education, and access to medical congress resources on the topic of sexuality and its relationship to reproductive health.
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Affiliation(s)
- F El-Kak
- Department of Health Education and Behavior, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Kindler CH, Szirt L, Sommer D, Häusler R, Langewitz W. A quantitative analysis of anaesthetist-patient communication during the pre-operative visit. Anaesthesia 2005; 60:53-9. [PMID: 15601273 DOI: 10.1111/j.1365-2044.2004.03995.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Previous communication research in general medical practice has shown that effective communication enhances patient compliance, satisfaction and medical outcome. It is expected that communication is equally important in anaesthesia, since patients often suffer from anxiety and lack of knowledge about anaesthetic procedures. However, little is known about the nature of communication during routine anaesthetic visits. The present study of 57 authentic anaesthetic visits provides the first results on the structure and content of communication in the pre-operative setting using the Roter Interaction Analysis System (RIAS). Patient-centred communication behaviours of anaesthetists and the extent of patient involvement were particularly investigated. From the 57 pre-operative visits, 18 267 utterances were coded. The mean (SD) [range] duration of the visit was 16.1 (7.8) [3.7-42.7] min. Anaesthetists provided 169 (68) and patients 153 (82) utterances per visit (53.5% vs. 46.5%). Physician and patient gender had no impact on the distribution of utterances and the duration of the visit. Conversation mainly focussed on biomedical issues with little psychosocial discussion (< 0.1% of all anaesthetist utterances). However, anaesthetists quite frequently used emotional comments toward patients (7%) and involved them in the conversation. The use of facilitators, open questions and emotional statements by the anaesthetist correlated with high patient involvement. The amount of patient participation in anaesthetic decisions was assessed with the Observing Patient Involvement Scale (OPTION). Compared with general practitioners, anaesthetists offered more opportunities to discuss treatment options (mean (SD) OPTION score 26.8 (16.8) vs. 16.8 (7.7)).
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Affiliation(s)
- C H Kindler
- Department of Anaesthesia, University Hospital Basel, CH-4031 Basel, Switzerland.
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Rizk DEE, El-Zubeir MA, Al-Dhaheri AM, Al-Mansouri FR, Al-Jenaibi HS. Determinants of women's choice of their obstetrician and gynecologist provider in the UAE. Acta Obstet Gynecol Scand 2004; 84:48-53. [PMID: 15603567 DOI: 10.1111/j.0001-6349.2005.00705.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of this study is to evaluate women's priorities and preferences in selecting their obstetrician and gynecologist in a non-Western society. METHODS Consecutive sample of 508 patients attending the obstetric and gynecologic services of AL-Ain Hospital; AL-Ain; United Arab Emirates during 4 months was recruited. Participants were interviewed by using a structured 26-item questionnaire administered by means of face-to-face interview within 24 h of admission in the ward or before consultation in the outpatient clinic. Respondents were asked about their preferences, priorities, determinants of choice of their obstetrician and gynecologist, their view of his/her role as a medical provider, and their perception of importance of each of provider's characteristics and roles on a five-point Likert scale. RESULTS Four hundred thirty-nine (86.4%) participants preferred female physicians. Sixty-one (12%) had no preference and eight (1.6%) preferred male physicians. Reasons for female selection were privacy during intimate examination (89.1%) or counseling (68.8%), religious beliefs (74.3%), and cultural traditions (45.3%). Female preference was significantly associated with higher parity (P = 0.002), religion (P = 0.005), nationality (P = 0.01), occupation (P = 0.02), education (P = 0.04), and poor recognition of physician's role as professional/expert (P < 0.00001). Male preference was significantly associated with experience at previous encounter (P = 0.03), obstetric consultation (P = 0.04), and perceiving physician's role as skilled communicator (P = 0.01) or health educator (P = 0.04). Other physician characteristics affecting choice were professionalism, bedside manners, empathy, communication, competence, availability, and religion. CONCLUSIONS Physician's attitude, professional profile, sex, and religious faith determine women's choice of obstetricians and gynecologists. Most women prefer female providers because of embarrassment during pelvic examination and reproductive counseling, religious beliefs, and sociocultural values.
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Affiliation(s)
- Diaa E E Rizk
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE.
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Roter DL, Hall JA. Physician Gender and Patient-Centered Communication: A Critical Review of Empirical Research. Annu Rev Public Health 2004; 25:497-519. [PMID: 15015932 DOI: 10.1146/annurev.publhealth.25.101802.123134] [Citation(s) in RCA: 350] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Physician gender has stimulated a good deal of interest as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians are more patient-centered in their communication with patients. Our objective is to synthesize the results of two meta-analytic reviews the effects of physician gender on communication in medical visits within a communication framework that reflects patient-centeredness and the functions of the medical visit. We performed online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and BIOETHICS), and 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 were identified through bibliographic and computerized searches. Medical visits with female physicians were, on average, two minutes (10%) longer than those of male physicians. During this time, female physicians engaged in significantly more communication that can be considered patient-centered. They engaged in more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. Moreover, the patients of female physicians spoke more overall, disclosed more biomedical and psychosocial information, and made more positive statements to their physicians than did the patients of male physicians. Obstetrics and gynecology may present a pattern different from that of primary care: Male physicians demonstrated higher levels of emotionally focused talk than their female colleagues. Female primary care physicians and their patients engaged in more communication that can be considered patient-centered and had longer visits than did their male colleagues. Limited studies exist outside of primary care, and gender-related practice patterns might differ in some subspecialties from those evident in primary care.
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Affiliation(s)
- Debra L Roter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Emmons SL, Adams KE, Nichols M, Cain J. The impact of perceived gender bias on obstetrics and gynecology skills acquisition by third-year medical students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2004; 79:326-332. [PMID: 15044164 DOI: 10.1097/00001888-200404000-00008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE To investigate the perceptions of third-year medical students about how their acquisition of skills during their obstetrics and gynecology clerkship may be affected by their gender. METHOD From January 1999 to December 2001, all third-year students at one school completing their obstetrics and gynecology rotation were given an anonymous questionnaire addressing whether gender had a positive, negative, or neutral effect on their learning experience. Students were also asked to enumerate procedures they had performed (e.g., deliveries and speculum examinations) and to rate their ability to counsel women on several clinical problems. To further investigate the perceptions of gender discrimination, a focus group of 12 fourth-year students was held. RESULTS A total of 263 questionnaires (95%) were returned. Of the respondents, 78% of the men felt their gender adversely affected their experience, and 67% of women felt gender had a positive affect. All but five of the remaining students were in the neutral group. Those students who reported a positive gender effect performed significantly more speculum examinations (15.5 versus 12.3), labor coaching (8.7 versus 6.2), and independent deliveries (3.4 versus 2.7) than did the negative gender-effect group. The positive gender-effect group felt more confident of counseling skills. The neutral group did not differ from the negative group. The overall numerical differences among groups were small, and all groups, on average, performed adequate numbers of skills to meet clerkship objectives. CONCLUSIONS There is a strong perception among medical students that gender influences experience on their obstetrics and gynecology clerkship, but the differences are actually small. Possible reasons for such strong feelings are addressed and related to the history of sexism in reproductive health care and to the ethics of patients' preferences.
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Affiliation(s)
- Sandra L Emmons
- Department of Obstetrics and Gynecology L466, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.
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Affiliation(s)
- Lenore Manderson
- Key Centre for Women's Health in Society, University of Melbourne, Victoria, Australia.
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Abstract
Evidence for gender differences in physicians' communication with their patients comes primarily from Western countries. Little is known about whether these gender differences would also be observed in Turkey, where there are explicit rules about male-female conduct. The purpose of this study was to observe male and female gynecologists' communication with their patients in a gynecology clinic at a state hospital in Istanbul, Turkey. Four male and three female gynecologists were observed in their interaction with 70 patients over 10 days. The observations were conducted during both the history taking and the actual examination sessions by a woman researcher. The results reported in this paper are based on the extensive field notes taken during the observations. Important differences were revealed in interactions between male vs female gynecologists and their patients. Namely, interactions differed in terms of conversation initiation, communication style, use of technical and colloquial language, frequency of eye contact, patience, and provision of information. Communication characteristics specific to interactions between male gynecologists and their patients included a 'blaming the victim' approach, differential treatment of patients, and underestimation of patients' abilities. Environmental factors that affected physicians' interaction with their patients are reported in conjunction with physicians' use of these external factors to explain the problems they experienced in physician-patient interaction. The discussion focuses on alternative explanations for and future research implications of the observed differences between male and female gynecologists in this setting.
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Affiliation(s)
- Ayse K Uskul
- Psychology Department, Graduate Program, York University, 4700 Keele Street, Toronto, Ont, Canada, M3J 1P3.
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Roter D, Larson S. The Roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions. PATIENT EDUCATION AND COUNSELING 2002; 46:243-251. [PMID: 11932123 DOI: 10.1016/s0738-3991(02)00012-5] [Citation(s) in RCA: 584] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Roter interaction analysis system (RIAS), a method for coding medical dialogue, is widely used in the US and Europe and has been applied to medical exchanges in Asia, Africa, and Latin America. Contributing to its rapid dissemination and adoption is the system's ability to provide reasonable depth, sensitivity, and breadth while maintaining practicality, functional specificity, flexibility, reliability, and predictive validity to a variety of patient and provider outcomes. The purpose of this essay is two-fold. First, to broadly overview the RIAS and to present key capabilities and coding conventions, and secondly to address the extent to which the RIAS is consistent with, or complementary to, linguistic-based techniques of communication analysis.
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Affiliation(s)
- Debra Roter
- Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
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Abstract
OBJECTIVE To investigate the effects of an experimental communication course on how gynaecologists handle psychosocial issues in gynaecological consultation. DESIGN Pre-post testing. Multilevel analysis was used to take into account the similarity among encounters with the same gynaecologist. SAMPLE Eighteen gynaecologists (13 consultants and 5 junior doctors) from five different hospitals participated. All gynaecologists videotaped consecutive outpatient encounters before and after attending an intensive training course. MAIN OUTCOME MEASURES The communicative performance of the gynaecologists at pre-and post measurement. RESULTS The gynaecologists recorded a total of 526 outpatient encounters, 272 before and 254 after the training. As a result of the training, gynaecologists' sensitivity to psychosocial aspects of their patients increased. At post measurement, the gynaecologists gave more signs of agreement, became less directive, asked fewer medical questions and more psychosocial questions. No difference was found in the duration of the outpatient visits. With the trained gynaecologists, patients asked more questions and provided more psychosocial information. CONCLUSIONS Junior doctors and clinically experienced gynaecologists can be taught to handle psychosocial issues without lengthening the visit.
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Affiliation(s)
- A M van Dulmen
- Netherlands Institute of Health Services Research, Utrecht
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van Dulmen A, van Weert J. Effects of gynaecological education on interpersonal communication skills. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0306-5456(00)00104-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bensing J, van Dulmen S, Kallerup H, Visser A, Borrell F, Finset A, Goedhuys J, Langewitz W, Mallinson C, Peltenburg M, Schofield T, Zimmermann C. The European Association for Communication in Healthcare. PATIENT EDUCATION AND COUNSELING 2001; 43:1-4. [PMID: 11311833 DOI: 10.1016/s0738-3991(01)00125-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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van Dulmen AM. Physician reimbursement and the medical encounter: an observational study in Dutch pediatrics. Clin Pediatr (Phila) 2000; 39:591-601. [PMID: 11063040 DOI: 10.1177/000992280003901004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatrician reimbursement is shifting from fee-for-service to a fixed salary. In the Netherlands, as physicians working on a fee-for-service basis have a financial interest in talking less and in carrying out more diagnostic tests and investigations, it may be questioned whether this will influence the structure and content of medical visits. With use of 302 videotaped outpatient encounters with either salaried or fee-for-service pediatricians, differences were examined in visit length, number of requests for diagnostic tests and investigations (laboratory test, endoscopy, and radiography), pediatrician-parent communication behaviors, and patient satisfaction. This investigation was carried out by means of bivariate and multilevel analysis. The results showed that the visits with salaried pediatricians lasted almost 4 minutes longer. This surplus time was not spent on social talk or on a more elaborate history taking but was used to provide more information and advice. In addition, salaried pediatricians engaged in more empathic behavior toward the patient, thereby facilitating a therapeutic relationship. No differences were found in the number of diagnostic tests and investigations or in patient satisfaction. It may be concluded that history taking and social talk took place in a fixed part of the visit. Salaried pediatricians spent more time on exchanging information with their patients and paid more attention to patient concerns and emotions. As the reimbursement shift is not likely to diminish the number of diagnostic tests and investigations and will increase the length of the medical visits, overall financial benefits may be limited.
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Affiliation(s)
- A M van Dulmen
- NIVEL (Netherlands Institute of Primary Health Care), Utrecht
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