How physician gender shapes the communication and evaluation of medical care

Association Between Anesthesiologist Sex and Patients' Postoperative Outcomes: A Population-based Cohort Study

OBJECTIVE

To examine the association of anesthesiologist sex on postoperative outcomes.

BACKGROUND

Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown.

METHODS

We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between the sex of the intraoperative anesthesiologist and the primary end point of the adverse postoperative outcome, defined as death, readmission, or complication within 30 days after surgery, using generalized estimating equations.

RESULTS

Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 311,822 (26.7%) received care from a female anesthesiologist and 853,889 (73.3%) from a male anesthesiologist. Overall, 10.8% of patients experienced one or more adverse postoperative outcomes, of whom 1.1% died. Multivariable adjusted rates of the composite primary end point were higher among patients treated by male anesthesiologists (10.6%) compared with female anesthesiologists (10.4%; adjusted odds ratio 1.02, 95% CI: 1.00-1.05, P =0.048).

CONCLUSIONS

We demonstrated a significant association between sex of the intraoperative anesthesiologist and patient short-term outcomes after surgery in a large cohort study. This study supports the growing literature of improved patient outcomes among female practitioners. The underlying mechanisms of why outcomes differ between male and female physicians remain elusive and require further in-depth study.

Differences in Practice Characteristics Between Male and Female Chiropractors in South Africa: Secondary Analysis of Data From Scope of Practice Survey 2015

OBJECTIVE

The aim of the study was to determine whether there were differences in practice characteristics between male and female chiropractors working in South Africa.

METHODS

A secondary analysis of data from the online survey "The Analysis of the Scope of Chiropractic Practice in South Africa in 2015" was performed, relating to demographic data, work environment, patient data, chief complaint, treatment techniques, and conditions treated. The original survey yielded a 30% response rate (n = 214), of which 212 responses to the question relating to sex, indicated 56.13% (n = 119) male respondents and 43.87% (n = 93) female respondents. Using the X² test, differences in practice characteristics between male and female chiropractors were compared.

RESULTS

Significant differences were noted for South African female chiropractors reporting that they spent more time with patients during initial (P = .028) and subsequent (P = .0001) visits and more time on direct patient care (P = .0001). South African male chiropractors showed significant differences in being in practice for longer (P = .002), treating more patients per week (P = .0001), number of new patients seen per week (P = .0001), and spending more time working in their practice per week.

CONCLUSION

We found differences between self-reported male and female chiropractors in their practice characteristics, particularly in the number of patients seen per week and hours worked per week. These factors may need to be considered in the profession as the number of female chiropractors increases.

Association Between Surgeon and Anesthesiologist Sex Discordance and Postoperative Outcomes: A Population-Based Cohort Study

OBJECTIVE

To examine the effect of surgeon-anesthesiologist sex discordance on postoperative outcomes.

SUMMARY BACKGROUND DATA

Optimal surgical outcomes depend on teamwork, with surgeons and anesthesiologists forming two key components. There are sex and gender-based differences in interpersonal communication and medical practice which may contribute to patients' perioperative outcomes.

METHODS

We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007-2019 in Ontario, Canada. We assessed the association between differences in sex between surgeon and anesthesiologists (sex discordance) on the primary endpoint of adverse postoperative outcome, defined as death, readmission, or complication within 30-days following surgery using generalized estimating equations.

RESULTS

Among 1,165,711 patients treated by 3,006 surgeons and 1,477 anesthesiologists, 791,819 patients were treated by sex concordant teams (male surgeon/male anesthesiologist: 747,327 and female surgeon/female anesthesiologist: 44,492) while 373,892 were sex discordant (male surgeon/female anesthesiologist: 267,330 and female surgeon/male anesthesiologist: 106,562). Overall, 12.3% of patients experienced one or more adverse postoperative outcomes of whom 1.3% died. Sex discordance between surgeon and anesthesiologist was not associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR] 1.00, 95% confidence interval [CI] 0.97-1.03).

CONCLUSIONS

We did not demonstrate an association between intraoperative surgeon and anesthesiologist sex discordance on adverse postoperative outcomes in a large patient cohort. Patients, clinicians, and administrators may be reassured that physician sex discordance in operating room teams is unlikely to clinically meaningfully affect patient outcomes after surgery.

Patient Satisfaction Ratings of Male and Female Residents Across Subspecialties

BACKGROUND

Females currently comprise approximately 50% of incoming medical students yet continue to be underrepresented in certain medical subspecialties.

OBJECTIVE

To assess whether gender plays a role in patients' perception of physician competency among different specialties.

METHODS

We administered surveys at 2 academic medical centers to patients who were stable, cognitively aware, and indicated English as their primary language. Survey questions evaluated communication, medical expertise, and quality of care.

RESULTS

A total of 4222 surveys were collected. Females comprised around half (n = 2133, 50.7%) of evaluated residents. First-year (n = 1647, 39%) and second-year (n = 1416, 33.5%) residents were assessed most frequently. Internal medicine conducted the most surveys (n = 1111, 23.6%), whereas head and neck surgery conducted the least (n = 137, 3.24%). There was no statistically significant difference between patients' perception of male and female residents of the same year in overall communication skills, medical expertise, and quality of medical care. Female residents outperformed their male counterparts on specific questions evaluating the communication of treatment plans, patient education, and patient satisfaction (P < .001, P = .03, P = .04, respectively). Unsurprisingly, patients' perceptions of residents' overall communication skills, medical expertise, and quality of medical care significantly improved when comparing more experienced residents to newer residents.

CONCLUSION

There is no difference between overall communication, medical expertise, and quality of care between sexes, and across subspecialties. Though gender inequalities currently exist most starkly in practitioners in surgical subspecialties, women in surgical residencies were much better communicators than their male counterparts, but still perceived to have similar levels of medical expertise and quality of care.

Gender differences in patient and caregiver psychoeducation for schizophrenia

Objective:

The aim of this research is to detect gender-related differences in patients and caregivers regarding knowledge about schizophrenia and attitudes towards drugs as well as gender as predictor for changes in these variables during psychoeducation.

Methods:

Data sets of one randomised-controlled (study 1) and one naturalistic psychoeducation study (study 2) were reanalysed. Main outcome measures (knowledge about schizophrenia, drug attitude, confidence in medication) were assessed at baseline, post-intervention and 12 months after index discharge.

Results:

The reanalysed samples consisted in total of 1002 patients and 176 caregivers. In study 2, baseline knowledge was significantly better in male patients and female caregivers. All participants improved significantly their knowledge. The amount of knowledge gain did not differ between genders in either study or either group. Gender was not a major predictor of baseline knowledge or knowledge gain. Only in study 1 did gender significantly impact the knowledge gain from baseline to follow-up. Regarding improvement of drug attitude, females seemed to benefit significantly better from psychoeducation. In both studies, however, changes in drug attitudes respectively confidence in medication were best explained by lower corresponding baseline scores, not gender. Patients’ gender did not influence outcomes of their caregivers.

Conclusion:

Our findings suggest that psychoeducational programs might be better adapted to males in order to improve their drug attitude. Concerning knowledge, gender-related changes do not seem to be necessary.

Internists' dilemmas in their interactions with chronically ill patients; A comparison of their interaction strategies and dilemmas in two different medical contexts

Background

Internists appear to define productive interactions, key concept of the Chronic Care Model, as goal-directed, catalyzed by achieving rapport, and depending on the medical context: i.e. medically explained symptoms (MES) or medically unexplained symptoms (MUS).

Objective

To explore internists’ interaction strategy discourses in the context of MES and MUS.

Methods

We interviewed twenty internists working in a Dutch academic hospital, identified relevant text fragments in the interview transcripts and analyzed the data based on a discourse analysis approach.

Results

We identified four interaction strategy discourses: relating, structuring, exploring, and influencing. Each was characterized by a dilemma: relating by ‘creating nearness versus keeping distance’; structuring by ‘giving space versus taking control’; exploring by ‘asking for physical versus psychosocial causes’; and influencing by ‘taking responsibility versus accepting a patient’s choice. The balance sought in these dilemmas depended on whether the patient’s symptoms were medically explained or unexplained (MES or MUS). Towards MUS the internists tended to maintain greater distance, take more control, ask more cautiously questions related to psychosocial causes, and take less responsibility for shared decision making.

Discussion and conclusions

Adopting a basic distinction between MES and MUS, the internists in our study appeared to seek a different balance in each of four rather fundamental clinical dilemmas. Balancing these dilemmas seemed more difficult regarding MUS where the internists seemed more distancing and controlling, and tended to draw on their medical expertise. Moving in this direction is counterproductive and in contradiction to guidelines which emphasize that MUS patients warrant emotional support requiring a shift towards interpersonal, empathic communication.

Family physicians' opinions on and difficulties with breaking bad news

Highlights

Breaking bad news is still deemed a difficult task by family physicians.Family physicians feel they need training in breaking bad news.The family physicians' attitude to this issue is different from what they would wish if they themselves had a life-threatening disease.

Background

Family practice is the specialty with the highest number of doctors and covers all of Portugal. Therefore, the attitude of these doctors may have a high impact on patients.

Objective

To explore the opinion and difficulties of Portuguese family doctors on dealing with communication with patients with life threatening diseases.

Methods

A questionnaire was sent to about 10% of family doctors of Northern Portugal. The questionnaire included questions about the disclosure of information, if they feel they need training courses and what they would want if they had a life-threatening disease.

Results

A questionnaire was given to 196 doctors and 159 (81%) participated in this study. The median age was 43 years (26-64) and 108 (68%) were females. One hundred thirty-five (85%) consider that breaking bad news is a difficult task. One hundred twenty-four (78%) feel they need training in breaking bad news. For many doctors, the disclosure of diagnoses and prognoses has a detrimental psychological effect and affects patients' hope, but gives patients' control of the situation. Given a situation where the doctors themselves had a life-threatening disease, the vast majority would want to know the diagnosis and the prognosis and to participate in treatment decisions.

Conclusions

Breaking bad news is still a difficult task. Their attitude to this duty is different from what they would wish if they themselves had a life-threatening disease. One important conclusion is the need of specific training in communication for family physicians that should begin in the training phase of their specialty.

The influence of patient gender on medical and psychology students’ illness attributions: Experiences with a narrative technique

We attempted to identify whether and how the gender of the patient influences interpretations of an illness narrative. We investigated how medical and psychology undergraduates’ ( n = 313) views change according to the patient’s gender, students’ gender, and field of study. A short story about a female patient was chosen as stimulus material, and a gender-modified version with a male protagonist was created for comparison. Responses were content analyzed by qualitative and quantitative methods. The female patient elicited more detailed descriptions and somatizing attributions. The gender of students had a stronger impact on responses than their field of study.

Physician communication behaviors and trust among black and white patients with hypertension

BACKGROUND

Racial differences in patient trust have been observed, but it is unclear which physician communication behaviors are related to trust, and whether the relationship of communication and trust differs among black and white patients.

OBJECTIVE

We sought to determine whether there were associations between physician communication behaviors, visit process measures, and patient trust, particularly within racial groups.

METHODS

Study participants included 39 primary care physicians and 227 black and white hypertensive patients from community-based practices in Baltimore, MD. Physician informational and affective communication behaviors and visit process measures were coded from visit audiotapes using the Roter Interaction Analysis System. Patient trust was measured using items from the Trust in Physician Scale, and dichotomized (high/low). Logistic regression analysis using generalized estimating equations was used to assess the association of each physician communication behavior and visit process measure with patient trust, among the entire sample and then stratified by patient race.

RESULTS

Positive physician affect and longer visits were significantly associated with high patient trust in unadjusted analyses. After adjustment for covariates, positive physician affect remained a significant predictor of high patient trust in the overall sample (odds ratio 1.26; 95% confidence interval, 1.08, 1.48; P=0.004) and after stratification by race, among black patients (odds ratio 1.35; 95% confidence interval, 1.09, 1.67; P=0.006).

CONCLUSIONS

Physician communication behaviors may have a varying effect on patient trust, depending on patient race. Communication skills training programs targeting emotion-handling and rapport-building behaviors are promising strategies to reduce disparities in health care and to enhance trust among ethnic minority patients.

A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients

BACKGROUND

African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations.

OBJECTIVE

To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups.

DESIGN

Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland.

PARTICIPANTS

Forty-one primary care physicians and 279 hypertension patients.

INTERVENTIONS

Physician communication skills training and patient coaching by community health workers.

MAIN MEASURES

Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control.

KEY RESULTS

Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p = 0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (β = +6.20 vs. -5.24, p = 0.03) and PIC dimensions related to doctor facilitation (β = +0.22 vs. -0.17, p = 0.03) and information exchange (β = +0.32 vs. -0.22, p = 0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive/physician minimal (-16.8 mmHg), compared to the patient+physician minimal group (-2.0 mmHg).

CONCLUSION

Interventions that enhance physicians' communication skills and activate patients to participate in their care positively affect patient-centered communication, patient perceptions of engagement in care, and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension.

Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient

PURPOSE

The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice.

METHODS

We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England.

RESULTS

Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12-4.40) and obesity (OR = 2.14; 95% CI, 1.30-3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30-3.18) and diabetes (OR = 6.55; 95% CI, 2.01-21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25-0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22-0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15-0.58).

CONCLUSION

Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.

Is it good to express uncertainty to a patient? Correlates and consequences for medical students in a standardized patient visit

OBJECTIVE

To examine the consequences of expressions of uncertainty (EOUs) in medical student interactions, with a particular focus on the gender of the expressor.

METHODS

EOUs were identified in 147 videotaped interactions between third-year medical students and standardized patients enacting four medical scenarios. The encounters were also analyzed using the Roter Interaction Analysis System (RIAS). A subset of these interactions was shown to 244 analogue patients who rated satisfaction, liking, and perceived competence and confidence.

RESULTS

Female medical students used more EOUs but not when adjusted for total number of statements. The EOU rate varied across scenarios. A higher EOU rate was perceived as more affectively negative by both RIAS trained coders and analogue patients. EOU rate was inversely related to analogue patient satisfaction and liking and this relationship was stronger for males than females. Female student use of EOUs was more strongly associated with ratings of anxiety than was male EOU use.

CONCLUSION

There was an overall negative perception of medical students who expressed uncertainty; however, the strength of the associations varied due to medical student gender.

PRACTICE IMPLICATIONS

The implications for medical education are discussed.

Obstetrician gender and the likelihood of performing a maternal request for a cesarean delivery

OBJECTIVE

To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics).

STUDY DESIGN

Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS.

RESULTS

After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR=1.53) and clinics (OR=2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals.

CONCLUSIONS

While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions.

Effect of gender and visit length on participation in pediatric visits

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.

Determinants of women's choice of their obstetrician and gynecologist provider in the UAE

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.

Physicians vary in approaches to the clinical management of delirium

OBJECTIVES

To ascertain the variation in strategies for managing delirium of physicians with expertise in geriatrics.

DESIGN

Cross-sectional mail survey.

SETTING

United States.

PARTICIPANTS

A probability sample of physician members of the American Geriatrics Society.

MEASUREMENTS

Management choices presented in a two-part case vignette of an older woman hospitalized with a hip fracture who develops mild and then severe delirium.

RESULTS

One hundred twenty-two respondents (43%) selected the three answers constituting current "best practice," 50 (18%) selected an unnecessary diagnostic test (brain imaging, lumbar puncture, or electroencephalogram), and 47 (17%) selected unnecessary pharmacologic therapy for mild delirium. For severe delirium, 270 (96%) selected pharmacological therapy, of whom 180 chose haloperidol alone, 55 chose lorazepam alone, 23 chose lorazepam in combination with haloperidol, and 12 wrote in another drug. Thirty percent of the respondents made any selection of lorazepam, alone or in combination with haloperidol, for mild or severe delirium. Sixty-one percent of those selecting haloperidol for severe delirium chose a dose greater than that recommended for geriatric patients. Sex, date of graduation from medical school, clinical specialty, completion of a geriatric fellowship, or certification in geriatrics had no significant effect on responses.

CONCLUSIONS

The common selection of lorazepam to treat delirium is troubling because benzodiazepines themselves are implicated in delirium. Selection of an initial dose of haloperidol higher than that recommended for geriatric patients by more than half of the respondents is also of concern. There is a paucity of sound clinical evidence to guide the choice of pharmacological agents for treating delirium in older hospitalized patients.

Does physician weight affect perception of health advice?

BACKGROUND

Obesity is considered a growing health threat in the United States. Although physicians have an important role in counseling their patients for obesity prevention and treatment, physicians themselves are often overweight. There are few data regarding how physician body weight might affect patient receptiveness to obesity counseling.

METHODS

A 43-item survey instrument was developed that consisted of three scales related to physician characteristics, health locus of control, and perceptions on receiving health advice from overweight physicians. The survey was administered to 226 patients in five physician offices. Two of the physicians were classified as obese using BMI calculations, and three were nonobese. The responses from the surveys were grouped into those from obese and nonobese physicians.

RESULTS

Significant differences were found for patient receptiveness to counseling for treatment of illness (P = 0.038) and health advice (P = 0.049), with the patients of nonobese physicians indicating greater confidence scores. The difference for weight and fitness counseling did not reach significance (P = 0.075). Analysis revealed that patient BMI was not a significant covariate nor were items related to physician characteristics in general or health locus of control.

CONCLUSIONS

Patients seeking care from nonobese physicians indicated greater confidence in general health counseling and treatment of illness than patients seeing obese physicians. It is not known if this can be translated into increased success in obesity prevention and treatment.

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

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

Communicating fatigue in general practice and the role of gender

The aim of this study has been to obtain more insight into the health condition of fatigued patients, their expectations when visiting the general practitioner (GP), the way they communicate, and possible gender differences. Data consisted of 579 patient questionnaires and 440 video-observations of these patients and 31 GPs. Results showed that fatigue is a common health problem but seldom on the agenda in general practice. More women indicated symptoms of fatigue than men did. Fatigued patients' health was worse than that of non-fatigued patients, and they expected more biomedical and especially psychosocial communication. Furthermore, male fatigued patients expected more biomedical communication than fatigued female patients did. While the GPs accommodated their verbal behavior to fatigued patients by giving more psychosocial information and more counseling, they were not more affective towards the fatigued than towards the non-fatigued patients. Female GPs were more affective than their male colleagues, and they used gender-specific communication strategies to explore the patient's agenda. It seems necessary to use a gender-sensitive approach in communication research.

Gender differences in health care provider-patient communication: are they due to style, stereotypes, or accommodation?

This article examines gender differences in health care provider-patient communication within the framework of an ecological model of communication in the medical encounter. The ecological perspective posits that, although health care provider-patient interactions are situated within a number of contexts (e.g. organizational, political, cultural), the interpersonal domain is the primary context within which these interactions unfold. Hence, gender may influence provider-patient interaction to the extent that it can be linked to the interactants' goals, skills, perceptions, emotions, and the way the participants adapt to their partner's communication. The evidence reviewed in this essay indicates that gender differences in medical encounters may come from several sources including differences in men's and women's communicative styles, perceptions of their partners, and in the way they accommodate their partner's behavior during the interaction. However, because gender is but one of many personal and partner variables (e.g. age, ethnicity, personal experiences) that can influence these processes, gender differences are often quite modest (if apparent at all) when examined across a population of health care providers and patients. Implications for future research and communicative skill training are discussed.

Do gender-dyads have different communication patterns? A comparative study in Western-European general practices

From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1). whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2). if so, whether these differences continue to exist when controlling for patient, GP and consultation characteristics. Doctor-patient communication was assessed in six Western-European countries by coding video taped consultations of 190 GPs and 2812 patients. Cluster analysis revealed three communication patterns: a biomedical, a biopsychosocial and a psychosocial pattern. Across countries, communication patterns of the female/female dyad differed from that of the other gender-dyads. Differences in communication patterns between countries could especially be explained by differences in consultations of male doctors, irrespective of the patients' gender. It is important to take into consideration differences between gender-dyads and between countries when studying gender effects on communication across countries or when comparing studies performed in different countries.

The importance of physician gender in the selection of an obstetrician or a gynecologist

OBJECTIVE

The purpose of this study was to determine the importance of gender in the selection of an obstetrician or a gynecologist.

STUDY DESIGN

At a university-based hospital, 46 patients after delivery and 79 patients after gynecologic surgery who had selected their physician within the previous year were interviewed to determine the importance of physician gender in the selection of an obstetrician or gynecologist. Chi-square test, Fisher exact test, and the Student t test were used for statistical analysis.

RESULTS

Of the 125 women who were surveyed, 52.8% of the women preferred a female physician, 9.6% of the women preferred a male physician, and 37.6% of the women stated no gender preference, with no significant difference between the obstetric and gynecologic groups. The groups were similar with respect to ranking the importance of gender; 24.8% of the women who were interviewed considered gender to be one of the 3 most important factors in the selection of a physician. When participants were asked to choose gender over physician experience, bedside manner, or competency, gender was selected by 12%, 10.4%, and 0.8%, respectively, with no significant differences between the groups.

CONCLUSION

For most women, physician gender is not of primary importance in the selection of an obstetrician or gynecologist.