Does gender matter in doctor–patient communication during standard gynaecological consultations? An analysis using mixed methods
Issue: Vol 11 No. 3 (2014)
Journal: Communication & Medicine
Subject Areas: Healthcare Communication Linguistics
Abstract:
This paper assesses whether gender plays a role when male and female participants discuss the quality of doctor–patient communication in gynaecological consultations. A European multi-centre study was conducted comprising 259 participants in 35 gender- and country-specific focus groups. In all focus groups, a set of four videotaped Objective Structured Clinical Examination (OSCE) consultations was used as a prompt for discussion. The doctors’ ability in communication was assessed by participants’ ratings and by a quantified content analysis of their comments, using a mixed-method approach. Gender analysis was performed applying a set of generalized linear regression models. The findings indicated that gender differences were smaller than expected. The individual ratings of the overall quality of communication were similar for male and female participants, and there were hardly any differences in the content of the discussions. The only two exceptions were that female doctors were criticized more than male doctors when they made impersonal comments and that female participants were more outspoken than men, positively and negatively. The prevalence of gender similarities suggests that doctors’ empathy, support, understanding and pleasantness are highly appreciated by both male and female participants and appear to transcend gender differences.
Author: Maria Angela Mazzi, Michela Rimondini, Myriam Deveugele, Christa Zimmermann, Giuseppe Deledda, Jozien Bensing
References :
Arber, J., McKinlay, J., Adams, A., Marceau, L., Link, C. and O’Donnell, A.(2006) Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: A video-simulation experiment. Social Science and Medicine 62 (1): 103–115. http://dx.doi.org/10.1016/j.socscimed.2005.05.028
Banerjee, A. and Sanyal, D. (2012) Dynamics of doctor-patient relationship: A cross-sectional study on concordance, trust, and patient enablement. Journal of Family & Community Medicine 19 (1): 12–19. http://dx.doi.org/10.4103/2230-8229.94006
Bensing, J. M., van den Brink-Muinen, A. and de Bakker, D. H. (1993) Gender differences in practice style: A Dutch study of general practitioners. Medical Care 31 (3): 219–229. http://dx.doi.org/10.1097/00005650-199303000-00004
Bernard, H. R. and Ray, G. W. (2010) Analyzing Qualitative Data: Systematic Approach. Thousand Oaks, CA: Sage.
Bertakis, K. D. and Azari, R. (2012) Patient-centered care: The influence of patient and resident physician gender and gender concordance in primary care. Journal of Women’s Health 21 (3): 326–333. http://dx.doi.org/10.1089/jwh.2011.2903
Bertakis, K. D., Franks, P. and Epstein, R. M. (2009) Patient-centered communication in primary care: Physician and patient gender and gender concordance. Journal of Women’s Health 18 (4): 539–545. http://dx.doi.org/10.1089/jwh.2008.0969
Betts, P., Wilmot, A. and Taylor, T. (2008) Developing survey questions on sexual identity: Exploratory focus groups. Data Collection Methodology – Social Surveys Census and Social Methodology. London: Office for National Statistics. Retrieved from: http://www.ons.gov.uk/ons/guide-method/measuring-equality/equality/sexual-identity-project/sexual-identity-focus-group-report.pdf
Blanch-Hartigan, D., Hall, J. A., Roter, D. L. and Frankel, R. M. (2010) Gender bias in patients’ perceptions of patient-centered behaviors. Patient Education and Counseling 80 (3): 315–320. http://dx.doi.org/10.1016/j.pec.2010.06.014
Brink-Muinen, A., van Dulmen, S., Messerli-Rohrbach, V. and Bensing, J. (2002) Do gender-dyads have different communication patterns? A comparative study in Western-European general practices. Patient Education and Counseling 48 (3): 253–264. http://dx.doi.org/10.1016/S0738-3991(02)00178-7
Christen, R. N., Alder, J. and Bitzer, J. (2008) Gender differences in physicians’ communicative skills and their influence on patient satisfaction in gynaecological outpatient consultations. Social Science and Medicine 66 (7): 1474–1483. http://dx.doi.org/10.1016/j.socscimed.2007.12.011
Dielissen, P. W., Bottema B. J., Verdonk, P. and Lagro-Janssen, T. L. (2009) Incorporating and evaluating an integrated gender-specific medicine curriculum: A survey study in Dutch GP training. BMC Medical Education 9: 58. http://dx.doi.org/10.1186/1472-6920-9-58, URL: http://www.biomedcentral.com/1472-6920/9/58
Dielissen, P., Bottema, B. J., Verdonk, P. and Lagro-Janssen, T. (2011) Attention to gender in communication skills assessment instruments in medical education: A review. Medical Education 45 (3): 239–248. http://dx.doi.org/10.1111/j.1365-2923.2010.03876.x
Dielissen, P., Verdonk, P., Bottema, B., Kramer, A. and Lagro-Janssen, T. (2012) Expert consensus on gender criteria for assessment in medical communication education. Patient Education and Counseling 88 (2): 189–195. http://dx.doi.org/10.1016/j.pec.2012.01.013
Hall, J. A., Blanch-Hartigan, D. and Roter, D. L. (2011) Patients’ satisfaction with male versus female physicians: A meta-analysis. Medical Care 49 (7): 611–617. http://dx.doi.org/10.1097/MLR.0b013e318213c03f
Hall, J. A., Irish, J. T., Roter, D. L., Ehrlich, C. M. and Miller, L. H. (1994) Satisfaction, gender, and communication in medical visits. Medical Care 32 (12): 1216–1223. http://dx.doi.org/10.1097/00005650-199412000-00005
Hall, J. A. and Roter, D. L. (1995) Patient gender and communication with physicians: Results of a community-based study. Women’s Health 1 (1): 77–95.
Hall, J. A. and Roter, D. L. (2002) Do patients talk differently to male and female physicians? A meta-analytic review. Patient Education and Counseling 48 (3): 217–224. http://dx.doi.org/10.1097/MLR.0b013e318213c03f
Hsieh, H. F. and Shannon, S. E. (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15: 1277–1288. http://dx.doi.org/10.1177/1049732305276687
Humphris, G. M. and Kaney, S. (2001) The Liverpool brief assessment system for communication skills in the making of doctors. Advances in Health Sciences Education: Theory and Practice 6 (1): 69–80. http://dx.doi.org/10.1023/A:1009879220949
Jefferson, L., Bloor, K., Birks, Y., Hewitt, C. and Bland, M. (2013) Effect of physicians’ gender on communication and consultation length: A systematic review and meta-analysis. Journal of Health Service Research & Policy 18 (4): 242–248. http://dx.doi.org/10.1177/1355819613486465
Kerssens, J. J., Bensing, J. M. and Andela, M. G. (1997) Patient preference for genders of health professionals. Social Science & Medicine 44 (10): 1531–1540. http://dx.doi.org/10.1016/S0277-9536(96)00272-9
Lagro-Janssen, T. (2010) Gender and sex: Issues in medical education. GMS Zeitschrift für Medizinische Ausbildung 27 (2): 48–53. http://dx.doi.org/10.3205/ zma000664.
Mazzi, M. A., Rimondini, M., Deveugele, M., Zimmermann, C., Moretti, F., van Vliet, L., Deledda, G., Fletcher, I. and Bensing, J. (2015) What do people appreciate in physicians’ communication? An international study with focus groups using videotaped medical consultations. Health Expectation 18 (5): 1215–1226. http://dx.doi.org/10.1111/hex.12097
Moretti, F., Fletcher, I., Mazzi, M. A., DeVeugele, M., Rimondini, M., Geurts, C., Zimmermann, C. and Bensing, J. (2012) GULiVer – travelling into the heart of good doctor-patient communication from a patient perspective: Study protocol of an international multicentre study. European Journal of Public Health 22(4): 464–469. http://dx.doi.org/10.1093/eurpub/ckr071
Moretti, F., van Vliet, L., Bensing, J., Deledda, G., Mazzi, M., Rimondini, M., Zimmermann, C. and Fletcher, I. (2011) A standardized approach to qualitative content analysis of focus group discussions from different countries. Patient Education and Counseling 82 (3): 420–428. http://dx.doi.org/10.1016/j.pec.2011.01.005
Morgan, D. L. (1996) Focus Groups. Annual Review of Sociology 22 (1): 129–152. http://dx.doi.org/10.1146/annurev.soc.22.1.129
Pluye, P. and Nha Hong, Q. (2014) Combining the power of stories and the power of numbers: Mixed methods research and mixed studies reviews. Annual Review of Public Health 35: 29–45. http://dx.doi.org/10.1146/annurev-publhealth-032013-182440
Risberg, G., Johansson, E. E. and Hamberg, K. (2011) ‘Important… but of low status’: Male education leaders’ views on gender in medicine. Medical Education 45 (6): 613–624. http://dx.doi.org/10.1111/j.1365-2923.2010.03920.x
Risberg, G., Johansson, E. E., Westman, G. H. and Hamberg, K. (2003) Gender in medicine – an issue for women only? A survey of physician teachers' gender attitudes. International Journal for Equity in Health 2 (1): 10. http://dx.doi.org/10.1186/1475-9276-2-10 URL: http://www.equityhealthj.com/content/2/1/10
Roter, D. L. and Hall, J. A. (2004) Physician gender and patient-centered communication: A critical review of empirical research. Annual Review of Public Health 25: 497–519. http://dx.doi.org/10.1146/annurev.publhealth.25.101802.123134
Roter, D. L., Hall, J. A. and Aoki, Y. (2002) Physician gender effects in medical communication: A meta-analytic review. Journal of the American Medical Association 288 (6): 756–764. http://dx.doi.org/10.1001/jama.288.6.756
Roter, D. L., Lipkin, M. and Korsgaard, A. (1991) Sex differences in patients’ and physicians’ communication during primary care medical visits. Medical Care 29 (11): 1083–1093. http://dx.doi.org/10.1097/00005650-199111000-00002
Sandhu, H., Adams, A., Singleton, L., Clark-Carter, D. and Kidd, J. (2009) The impact of gender dyads on doctor-patient communication: A systematic review. Patient Education and Counseling 76 (3): 348–355. http://dx.doi.org/10.1016/j.pec.2009.07.010
Schieber, A. C., Delpierre, C., Lepage, B., Afrite, A., Pascal, J., Cases, C., Lombrail, P., Lang, T. and Kelly-Irving M. (2014) Do gender differences affect the doctor–patient interaction during consultations in general practice? Results from the INTERMEDE study. Family Practice 31 (6): 706–713. http://dx.doi.org/10.1093/fampra/cmu057
Schmid Mast, M., Hall, J. A., Cronauer, C. K. and Cousin, G. (2011) Perceived dominance in physicians: are female physicians under scrutiny? Patient Education and Counseling 83 (2): 174–179. http://dx.doi.org/10.1016/j.pec.2010.06.030
Schmid Mast, M., Hall, J. A., Klöckner, C. and Choi, E. (2008) Physician gender affects how physician nonverbal behavior is related to patient satisfaction. Medical Care 46 (12): 1212–1218. http://dx.doi.org/10.1097/MLR.0b013e31817e1877
Stata Statistical Software (2011) Release 11.2. College Station, TX: StataCorp LP.
Stewart, D. W. and Shamdasasi, P. N. (2014) Focus Groups: Theory and Practice. Thousand Oaks, CA: Sage.
Swenson, S. L., Buell, S., Zettler, P., White, M., Ruston, D. C. and Lo, B. (2004) Patient-centered communication: Do patients really prefer it? Journal of General Internal Medicine 19 (11): 1069–1079. http://dx.doi.org/10.1111/j.1525-1497.2004.30384.x
Thornton, R. L., Powe, N. R., Roter, D. and Cooper, L. A. (2011) Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality. Patient Education and Counseling 85 (2): 201–208. http://dx.doi.org/10.1016/j.pec.2011.07.015
van Dulmen, A. M. and Bensing, J. M. (2000) Gender differences in gynaecologist communication. Women Health 30 (3): 49–61. http://dx.doi.org/10.1300/J013v30n03_04
West, C. (1993) Reconceptualizing gender in physician-patient relationships. Social Science and Medicine 36 (1): 57–66. http://dx.doi.org/10.1016/0277-9536(93)90305-N
Wolosin, R. J. and Gesell, S. B. (2006) Physician gender and primary care patient satisfaction: No evidence of ‘feminization’. Quality Management in Health Care 15 (2): 96–103. http://dx.doi.org/10.1097/00019514-200604000-00004
Yanikkerem, E., Ozdemir, M., Bingol, H., Tatar, A. and Karadeniz, G. (2009) Women’s attitudes and expectations regarding gynaecological examination. Midwifery 25 (5): 500–508. http://dx.doi.org/10.1016/j.midw.2007.08.006