The impact of gender stereotypes on the evaluation of general practitioners' communication skills: an experimental study using transcripts of physician-patient encounters. Effective physician-patient communication and health outcomes: a review. The impact of patient-centered care on outcomes. The Influence of Gender on Physician Practice Style Effects of physician gender on patient satisfaction. Comparison of activity level and service intensity of male and female physicians in five fields of medicine in Ontario.
OBJECTIVE The present study has been design ed to test for the effect of physicians ' gender on the perception and assessment of empathic communication in medical encounters . METHODS Eighty-eight volunteers were asked to assess six transcribed interactions between physicians and a st and ardized patient . The effects of physicians ' gender were tested by the experimental manipulation of physicians ' gender labels in transcripts . Participants were r and omly assigned to one of two testing conditions : ( 1 ) perceived gender corresponds to the physician 's true gender ; ( 2 ) perceived gender differs from the physician 's true gender . Empathic communication  was assessed using the  Rating Scales for the Assessment of Empathic Communication in Medical Interviews . RESULTS A 2 ( physician 's true gender : female vs. male)x2 ( physician 's perceived gender : female vs. male)x2 ( rater 's gender : female vs. male ) mixed multivariate analysis of variance ( MANOVA ) yielded a main effect for physician 's true gender . Female physicians were rated higher on empathic communication than male physicians irrespective of any gender labels . CONCLUSION The present findings suggest that gender differences in the perception of physician 's empathy are not merely a function of the gender label . These findings provide evidence for differences in male and female physicians ' empathic communication that can not be attributed to stereotype bias . PRACTICE IMPLICATION S Future efforts to evaluate communication skills training for general practitioners may consider gender differences OBJECTIVE To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes . DATA SOURCES The MEDLINE data base was search ed for articles published from 1983 to 1993 using " physician-patient relations " as the primary medical subject heading . Several bibliographies and conference proceedings were also review ed . STUDY SELECTION R and omized controlled trials ( RCTs ) and analytic studies of physician-patient communication in which patient health was an outcome variable . DATA EXTRACTION The following information was recorded about each study : sample size , patient characteristics , clinical setting , elements of communication assessed , patient outcomes measured , and direction and significance of any association found between aspects of communication and patient outcomes . DATA SYNTHESIS Of the 21 studies that met the final criteria for review , 16 reported positive results , 4 reported negative ( i.e. , nonsignificant ) results , and 1 was inconclusive . The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes . The outcomes affected were , in descending order of frequency , emotional health , symptom resolution , function , physiologic measures ( i.e. , blood pressure and blood sugar level ) and pain control . CONCLUSIONS Most of the studies review ed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes . The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs . Future research should focus on evaluating such educational programs BACKGROUND We design ed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization . METHODS We selected 39 family physicians at r and om , and 315 of their patients participated . Office visits were audiotaped and scored for patient-centered communication . In addition , patients were asked for their perceptions of the patient-centeredness of the visit . The outcomes were : ( 1 ) patients ' health , assessed by a visual analogue scale on symptom discomfort and concern ; ( 2 ) self-report of health , using the Medical Outcomes Study Short Form-36 ; and ( 3 ) medical care utilization variables of diagnostic tests , referrals , and visits to the family physician , assessed by chart review . The 2 measures of patient-centeredness were correlated with the outcomes of visits , adjusting for the clustering of patients by physician and controlling for confounding variables . RESULTS Patient-centered communication was correlated with the patients ' perceptions of finding common ground . In addition , positive perceptions ( both the total score and the subscore on finding common ground ) were associated with better recovery from their discomfort and concern , better emotional health 2 months later , and fewer diagnostic tests and referrals . CONCLUSIONS Patient-centered communication influences patients ' health through perceptions that their visit was patient centered , and especially through perceptions that common ground was achieved with the physician . Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals As more women enter medicine , intriguing questions arise about how physician gender impacts practice style . To measure this influence in primary care encounters , 118 male and 132 female adult new patients , having no stated preference for a specific physician , were r and omly assigned to university hospital primary care residents , and their initial encounters  were videotaped .  Forty-eight male and 33 female physicians participated .  Patient health status was assessed before the visit with the Medical Outcomes Study Short-Form General Health Survey . Physician practice style was evaluated by using the  Davis Observation Code  to analyze videotapes of each initial visit . Patient satisfaction with medical care was assessed with satisfaction question naires . Contrary to prior reports , the difference between male and female physicians in total time spent with patients was small and statistically insignificant , and diminished further when controlling for patient gender and health status . Female physicians , however , were observed to engage in more preventive services and to communicate differently with their patients . These differences in practice style appear to explain partially the observed higher patient satisfaction scores for female physicians . This study underscores the importance of careful measurement and control of potential confounding factors in clarifying the impact of physician gender on practice style OBJECTIVES To measure the impact of physician gender on patient satisfaction , controlling for confounding patient variables , and to examine the extent to which differences in satisfaction with male and female physicians can be explained by physician practice styles . METHOD New adult patients ( n=509 ) were r and omized to see male and female primary care physicians at a university medical center outpatient facility . Patient sociodemographics and self-reported health status ( using the Medical Outcomes Study Short Form-36 ) were measured before the initial visit , and satisfaction with the physician was measured immediately following the visit . The entire medical encounter was videotaped and physician practice style was later analyzed using the Davis Observation Code . RESULTS Female physicians spent a significantly greater proportion of the visit on preventive services and counseling than male physicians did , and male physicians devoted more time to technical practice behaviors and discussion s of substance abuse . Visit length was not significantly different for male and female physicians . Patients of female physicians were more satisfied than were those of male physicians , even after adjusting for patient characteristics , visit length , and physician practice style behaviors . CONCLUSION Patient satisfaction with primary care physicians appears to be influenced not only by patient characteristics and physician behaviors , but also by the gender of the provider . Possible explanations for this may be that psychosocial aspects of the physician-patient interaction are different for male and female physicians . Patients may also bring expectations about female physicians to the encounter , presuming them to be more empathetic , nurturing , and responsive OBJECTIVE To examine the extent to which physician 's sex explains variation in the activity level and service intensity of a cohort of physicians in each of five medical fields after other sources of variation are taken into account . DESIGN Data from the Ontario Ministry of Health ( MOH ) and the CMA were analysed by means of multivariate regression techniques for panel data . SETTING Ontario . PARTICIPANTS A total of 137 dermatologists , 974 general internists , 330 pediatricians and 941 psychiatrists and a r and om sample of 2771 family physicians and general practitioners who met the eligibility criteria . Physicians were eligible if they billed the MOH for at least three quarters in 1983 , did not bill as a medical laboratory director , provided direct patient care , did not have an alternative funding arrangement with the MOH , remained in the same specialty throughout the study period ( 1983 - 90 ) and billed from an Ontario address . OUTCOME MEASURES Three measures of total activity level ( annual number of services provided , annual fee-for-service billings and annual mean number of patients seen per quarter ) and one measure of service intensity ( annual mean number of services per patient per quarter ) . RESULTS Although several variables ( e.g. , full-time work status , age , type of practice and recent practice move ) influenced the four measures examined , physician 's sex contributed significantly to explaining variation in activity in 70 % of the regression equations . The women provided 33.0 % fewere services per year than the men in family and general practice ( p < 0.001 ) , 25.0 % fewer services in general internal medicine ( p < 0.01 ) , 22.1 % fewer services in pediatrics ( p < 0.05 ) and 22.3 % fewer services in psychiatry ( p < 0.001 ) . Total billings by the women in these fields were also significantly less than those of their male colleagues , the difference being greatest among the family physicians and general practitioners ( 28.0 % ) and the general internists ( 27.0 % ) ( p < 0.001 ) . The women in these four fields saw significantly fewer patients per quarter than their male colleagues , the difference being greatest in psychiatry ( 33.0 % ) ( p < 0.001 ) . Sex affected service intensity in three fields . The female psychiatrists ( 14.8 % ) ( p < 0.001 ) and general intenists ( 5.5 % ) ( p < 0.10 ) provided more services per quarter than their male colleagues , whereas the female family physicians and general practitioners delivered 2.2 % fewer services per patient per quarter than their male colleagues ( p < 0.01 ) . In two specialties differences between women aged 40 years or less and those over 40 years were observed . In general internal medicine the younger women had higher activity levels than the older women ( p < 0.01 ) . Conversely , in dermatology the younger women had lower activity levels ( p < 0.05 ) and provided fewer services per patient per quarter ( p < 0.001 ) than the older women . CONCLUSIONS Although physician 's sex explained much of the variation in activity level and service intensity , even after other important correlates were controlled for , the type and extent of differences observed between female and male physicians depended on the particular medical field examined . To underst and the effect of the large increase in the number of women on the physician workforce , more detailed analyses by medical field are needed of the volume , mix and intensity of services provided by men and women , with adjustment for any possible differences in the patients seen in their practice
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 systematic ally research on gender differences in the length , style and content of communication with patients .