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

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Abstract

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.

Introduction

Gender has been identified as one source of systematic variation in medical encounters. As will be discussed later, a number of studies have found that, as health care providers, women and men differ in the way they communicate with their patients. While differences between male and female patients are less clear-cut, some research does show that patients, regardless of sex, often vary their responses depending on the clinician’s gender. Because provider–patient communication can have a significant impact on outcomes following the consultation (e.g. satisfaction, adherence, health improvement) [1], [2], [3], the possibility that the participants’ gender may influence the structure and content of the consultation becomes a question of considerable importance.

How do we make sense of gender differences in medical encounters? One problem with previous research is that gender typically is studied as an individual difference variable and not as a construct grounded in a conceptual framework to explain why these differences exist [4]. In this essay, I analyze these findings from the perspective of an ecological model of communication in medical consultations. At the heart of the model is the idea that individual differences cannot be examined in isolation of other variables or processes that also account for communicative action. I conclude with a discussion of the implications of this analysis for future research and communication skills training.

Section snippets

Overview

Fig. 1 presents an ecological model of communication in medical encounters [5]. Two features of the model are important for the purposes of this chapter. First, medical encounters occur in context. Thus, the way in which health care providers and patients communicate with one another may in part depend on the type of health care organization (e.g. managed care, fee-for-service), political and legal issues (experience with malpractice, patients’ bill of rights), use of and exposure to media (the

Overview

Research to date indicates that women health care providers generally tend to conduct longer consultations, give more information, engage in more partnership-building, are less directive, express more interest in psychosocial aspects of health (e.g. emotions, lifestyle, family), and are more explicitly reassuring and encouraging than are male clinicians [17], [18], [19], [20], [21], [22], [23], [24]. However, to infer that women are more patient-focused and better health care providers than men

Acknowledgements

This research was supported in part from an AHRQ Project Grant (PO1 HS10876), Racial and Ethnic Variation in Medical Interactions.

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