"Our review found that female physicians more often engage in communication that we would consider more patient-centered and broadly relates to the larger life context of the patient's conditions. They do this by addressing psychosocial issues through questioning and counseling, and more emotional and positive talk," said Debra L. Roter, DrPH, lead author of the study and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. "Doctors are supposed to be considered doctors first, but we know that men and women communicate differently. The results are consistent with what we would expect in everyday life," added Dr. Roter.
For their review, the investigators searched online databases for studies relating to physician communication published between 1967 and 2001. Twenty-three observational studies and three large physician-report studies of length of visit were selected and statistically analyzed.
The analysis found that female primary care physicians engaged in significantly more partnership behaviors, which the researchers describe as actively enlisting the patient in medical decisions and equalizing the status between doctor and patient. Six out of 12 studies reviewed showed significantly higher levels of active partnership enlistment on the part of female doctors, while two showed the reverse.
Other studies reviewed showed female physicians engaged in significantly more positive talk, psychosocial question asking and counseling, and emotionally focused talk compared to their male counterparts. However, there were no gender differences in the amount, quality, or manner of biomedical information giving, which includes discussion about diagnosis, medical treatment, and prognosis, or in social conversation.
The review also found that medical visits with female physician were about 10 percent longer than visits with male physicians. Five out of ten observational studies and all three physician-report studies examined showed significantly longer length of visits for female doctors. On average, women spent 23 minutes with their patients compared to 21 minutes for men.
The researchers noted that the findings did not hold true for obstetrics and gynecology, where male doctors spent more time with patients and demonstrated higher levels of emotionally focused talk compared to female physicians. They added that few studies looked beyond primary care physicians and that more research is needed to determine gender-related practices among subspecialty physicians. None of the studies reviewed linked communication skills to clinical outcomes.
"Even though the differences we found were real, there appears to be a great deal of overlap in the communication styles of both male and female physicians, because the effects we uncovered were not large in magnitude. There is room for both men and women to improve their interview styles and to be open to education efforts. Other research demonstrates that physicians can be trained in their interview style. These differences in communication are a product of our society, but they are not unchangeable," explained co-author Judith A. Hall, PhD, professor of psychology at Northeastern University.
"Physician Gender Effects in Medical Communication: A Meta-analytic Review" by Debra L. Roter, DrPH, Judith A. Hall, PhD, and Yutaka Aoki, MS, MPH, ME. It is published in the August 14, 2002, issue of the Journal of the American Medical Association (JAMA)
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