Psych 160b Physician Gender 1<\/p>\n
Running head: PHYSCIAN GENDER AND HEALTH<\/p>\n
Physician Gender and Health Care Services<\/p>\n
Student Name<\/p>\n
December 12, 2007<\/p>\n
Brandeis University<\/p>\n
Physician Gender and Health Care Services<\/p>\n
A vast body of research has demonstrated that there are gender differences between male and female physicians. These differences have been shown to exist in several different ways across several domains. Research has demonstrated differences in the length of time physicians spend with their patients, the ways that physicians communicate with their patients, and the amount and type of services a physician is likely to provide their patients (Bylund & Makoul, 2002; Hall et al., 1990; Henderson & Weisman, 2001; Lurie et al., 1993; Roter, Geller, Bernhardt, Larson, & Doksum, 1999; Roter, Hall, & Aoki, 2002; Roter, Lipkin, & Korsgaard, 1991). <\/p>\n
Gender differences in how physicians deal with and treat their patients are significant because research has demonstrated that these differences can lead to differences in patient satisfaction and perceptions of their physician (Fennema, Meyer, & Owen, 1990; Schmittdiel et al., 2000). Additionally, it is important to consider factors other than gender of physician that may account for differences in patient treatment and patient satisfaction. <\/p>\n
Length of Visit<\/p>\n
Research has demonstrated that the amount of time a physician spends with her or his patient may vary according to the gender of the physician. In one study, Roter et al. (1991) coding the audiotaped recordings of 537 patient-physician interactions, found that the average time female physicians spent with their patients was more than two minutes longer than the average time male physicians spent with their patients. Additionally, the researchers found that the length of the visit was longer when the patient and the physician were of the same gender. Several years later, Roter et al. (2002) expanded on their previous research and conducted a meta-analysis in which they reviewed the findings of twenty-six studies examining the differences between male and female physicians. The studies included in this meta-analysis examined medical students, physicians, or physicians in training. Roter et al. (2002) found once again that in general female physicians spent longer with their patients than did male physicians. <\/p>\n
In contrast to the results of Roter et al. (1991) and Roter et al. (2002), Roter et al. (1999) found that male obstetricians spent longer with their patients than did female obstetricians. Roter et al. (1999), coding audiotapes of the first prenatal visit women had with their obstetrician, found that male obstetricians spent on average 5.5 minutes longer with their patients than did female obstetricians. This study was included in the meta-analysis conducted by Roter et al. (2002) and was the only study to find that male physicians spent longer with their patients than did female physicians. The most significant difference between this and other studies is that this study examined only obstetricians. It is possible that male obstetricians were working extra hard to compensate for the fact that female patients show a strong preference for female obstetricians (Elstad, 1994; Pearse, 1994; Roter & Hall, 1995, as cited by Roter et al., 2002). Additionally, Roter et al. (1999) pointed out that a very small proportion of obstetricians contacted actually participated in their study. This could skew the results because the small percentage of obstetricians that did decide to participate may not fairly reflect the practices of obstetricians as a group (Roter et al., 1999). Their willingness to participate may reflect a general comfort in communicating with their patients that may be greater than that of obstetricians unwilling to participate. It is unlikely however that this skewed the results significantly because this characteristic would likely be the same for both the male and female obstetricians. <\/p>\n
Based on the initial results of Roter et al. (1991) and the later meta-analysis of Roter et al. (2002), it seems clear that female physicians spend longer with their patients than do male physicians. When examining only obstetricians, however, males spent longer with their patients than did females. More research needs to be conducted on this topic in order to examine the causes of the discrepancy between physicians in general and obstetricians specifically and to examine the relationship between the amount of time spent with patients and patient satisfaction and quality of care.<\/p>\n
Ways of Communication<\/p>\n
Research has demonstrated that female and male physicians differ in how they communicate with their patients. These differences are reflected, not only in the amount of time that physicians talk with their patients, but also the techniques physicians use in their communication with their patients, the topics physicians discuss with their patients, and the empathy physicians provide their patients. <\/p>\n
Research has demonstrated that female physicians talk more with their patients than do male physicians. In research conducted by Roter et al. (1991), the researchers found that in addition to spending more time with their patients, female physicians talked more than male physicians did and that patients seeing female physicians talked more than patients seeing male physicians did. Roter et al. (1991) found this effect was only significant during the history portion of the visit and the examination portion of the visit. They point out, however, that the history portion of the exam is an important time because the patient and the physician discuss which issues of the visit will be the most important to delve into more deeply (Roter et al., 1991). <\/p>\n
Male and female physician discussion techniques also vary. Roter et al. (1991) coded 500 patient-physician interactions and found that female physicians, more than male physicians, used positive-talk, used tasks that built partnerships with their patients, asked their patients more questions, and provided their patients with more information. In a meta-analysis that was later conducted by Roter et al. (2002), the researchers found that female physicians engaged in more positive talk than did male physicians and engaged in more behaviors that encouraged their patient to participate in the medical conversation than did male physicians. These results, similar to the results of previous literature, demonstrate that female physicians are more emotionally involved with their patients. <\/p>\n
Roter et al. (1999) found these results to be somewhat different when only obstetricians were examined; male obstetricians were more likely to check for their patients\u2019 understanding and to show concern for their patients than female obstetricians were. One possibility for this discrepancy is that obstetrics is a field that requires a higher level of emotionality overall and, therefore, males that choose to be obstetricians may have higher levels of emotionality. This is further supported by the results of Roter et al. (2002), who showed that male obstetricians spent longer with their patients than did female obstetricians. <\/p>\n
Additionally, male and female physicians discuss different topics with their patients. Henderson and Weisman (2001) surveying 1,661 adult women and 1,288 adult men about their health care experiences and the services they had received, found that female physicians, more than male physicians, gave counseling services to their patients. This included counseling around sensitive topics and counseling about health habits. With female patients, this also included counseling that was specific to females (Henderson & Weisman, 2001). The researchers found that the effect of female physicians\u2019 talking more to their patients about sensitive topics than male physicians was the most significant of all the factors studied, including providing preventive services, counseling on health habits, and counseling on gender-specific topics. Roter et al. (1991) demonstrated that female physicians used techniques that allowed them to communicate with their patients on a more personal level. Similarly, Henderson and Weisman (2001) showed that female physicians were more likely to provide counseling services to their patients, which requires inter-personal communication. The results of Henderson and Weisman (2001), therefore, are consistent with the results of Roter et al. (1991) in that both studies demonstrate that female physicians are more likely to communicate on a personal level with their patients. <\/p>\n
Another important factor in patient-physician communication is the amount of empathy displayed by the physician. A study conducted by Bylund and Makoul (2002) showed that female physicians were more likely to display empathy toward their patients than were male physicians. In this study, the researchers created a coding system called the \u201cEmpathic Communication Coding System (ECCS)\u201d (Bylund & Makoul, 2002, p. 207), which they used to code the level of empathy that physicians demonstrated toward their patients. The researchers found overall no gender differences in the patients\u2019 likelihood to create an opportunity for the physician to demonstrate empathy. The researchers found, however, that female physicians provided responses with higher levels of empathy than did male physicians. Henderson and Weisman (2001) demonstrated that female physicians were more likely than male physicians were to provide counseling services to their patients and Roter et al. (1991) demonstrated that female physicians spent more time and engaged in more partner-building tasks with their patients than did male physicians. The results of Bylund and Makoul (2002) are consistent with these results because they again demonstrate the female physician engaging emotionally with her patient. These results suggest therefore that patients may receive care that is more emotionally and personally supportive with a female physician than they do with a male physician. <\/p>\n
It is also important to consider how physician gender affects patient communication. Hall and Roter (2002) conducted a meta-analysis in which they examined the results of seven studies that looked at how patients interact with female compared to male physicians. The researchers found overall that patients talk more with, provide more information to, and provide more comments that are positive to female rather than male physicians. They also found that when dealing with a female physician, patients were more assertive than if they were dealing with a male physician. The researchers speculate, and I agree, that this could be a result of the patients\u2019 feeling more empowered with female physicians (Hall & Roter, 2002). In contrast to these results, Roter et al. (1999) found that patients were no more likely to talk with female obstetricians than with male obstetricians. Because this study examined obstetricians and not general practice doctors, this difference could be related to a heightened need for patients, with male and female physicians alike, to talk during a visit with an obstetrician. Roter et al. (1999) examined only the first pre-natal visit that patients had with their obstetrician and therefore a lot of talking may be necessary regardless of the physician\u2019s gender. <\/p>\n
Amount and Types of Services<\/p>\n
Research has also demonstrated that the gender of the physician affects the amount of preventive services that their patients receive. Henderson and Weisman (2001) hypothesized that communication differences that exist because of socialized gender differences may be a cause for the difference in rates of preventive treatment provided by female versus male physicians. In a study conducted by Hall et al. (1990), the researchers evaluated the quality of care that staff physicians, resident physicians, and nonphysician health care providers provided their patients with regard to several medical tasks. Researchers found that when male and female physicians were rated by other physicians on the effectiveness of their cancer screening, female staff physicians received higher ratings than did male staff physicians. However, the researchers found that male residents were evaluated more highly for their treatment of urinary tract infections in children than were female residents. These results are interesting because they demonstrate gender differences that are dependent on the level of experience of the physician; patients receiving care from physicians with more experience, a positive attribute that is likely sought out by those patients, will experience this gender difference. The gender differences in quality of urinary tract infection treatment is seen only in residents, which means this gender discrepancy could decrease or disappear as the female residents gain more experience with the treatment of urinary tract infections. <\/p>\n
Research conducted by Schmittdiel et al. (2000) contradicts the results found by Hall et al. (1990), Henderson and Weisman (2001), and Lurie et al. (1993). Schmittdiel et al. (2000) surveyed 10, 205 patients between 35 and 85 years old in large HMO groups. The researchers found that patients reported no differences in the amount of preventive screening that was provided to them whether their physician was male or female. <\/p>\n
There are several reasons why Schmittdiel et al. (2002) found results that are different from the findings of Hall et al. (1990) and Lurie et al. (1993). First, Hall et al. (1990) and Lurie et al. (1993) actually examined physician practices, whereas Schmittdiel et al. (2002) only surveyed patients about their experiences. The results of Schmittdiel et al. (2002) therefore may be undermined by patient reporting factors. The patients may not remember their experiences, for example. Additionally, while Schmittdiel et al. (2002) and Henderson and Weisman (2001) looked only at primary care physicians, Hall et al. (1990) looked at physicians, staff physicians, and resident physicians and Lurie et al. (1993( looked at physicians in primary care, obstetrics-gynecology, internal medicine, and family practice. It is possible that the discrepancy in results could be because Schmittdiel et al. (2002) did not look at gender differences with other types of physicians. Lastly, the study conducted by Schmittdiel et al. (2002) was conducted nearly ten years later than most of the previous studies. The recency of this study, therefore, could demonstrate progress, in that the physician gender differences in amount of preventive services provided could be disappearing. Because of the discrepancy between this study and previous literature, future research should take into account both the type of physician and the way that physicians are evaluated.<\/p>\n
Additionally, studies on preventive services specific to women are important to consider. According to Lurie et al. (1993), women who do not seek out services to screen for breast cancer and cervical cancer provide as the main reason that these services are not recommended or offered by their physicians. Because of this, it is important to consider which factors affect whether physicians provide female-specific preventive services to their female patients (Lurie et al., 1993). Hall et al. (1990) found that female staff physicians were more likely than male staff physicians were to provide pap smears and breast examinations to their female patients. The researchers suggest that this may be because female physicians with more experience become increasingly sensitive to these issues (Hall et al., 1990). <\/p>\n
In another study, conducted by Lurie et al. (1993), rates of mammograms and Pap smears administered to 97, 962 female patients were examined. The researchers looked at physicians in primary care, obstetrics-gynecology, internal medicine, or family practice (Lurie et al., 1993). The researchers found that female physicians were more likely than male physicians were to administer Pap smears and mammograms. These results were not found in physicians that were roughly fifty years old and the gender difference was the largest among family practitioners and internists. Additionally, Henderson and Weisman (2001) found that female physicians were more likely to provide their female patients screening services that were gender-specific than were male physicians. Lurie et al. (1993) suggest that the discrepancies in male and female physicians\u2019 likelihood to provide preventive services specific to women\u2019s health may be due to the males\u2019 discomfort in discussing these issues with female patients. Additionally, Hall et al. (1990) suggest that female physicians with more experience may become more sensitive to screening for gender-specific cancer in women. Therefore, research needs to be done to examine why male physicians are less likely to provide female-specific preventive services so that women have greater access to preventive services. <\/p>\n
Patient Satisfaction<\/p>\n
Research on differences between male and female physicians is important because physicians\u2019 interactions with their patients affect the patients\u2019 satisfaction with their physicians. In one study, researchers administered a four-part questionnaire to 185 adult patients with questions regarding the patients\u2019 preference for male versus female physicians, the patients\u2019 views about certain characteristics related to gender differences in physicians, and questions about how the patients prioritized certain characteristics of physicians\u2019 behavior (Fennema et al., 1990). The researchers found that women were more likely than men were to express a preference for a same-sex physician for their overall health care. Additionally, they found that patient preferences for same-sex physicians were most likely to occur with genital or anal examinations. Additionally, it has been demonstrated that female patients are more satisfied with female physicians than with male physicians (Comstock, Hooper, Goodwin, & Goodwin, 1982, as cited by Lurie et al., 1993). In addition, patients were more likely to prefer using a female physician when the concern was about depression or family problems. These results demonstrate that, for issues such as depression and family problems, female physicians are preferred and that for sensitive and private medical issues, same-sex physicians are preferred. <\/p>\n
Another study demonstrated no differences in patient preference for female versus male physicians (Hall & Roter, 1998, as cited by Roter et al., 2002). Because of the wide discrepancies in patient satisfaction, more research needs to be conducted to explore the links between physician gender and patient satisfaction, and to delineate what other factors could account for differences in satisfaction. Because the studies that demonstrate preferences for a particular gender of physician generally show that the gender of the patient affects these preferences, research should be conducted to see whether the underlying cause of satisfaction is simply a matter of the patient\u2019s preference for a same-sex physician. <\/p>\n
Other Factors<\/p>\n
Factors other than physician gender have been shown to affect the type and quality of care that patients receive and to affect patient satisfaction. Henderson and Weisman (2001) found that women who saw OB\/GYN doctors in addition to or instead of a generalist were more likely to receive better preventive care than those seeing only a generalist. This finding demonstrates that physician specialty is also a factor in the quality of care provided to patients. In a meta-analysis conducted by Roter et al. (1999), male obstetricians spent longer with, talked more with, and showed more concern for their patients than did female obstetricians. These results are in contrast with several other results discussed and this is likely due to the specialty of the physician being different. <\/p>\n
Additionally, as previously discussed, female patients were more likely than male patients were to express a preference for a same-sex physician and were more satisfied with female physicians than with male physicians (Comstock, Hooper, Goodwin, and Goodwin, 1982, as cited by Lurie et al., 1993; Fennema et al., 1990).<\/p>\n
Another factor that may be important is the patient\u2019s level of experience with his or her physician. Fennema et al. (1990) found that females who had more experience with female physicians were more likely than female patients without experience with female physicians were to show a preference for female physicians. Additionally, Roter et al. (1999) found that patients demonstrated higher levels of satisfaction interacting with physicians with whom they already had experience. It could be therefore that a preference for female physicians may be a result of more experience with female physicians. <\/p>\n
Conclusion<\/p>\n
Several studies have demonstrated that female and male physicians differ in the length of visits they conduct with their patients, the way they communicate with their patients, and the amount of preventive services they provide their patients. Within these general results, the extent, nature, and underlying causes of these physician gender differences vary. Additionally, factors related to the patient, such as the patient\u2019s gender and the patient\u2019s level of experience with the physician, affect patient satisfaction with physicians of one gender versus the other.<\/p>\n
Further research should be conducted to improve patients\u2019 experiences with physicians of both genders. While factors other than physician gender affect the quality and type of care that is provided to patients, overwhelmingly research demonstrates that physician gender plays a significant role in the quality and type of care provided. More research needs to be conducted to examine the underlying causes of these gender differences, the implications of these gender differences on the quality of care provided to patients, and possible remedies for these gender differences so that both male and female physicians can increase the quality of their care. <\/p>\n
References<\/p>\n
Bylund, C.L., & Makoul, G. (2002). Empathic communication and gender in the physician-patient encounter [Electronic version]. Patient Education and Counseling, 48, 207-216.<\/p>\n
Fennema, K., Meyer, D.L., & Owen, N. (1990). Sex of physician: Patient\u2019s preferences and stereotypes [Electronic version]. Journal of Family Practice, 30, 441-446.<\/p>\n
Hall, J.A., Palmer, H., Orav, E.J., Hargraves, L., Wright, E.A., & Louis, T.A. (1990) Performance quality, gender, and professional role: A study of physicians and nonphysicians in 16 ambulatory care practices [Electronic version]. Medical Care, 28, 489-501.<\/p>\n
Hall, J.A., & Roter, D.L. (2002). Do patients talk differently to male and female physicians? A meta-analytic review [Electronic version]. Patient Education and Counseling, 48, 217-224.<\/p>\n
Henderson, J.T., & Weisman, C.S. (2001). Physician gender effects on preventive screening and counseling: An analysis of male and female patients\u2019 health care experiences [Electronic version]. Medical Care, 39, 1281-1292.<\/p>\n
Lurie, N., Slater, J., McGovern, P., Ekstrum, J., Quam, L., & Margolis, K. (1993). Preventive care for women\u2014Does the sex of the physician matter? [Electronic version]. The New England Journal of Medicine, 329, 478-482.<\/p>\n
Roter, D.L., Geller, G., Bernhardt, B.A., Larson, S.M., & Doksum, T. (1999). Effects of obstetrician gender on communication and patient satisfaction [Electronic version]. Obstetrics & Gynecology, 93, 635-641.<\/p>\n
Roter, D.L., Hall, J.A., Aoki, Y.A. Physician gender effects in medical communication [Electronic version]. The Patient-Physician Relationship, 288, 756-764.<\/p>\n
Roter, D., Lipkin, M., & Korsgaard, A. (1991). Sex differences in patients\u2019 and physicians\u2019 communication during primary care medical visits [Electronic version]. Medical Care, 29, 1083-1093.<\/p>\n
Schmittdiel, J., Grumbach, K., Selby, J.V., & Quesenberry, C.P. (2002). Effect of physician and patient gender concordance on patient satisfaction and preventive care practices [Electronic version]. Journal of General Internal Medicine, 15, 761-769.
Table 1<\/p>\n
Summary of Research Results<\/p>\n
Length of Visit<\/p>\n
Ways of Communication<\/p>\n
Amount of Preventive Services<\/p>\n
Roter et al. (1991): Female physicians spent longer with their patients than did male physicians. <\/p>\n
Roter et al. (1991): Female physicians talked more with their patients than did male physicians. <\/p>\n
Henderson and Weisman (2001): Female physicians were more likely to give out screening services than were male physicians. <\/p>\n
Roter et al. (2002): Female physicians spent longer with their patients than did male physicians. <\/p>\n
Bylund and Makoul (2002): Female physicians showed more empathy toward their patients than did male physicians. <\/p>\n
Hall et al. (1990): Female staff physicians were more likely to provide cancer screening, pap smears, and breast examinations to their patients than were male staff physicians. <\/p>\n
Roter et al. (1999): Male obstetricians spent longer with their patients than did female obstetricians. <\/p>\n
Roter et al. (1991): Female physicians used more interpersonal communication techniques than did male physicians. <\/p>\n
Lurie (1993): Female physicians were more likely to provide their patients pap smears and mammograms than were male physicians. <\/p>\n
Roter et al. (2002): Female physicians used more interpersonal communication than did male physicians. <\/p>\n
Roter et al. (1999): Male obstetricians demonstrate more concern for their patients than did female obstetricians. <\/p>\n
Henderson and Weisman (2001): Female physicians provided more counseling services to their patients than did male physicians.<\/p>\n
Hall and Roter (2002): Patients talked more with female physicians than they did with male physicians. <\/p>\n
Roter et al. (1999): Patients were no more likely to talk with male obstetricians than they were with female obstetricians. <\/p>\n
Grading Scheme for Literature Review Assignment – <\/p>\n
Writing Style \u2013 15 points \u2013 14<\/p>\n
Spelling, grammar, punctuation, capitalization, sentence structure, fluency of writing, word choice<\/p>\n
Writing Structure and Organization \u2013 15 points \u2013 14.5<\/p>\n
Clear thesis statement, organization of paper, introduction and conclusion; Reader is provided with strong “umbrella” sentences at beginnings of paragraphs, “signposts” throughout, and brief “so what” summary sentences at intermediate points in the review to aid in understanding comparisons and analyses<\/p>\n
Paper Content \u2013 60 points \u2013 58<\/p>\n
Abstract: provides a brief summation of the topic, the general organization (your common denominators), and some general conclusions. <\/p>\n
Introduction: defines\/identifies the topic, providing an appropriate context for reviewing the literature and points out overall trends in what has been published, establishes your reason for writing the literature review. <\/p>\n
Body: research is organized around common denominators; individual studies are summarized with as much or as little detail as each merits according to its comparative importance (length = significance); <\/p>\n
Conclusions: provides summaries of major contributions of significant studies\/articles to the body of knowledge under review, maintains the focus established in the introduction, evaluates the current “state of the art” for the area reviewed, points out major methodological flaws, gaps in research, inconsistencies in theory and findings, and areas or issues pertinent to future study. Paper provides insight into the connections between the specific topic and the overall area, or some application.<\/p>\n
APA Style and Citations \u2013 10 points \u2013 9<\/p>\n
Parenthetical citations, headings, and reference section follow APA guidelines<\/p>\n
Writing Style \u2013 keep working on writing more actively and directly. Avoid wordy sentence and phrase constructions. Your comparison style could still use some work.<\/p>\n
Writing Structure and Organization \u2013 the table you made definitely helped with organization. Nice job! And very good structure to your paper overall. Except, maybe, the paragraph in which you were dealing with sex differences in topics.<\/p>\n
Paper Content \u2013 Please note that it is generally customary to include an abstract, even when you are writing a literature review. I didn\u2019t take off for it because I realized I had never made that clear in class (so few of you who did lit reviews included one ); just thought I would let you know.<\/p>\n
Abstract \u2013 n\/a<\/p>\n
Introduction \u2013 good introduction to your literature review<\/p>\n
Body \u2013 good analysis of the strengths and weaknesses of the study. Also, good integration of the studies. This was very well organized! You pulled out the themes nicely<\/p>\n
Conclusion \u2013 great conclusion! <\/p>\n
Total points \u2013 <\/p>\n
APA Citations and Reference section \u2013 just a couple of minor mistakes on your reference section. Similarly, just a couple of minor mistakes on parenthetical citations.<\/p>\n","protected":false},"excerpt":{"rendered":"
Psych 160b Physician Gender 1 Running head: PHYSCIAN GENDER AND HEALTH Physician Gender and Health Care Services Student Name December 12, 2007 Brandeis University Physician Gender and Health Care Services A vast body of research has demonstrated that there are gender differences between male and female physicians. These differences have been shown to exist in […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[10],"class_list":["post-91622","post","type-post","status-publish","format-standard","hentry","category-research-paper-writing","tag-writing"],"_links":{"self":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/91622","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/comments?post=91622"}],"version-history":[{"count":0,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/91622\/revisions"}],"wp:attachment":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/media?parent=91622"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/categories?post=91622"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/tags?post=91622"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}