Physician's gender,communication style,patient preferences and patient satisfaction in gynecology and obstetrics: A systematic review

Objective

Review of studies published in the last 10 years about women seeking gynecological- or obstetrical care and physician's gender in relation to patient preferences, differences in communication style and patient satisfaction.

Methods

Studies were identified by searching the online databases PubMed, PsycINFO, Embase and the Cochrane Library. The search strategies ‘gender’; ‘obstetrics’ and ‘gynecology’ were combined with ‘communication’; ‘physician–patient relations’; ‘patient preference’ and ‘patient satisfaction’.

Results

After screening title and abstract, evaluating full text and quality assessment, 9 articles were included in this review. Most patients preferred a female rather than a male gynecologist–obstetrician. This was partly explained by a more patient-centered communication style used by female gynecologists–obstetricians. Also experience and clinical competence were important factors in choosing a gynecologist–obstetrician. It was not clear whether patient's age or ethnicity influenced patients gender preference. Patient satisfaction increased when gynecologists–obstetricians used a patient-centered communication style.

Conclusion

Preference for a female gynecologist–obstetrician might be explained by a more patient-centered communication style used by female gynecologists–obstetricians. Using a patient-centered communication style increases patient satisfaction.

Practice implications

To increase patient satisfaction, gynecologists–obstetricians should learn to integrate patient-centered communication style into the consultation.     

The impact of gender dyads on doctor–patient communication: A systematic review

Objective

Systematic review of evidence about the impact of gender dyads on clinician–patient communication.

Methods

Search of Medline, CINAHL and PsychINFO (1960–2007) and the British Library of grey literature, and hand searching of Patient Education and Counselling and Social Science and Medicine (2005–2007), returning 648 articles. Ten studies met all inclusion criteria.

Results

Gender dyads influenced the patient agendas elicited, talk content, communication style, non-verbal communication, the exhibition of power, and consultation length. Consultation length was studied and affected by gender dyads more frequently than any other phenomenon. Distinctive differences between the dyads were identified, largely as expected, but with some surprises. For example, female/female dyads were the most patient-centred, and had longer consultations containing the most talk. However they also contained the most bio-medical talk.

Conclusion

The evidence base is small, and a more rigorous approach to reporting quality indicators is needed. However, observed dyad differences may provide different opportunities for effective communication and clinical outcomes for patients. Further research with a primary focus on gender dyad effects is needed to test this.

Practice implications

Findings have implications for policy, healthcare organisations, and individual doctors alike, raising awareness about workforce issues and communication skills training needs in particular.     

Loss of patient centeredness in interpreter-mediated primary care visits

ObjectivesTo explore consequences of interpreter mediation of visit communication on patient centered dialogue and patient satisfaction with interpreter listening.MethodsFifty-five professionally interpreted primary care visits were coded using the Roter Interaction Analysis System (RIAS). Two corresponding quantitative measures of patient-centered dialogue were calculated as ratios of psycho-emotional to biomedical statements based on (1) patient and clinician expressed codes and (2) interpreter conveyed codes. Multilevel models examined consequences of interpreter mediation on patient-centered dialogue and patient ratings of interpreter listening.ResultsStudy participants included 27 Cantonese, 17 Mandarin and 11 Spanish-speaking primary care patients and 31 of their clinicians. Overall, clinicians expressed 2.26 times more statements and patients expressed 1.74 times more statements than interpreters conveyed. Interpreters conveyed significantly less patient-centered dialogue than expressed by patients and clinicians. All differences were evident within each study language. Interpreter conveyed patient centered dialogue positively predicted patient ratings of interpreter listening (B = 0.817; p < .007).ConclusionsThe level of interpreter-conveyed patient-centered dialogue was both substantially lower than that expressed by patients and clinicians and a positive predictor of patient satisfaction with interpreter listening.Practice implicationsFuller interpretation of patient-centered dialogue may enhance patient experience with interpreters and thereby increase care quality.     

Physician gender,physician patient-centered behavior,and patient satisfaction: A study in three practice settings within a hospital

Objective

To compare male and female physicians on patient-centeredness and patients’ satisfaction in three practice settings within a hospital; to test whether satisfaction is more strongly predicted by patient-centeredness in male than female physicians.

Methods

Encounters between physicians (N = 71) and patients (N = 497) in a hospital were videotaped and patients’ satisfaction was measured. Patient-centeredness was measured by trained coders.

Results

In the outpatient setting, female physicians were somewhat more patient-centered than male physicians; patient satisfaction did not differ. In the inpatient and emergency room settings, female physicians were notably more patient-centered than male physicians; satisfaction paralleled these differences. Nevertheless, there was some, though mixed, evidence that patient-centeredness predicted satisfaction more strongly in male than female physicians, suggesting that patients valued patient-centered behavior more in male than female physicians.

Conclusion

Even though satisfaction mirrored the different behavior styles of male and female physicians in the inpatient and emergency room settings, in all settings male physicians got somewhat more credit for being patient-centered than female physicians did.

Practice implications

If female physicians do not consistently receive credit for high patient-centeredness in the eyes of patients, this could lead female physicians to reduce their patient-centered behavior.     

The impact of patient and physician computer mediated communication skill training on reported communication and patient satisfaction

Objective

The objective was to evaluate parallel patient and physician computer-mediated communication skill training on participants’ report of skill use and patient satisfaction.

Methods

Separate patient and clinician web-tools comprised of over 500, 10-s video clips demonstrating patient-centered skills in various ways. Four clinician members of the American Academy of Family Physicians National Research Network participated by enrolling 194 patients into a randomized patient trial and 29 physicians into a non-randomized clinician trial of respective interventions. All participants completed baseline and follow-up self-report measures of visit communication and satisfaction.

Results

Intervention patients reported using more skills than controls in five of six skill areas, including identification of problems/concerns, information exchange, treatment adherence, shared decision-making and interpersonal rapport (all p < .05); post intervention, physicians reported using more skills in the same 5 areas (all p < .01). Intervention group patients reported higher levels of satisfaction than controls in five of six domains (all p < .05).

Conclusion

Communication skill training delivered in a computer mediated format had a positive and parallel impact on both patient and clinician reported use of patient-centered communication and in patient satisfaction.

Practice Implications

Computer-mediated interventions are cost and time effective thereby increasing patient and clinician willingness to undertake training.     

Effect of gender and visit length on participation in pediatric visits

OBJECTIVE: To examine the effect of child, physician and parent genders as well as visit length on participation. METHODS: We analyzed videotapes and sociodemographics from 100 pediatric visits. Using the Roter Interaction Analysis System, coded utterances were aggregated to reflect key visit tasks: information giving, information gathering and relationship building. Negative binomial models were used to analyze how participation was associated with participants' genders and visit length. RESULTS: After adjustment, girls did twice as much relationship building as boys (incidence rate ratio = 2.33, 95% confidence interval = 1.01-5.36) and their physicians did 34% more information gathering (1.34, 1.16-1.55). Female physicians did 29% less information giving (0.71, 0.54-0.94). Having the father accompany the child reduced child relationship building 76% (0.24, 0.08-0.69) and reduced physician information giving 14% (0.86, 0.75-0.995), compared to having mother accompany. After adjusting for participants' genders, longer visits were associated with more participation for all participants. CONCLUSION: Child participation was impacted by child gender and by the accompanying parent's gender as well as the visit length. PRACTICE IMPLICATIONS: Because gender-based patterns of participation are evident in childhood, interventions to facilitate participation might begin early in life. To improve participation, interventions might include advocating for policies to support longer visit lengths.     

Talking about depression: An analogue study of physician gender and communication style on patient disclosures

Objectives

To disentangle the effects of physician gender and patient-centered communication style on patients’ oral engagement in depression care.

Methods

Physician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS).

Results

Both male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p < .05). APs were more willing to continue treatment with gender-discordant HPC physicians (p < .05). No effects were evident in the LPC condition.

Conclusions

Findings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender.

Practice implications

High patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads.     

Intensity of exposure to a patient activation intervention and patient engagement in medical visit communication

ObjectiveWe examined associations between intensity of exposure to a community health worker (CHW) delivered communication activation intervention targeting low-income patients with hypertension.MethodsWe analyzed question-asking behaviors of patients assigned to the intervention arms (n = 140) in a randomized controlled trial. Intensity of exposure to the intervention was operationalized as the duration of face-to-face coaching and number of protocol-specified topics discussed. Mixed effects models characterized the relationship between intensity of exposure and patients’ communication in a subsequent medical visit.ResultsThe number of topics discussed during the coaching session was positively associated with patients’ asking psychosocial-related questions during their visit. The duration of the coaching session was positively associated with patients’ use of communication engagement strategies to facilitate their participation in the visit dialogue. Exposure to a physician trained in patient-centered communication did not influence these relationships.ConclusionsA dose-response relationship was observed between exposure to a CHW- delivered communication activation intervention and patient-provider communication.Practice implicationsThis study supports the use of CHWs in activating patients toward greater communication in the therapeutic exchange.     

The influence of gender on the doctor–patient interaction

Objective

This paper discusses the research focused on gender issues in healthcare communication.

Methods

The majority of papers discussed here are based on a research study in which 509 new adult patients were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for one year of care.

Results

There are significant differences in the practice style behaviors of female and male doctors. Female doctors provide more preventive services and psychosocial counseling; male doctors spend more time on technical practice behaviors, such as medical history taking and physical examination. The patients of female doctors are more satisfied, even after adjusting for patient characteristics and physician practice style.Female patients make more medical visits and have higher total annual medical charges; their visits include more preventive services, less physical examination, and fewer discussions about tobacco, alcohol and other substance abuse (controlling for health status and sociodemographic variables).The examination of gender concordant and discordant doctor–patient dyads provides a unique strategy for assessing the effect of gender on what takes place during the medical visit.

Conclusion

Doctor and patient gender can impact the physician–patient interaction and its outcomes.

Practice implications

The development of appropriate strategies for the implementation of knowledge about physician and patient gender differences will be crucial for the delivery of high quality gender-sensitive healthcare.     

Further examination of the impact of patient participation on physicians' communication style

Objective

Previous research in primary care has shown that physicians are more informative and/or patient-centered when they interact with high participation patients (e.g., those who ask questions, express preferences and concerns). This study contributes to this literature by examining parents’ participation and physicians’ discourse in a pediatric surgery context.

Methods

The audiotapes of 7 pediatric surgeons and 68 of their patients’ parents/guardians were coded and examined for physicians’ information exchange and support utterances as they interacted with parents/guardians with varying degrees of participation.

Results

The results of a multilevel regression analysis showed, consistent with related research, that the same physicians were more informative overall and provided more information in response to parents’ questions when interacting with high participation parents. However, participation was not associated with physicians’ volunteered information, general explanations, or support utterances.

Discussion and conclusion

The results are discussed with respect to the impact of participation on physicians’ information provision and implications for future research, particularly with respect to general explanations, volunteered information, and medical context.

Practice implications

This study suggests that surgeons may provide more detailed information to patients who are active participants in the preoperative interview, thereby improving the adequacy and validity of informed consent for surgical procedures.     

Disentangling physician sex and physician communication style: their effects on patient satisfaction in a virtual medical visit

OBJECTIVE: The present study aimed to investigate the effect of physician sex and physician communication style on patient satisfaction. In real medical visits, physician sex and physician communication style are confounded variables. By using the virtual medical visit paradigm, we were able to disentangle the two variables and study their separate and/or joint effects on patient satisfaction. METHOD: In an experimental design, analogue patients (167 students) interacted with a computer-generated virtual physician on a computer screen. The patients' satisfaction during the visit was assessed. RESULTS: Depending on the sex composition of the dyad, physician communication style affected analogue patients' satisfaction differently. For instance, in male-male dyads, physician communication style did not affect the patients' satisfaction, whereas in female-female dyads, analogue patients were more satisfied when the physician adopted a caring as opposed to a non-caring communication style. CONCLUSION: Sex of the physician and sex of the patient moderate how different physician communication styles affect patient satisfaction. In particular, a female-sex role congruent communication style leads to higher patient satisfaction when women see a female physician. PRACTICE IMPLICATIONS: Physician communication training cannot be one size fits all. Rather female and male physicians should obtain different training and they need to be made aware of the fact that female and male patients harbor different expectations toward them.     

Waiting time,communication quality,and patient satisfaction: An analysis of moderating influences on the relationship between perceived waiting time and the satisfaction of breast cancer patients during their inpatient stay

ObjectiveWaiting time has been consistently found to be a significant predictor of patient dissatisfaction. The aim of this study is to examine whether positive communication experiences with health care providers could moderate the negative relationship between waiting time and patient satisfaction.MethodsData from a sample of 4626 breast cancer patients in Germany during their inpatient stay were analyzed. Multilevel logistic regression models were estimated in order to examine whether health literacy-sensitive communication (HL-COM) moderates the negative effects of perceived long waiting times on satisfaction. The models were adjusted for sociodemographic and clinical information and personality.ResultsPatients who perceived long waiting times were significantly less likely to be satisfied with treatment and with their hospital. Among patients who experienced high HL-COM, the negative relationship between perceived waiting time and satisfaction disappeared, with minimal differences in satisfaction between those who perceived waiting long and those who did not.ConclusionWhile waiting time persists as a significant predictor of satisfaction, this study finds that positive communication experiences with health care providers could potentially alleviate negative effects of long waiting time.Practice implicationsAlong with the ongoing efforts to reduce waiting time, the improvement of health literacy-sensitive communication could be instrumental in patients’ overall inpatient assessment.     

Analysis of the relationship among health awareness and health literacy,patient satisfaction levels with primary care in patients admitting to primary care health centers

Objective

The aim of the study was to examine the relationships between health literacy, primary care satisfaction levels and health awareness of the patients who were admitted to primary care centers (Family Health Centers).

Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions

ObjectiveTo report on patients’ satisfaction and experience of care across three different modes of weight loss counseling.Methods1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses.Results1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight.ConclusionRural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment.Practice implicationsPrimary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.     

Assessing validity of standardized patient ratings of medical students' communication behavior using the Roter interaction analysis system

OBJECTIVE: The primary objective of this study is to examine concurrent validity of standardized patient (SP) ratings of second year medical students' communication skills with the Roter interaction analysis system (RIAS). METHODS: We designed An Integrated Medical Encounter (AIME), to teach second year medical students the link between communication and clinical reasoning with emphasis placed on understanding the connection between biomedical and psychosocial aspects of patient care. We randomized 120 students to intervention (AIME) and control groups (non-AIME). Students completed two post-intervention SP encounters which were videotaped and coded using RIAS. SPs used a 30-item checklist to rate students' communication behaviors. RESULTS: There were no differences between AIME and non-AIME students in age, ethnicity, gender, or college major; however, more AIME students reported prior health professional work. SPs rated AIME students' rapport-building skills higher (mean [S.E.]: 4.1 [0.15] vs. 3.9 [0.15], p=0.05); however, there were no differences in data gathering, patient education/counseling. RIAS demonstrated that AIME students more frequently used rapport-building statements (60.4 [2.7] vs. 52.1 [2.8], p=0.03). CONCLUSION: The RIAS confirmed SP ratings of differences in AIME and non-AIME students' rapport-building skills. PRACTICE IMPLICATIONS: Future studies in medical education should further examine the minimum number of SP ratings needed to effectively evaluate communication skills curricula when resources are limited.     

The impact of residents sitting at the bedside on patient satisfaction during team rounds

ObjectivesPatient satisfaction ratings are a priority for academic medical centers. Sitting during patient encounters has been recommended as a “best practice.”¹ A prior study showed that hospitalists had higher-rated communication skills when sitting compared to standing at the bedside during rounds.² It is unclear whether the same is true of resident-led team rounds.MethodsWe performed a cluster-randomized crossover trial assigning 18 internal medicine residents to sit or stand at the bedside during rounds.ResultsA total of 347 patients were surveyed to assess physician communication skills. Standing residents received higher ratings than sitting residents on 2 of 5 survey items and rounding duration did not differ. These results differ from prior work that suggests sitting is superior to standing^2–6.ConclusionWe suspect that one rounding member sitting, while all others stand, is not enough to impact patients’ perceptions. These results suggest that initiatives to optimize patient satisfaction on resident-staffed units should be focused elsewhere.Practice implicationsPatients do not have better impressions of physician communication skills when one team member is sitting and the rest are standing.     

Adapting a patient satisfaction instrument for low literate and Spanish-speaking populations: comparison of three formats

Objective

To compare responses to print versions of the Consumer Assessment of Healthcare Providers and Systems 2.0 survey (CAHPS™) to those for an illustration enhanced format and a telephone based interactive voice response format.

Methods

First, 2015 adult patients awaiting primary care visits completed: demographic information, Test of Functional Health Literacy (S-TOFHLA), CAHPS in one of three formats: print, illustrated, or interactive voice. A second sample of 4800 active patients was randomized to receive alternative formats.

Results

Response rates for the illustrated (31.3%) and print (30.4%) formats were significantly higher than for the interactive voice format (18.1%). The results of the illustrated format were comparable to the traditional text version, but required about 2 min more to complete by both low and high literacy groups. There were almost no invalid responses for the interactive voice format, but the format was associated with lower CAHPS satisfaction scores.

Conclusion

Despite extensive efforts to produce formats tailored to individuals with limited literacy, surprisingly we found no consistent advantages to either alternative format. In fact, the interactive voice format yielded lower satisfaction scores and lower response rates.

Practice implications

Practitioners need to ensure the health instruments they use are aligned with literacy skills and delivery preferences of their consumers. The lack of benefit of the illustrated form does not support investment of resources in these formats to measure satisfaction. The interactive voice response deserves more study—do lower scores register limited access to or use of telephones, irritation or true signal?     

Characteristics of teach-back as practiced in a university health center,and its association with patient understanding,self-efficacy,and satisfaction

ObjectivesThe purpose of this research was to investigate the extent to which recommended characteristics of teach-back were employed by providers in a university Student Health Services department, and to evaluate its association with patient understanding, self-efficacy, and satisfaction.MethodThe study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded for presence and characteristics of teach-back. Patients and providers filled out post-encounter questionnaires.ResultsWhen teach-back was used, most recommended characteristics of teach-back were regularly employed. However, providers rarely placed the onus for understanding on themselves, and almost never “closed the loop” by asking patients to repeat back information until they got it correct. Teach-back was associated with higher patient self-efficacy, and high fidelity of implementation with better patient understanding of the reason for the treatment plan.ConclusionsFindings add to existing evidence regarding effectiveness of teach-back. Additional benefits may be realized when implementation is true to recommended characteristics. More research is needed into the necessity of closing the loop and placing onus on the provider.Practice implicationsGiven that neither patients nor providers accurately gauged the level of patient understanding in the medical encounter, teach-back may offer a simple, quick means of reinforcing provider health information and raising patient self-efficacy.