Layna Holk

Allison Jalbert

Kiersten Laramee

Maria Munschy

Julia Winterhalter

Introduction

This paper discusses the influence of sex on physician-patient verbal communication.

Both the physician and patient bring their own attitudes and beliefs, expectations, and

communication styles to their medical interaction. Our paper explores the effect of social roles,

communication styles, verbal communication and patient-centeredness on same-sex physician-

patient dyads. The significant differences in the medical practices of male and female physicians

are examined in order to determine the impact on physician-patient interaction and its outcomes.

Based on social exchange theory, we focus on the cost-benefit analysts that patients use to

evaluate their physician and overall patient satisfaction. The study correlates the effect of social

roles, communication styles, verbal communication and patient-centeredness on patient

disclosure of health problems. 

Literature Review

The research showed that general practitioners often filled their expected sex social roles.

Male physicians tend to control medical consultations more than their female counterparts due to

the fact that men are typically more authoritative speakers. Comparatively, female physicians

tend to let patients have more control over the consultation by asking questions. 

In general men are often perceived as being more authoritative, demanding, standoffish,

and hostile, all of which leads to a tense, unwelcoming environment that makes it difficult
getting others to disclose. Male physicians were far more likely to interrupt the patient and ask

questions of little to no importance during a consultation or appointment. Their questions led to

the patients feeling stressed and not as forthcoming with their concerns and problems (Menz et

al., 2008). 

Another study looking at patient disclosure to physicians in different situations found that

overall, male physicians were seen as using more medical jargon which confused patients and

made them less likely to partake in open communication. However, male patients still preferred

to have a male doctor when discussing genital problems, due to how intimate the problem and

examination are (Delgado et al., 2011).

It was not just physicians’ behaviors that dictated the social roles they filled. Patients

judged how physicians would treat them and speak around them even before they met the

physician. These expectations had created barriers and stereotypes that already disrupted the

patient’s level of disclosure resulting in them sharing less with the physicians. This was

especially prevalent in male physician and male patient relationships, where the perceived, once

again, as being more authoritative (Wang et al., 2014).

The other side to these articles is how female physicians interact with their patients,

which is in an empathetic and supportive fashion. As proven by Nicolai et al. (2007) when they

studied physicians’ behaviors and how they were perceived by patients. Overall both men and

women patients perceived female physicians as being more empathetic, thus being easier to

disclose to about problems.

Patients perceptions about female physicians being more empathetic however is not

limited to just the health sector. Male and female patients prefer to speak with female physicians

when discussing psychological problems because they offer a more interpersonal and relational
approach due to the fact that females are also seen as being more empathetic and having a more

humane approach to speaking with patients (Delgado et al., 2011).

Female physicians further reinforce this empathetic stereotype when conducting an

examination or consultation. On average female dyads had longer consultations and more

personal consultations than any other pairing of physicians and patients. This led to more patient

satisfaction however compared to other dyads, be it the same or varying sexes (Sandhu et al.,

2009).

According to a study conducted by Menz et al. (2008), during consultations with female

dyads when physicians interrupted the patient it was in a supportive way. The interruptions

occurred when the physician had a question or offered up possible symptoms that the patient

might also be suffering from. The whole conversation though stayed patient focused and was

constructive rather than stressful, as was the case with male physicians.

            Overall the literature shows that female physicians were more empathetic and

cooperative than male physicians, which led to their patients leaving their examination more

satisfied. Male physicians, on the other hand, were seen as being more authoritative which led to

patients not disclosing as much and feeling stressed rather than satisfied with their examination.

Patients would still rather have a physician of the same gender when getting an examination. 

On the basis of the social exchange theory, patients that do not receive meaningful

communication from their physician are less likely to build an emotional relation to them,

therefore deterring them from sharing personal information (Bakker et al., 2000). Jiang’s (2015)

research study states that when people share more with others, their relationship will strengthen,

and they will especially benefit more when that relationship is with someone of the same sex.

Based on this research, patients will receive more benefits from their relationship with their
physician when they are willingly being open with one another. Bakker et al. (2000) further

states that physicians can potentially experience the burnout syndrome, where their lack of

emotional reciprocity decreases the likelihood of creating a good patient-physician relationship.

In some cases, sharing too much when communicating with someone could actually deteriorate

the relationship and cause one person to pull back (Weisel, 2007). A physician’s attitude may

turn negative towards their over-sharing patient and have an effect on how willing they are to

share in the future. Physicians are concerned with their patient’s overall healthcare; therefore,

sex has little to no impact on whether or not the relationship will benefit from the interaction

(Hermansen, 2001). Patients are looking to get the most benefits out of their relationship with

their physician, so the impact of sex on the social exchange theory is relatively small.

According to previous research, communication styles vary based on the sex of both the

physician and patient. Studies have shown that patients, both male and female, are more likely to

open up to a female physician about their health concerns due to their nurturing and empathetic

behaviors (Bertakis, 2009). The environment created by a female physician’s communication

style is much more acknowledging and relationship-building than those provided by male

physicians. This has a great impact on how comfortable patients are during their medical visits

and how likely they are to open up about medical issues. Delgado et al. (2011) found that

patients wanting a more interpersonal relationship with their physicians are likely to opt for a

female one, rather than preferring one of the same sex. This study showed that it varies based on

the type of medical issue, as well, such as standard biomedical ones versus more intimate

problems. Patients looking for intimate, genital related medical help prefer a physician of the

same sex, prefer female physicians for psychosocial help, and have no preference for regular

checkups (Delgado et al., 2011). This puts female physicians at the forefront of patient
healthcare concerns and disclosure levels due to their ability to communicate in a more

reassuring and compassionate way. Male physicians, in nature, are very direct and assertive with

their patients when delivering medical information (Nicolai et al., 2007). Research has suggested

that this is due to them wanting to give the impression of being more dominant and masculine

towards their patients. When it comes to communicating general information, male physicians

interrupt conversations in ways that are less supportive, which steers the patient away from

further opening up (Menz et al., 2007). Female physicians, in contrast, have been shown to spend

more time discussing the patient’s psychological concerns and making sure that any topic

interruptions are constructive to the conversation (Bateman et al., 2017). Interpersonal

communication skills are reported to be very important in the consultation of a patient’s medical

information and influences their degree of openness with their physician.

Research has found that there may be relatively small margins for preference of physician

sex based on communication differences. Alecu’s (2019) study concluded that although patients

have shown preference towards female physicians due to their communication styles, the gap

between preferring male or female was not large. This is a potentially case for general physician

visits because they are not as intimate in conversation or procedure as one would be, for

example, with gynecologists or urologists. One of the studies conducted by Menz et al. (2008)

found that sex had little impact on how often a physician would interrupt a patient in an

unconstructive way. This lessened the patient’s willingness to open up to their physician, not due

to the sex relation between the two, but rather the overall level of communication comfortability

in the relationship. The communication tendencies of physicians have the ability to influence

how satisfied and comfortable a patient is during their consultation.

 When it comes to the verbal communication within the patient-physician relationship,

from medical jargon to patient-openness, there are a variety of instances and experiments that

will benefit our future findings. Connecting back to the preference of communication style based

on the sex of the physician or patient, Bertakis’ research study focused on how the gender of

both the physician and the patient can impact their communication of healthcare. Bertakis

hypothesized that gender plays a big role in whether or not patients will share intimate details

about their health to their general physician. The study found that patients feel more comfortable

with female physicians because they provide an environment that is more acknowledging and

relationship-building than the environment male physicians create, which is more assertive and

direct (Bertakis, 2009). Communication on its own can affect the medical process in many ways,

as Howard uncovered in their study that a patient with a lower health literacy is less likely to ask

questions to their provider and have a more difficult time understanding instructions. These

results showed that providers tend to use medical jargon more often than they claim to and did

not have their patients repeat information back to them as they so claimed as well (Howard,

2013). 

Mercer, Rose, Talerico, Wells, Manne, Vakharia, Kattan and others introduce an

alternative to Howard’s finding, as they curated the idea of patient involvement during the

medical decision-making process and what effect that has on the clinical or patient-centered care.

Taking Risk Calculators (RCs) into consideration as a determinant of delivering medical news,

good or bad, there are some potential barriers. From low numeracy skills, to physicians having

trouble explaining risk information, a RC with a visual decision aid (DA), may make the

decision-making process in the clinical setting, easier and a more shared decision. Of the

observed behaviors, 15 patients, 100%, had their physician refer to the RC&DA, with 80% even
being given the paper, and 100% of patients “appeared to read RC&DA” (Mercer, 2018, p. 171).

Of the audio recording, 14 of 15 dialogues were available, where it was uncovered that

physicians talked more in general, but when it came to discussing the RC&DA, patients talked

more than their doctors, whether asking about information on the medical condition, therapeutic

regimens, and lifestyle and psychosocial suggestions (Mercer et al., 2018). 

A final alternative to medical verbal communication findings, Wouda and va de Wiel

explain that the CanMEDS physician competency framework is used as the standard in medical

training, enabling physicians to have expertise in communication, with competencies they must

pass. With six factors complicating the learning of professional communication, Wouda and va

de Wiel adapted the reflective-impulsive model of social behavior to learn and describe how the

communication behavior of physicians is controlled and learned. After sustaining the

recommendations within their researched literature, the reflective-impulsive model of

communication behavior explains the limited results of education in communication, rather it

provides recommendations for the learning objectives and methods to improve. While the

implementation would require time, money and human resources, what Wouda and va de Wiel

can recommend is to use CanMEDS not as an endpoint, but as a useful guideline (Wouda, et al.,

2012). 

The patient-centeredness theory, providing care that is respective, responsive and

individually preferenced based on a patient’s needs and values during the medical process is

valuable information as we further examine their findings in preparation for our study. Gabbard-

Alley’s study conducted research on reviewing the relationship between health communication

and gender. It studied the relationship between patient gender, compliance, and satisfaction

(Gabbard-Alley 1995). Testing whether physicians have the behavioral adaptability to meet the
needs of their patients, as well as establish trust and satisfaction with the physician, a certain

study performed by Carrard (2018) measured a set of specific physician behaviors (behavioral

adaptive and interpersonally accurate) and the positive or negative outcomes they result in for the

patient. The results found nonverbal behavioral adaptability in female physicians was

significantly positively linked to patient outcomes (Carrard et al., 2018). The results of an

experiment conducted by Menz (2008) yielded some very interesting findings, first being that

gender had little to no influence on how often doctors interrupted the patients in a non-supportive

way, not adding to the discussions in a constructive way. Doctors were far more likely to

interrupt the patient and ask questions of little to no importance, which further confused and

diminished the patient's ability to open up. The second major finding of the study was that

female physicians and patients do more supportive interruptions than males. Meaning that when

they do interrupt the conversation stays patient focused and are constructive. Finally the more

practitioners interrupt patients the more likely patients are to develop stress and will never bring

up their main concern (Menz et al., 2008).

A study performed by Hall (2015) was set to prove that patients respond favorably to

physicians who provide a more personalized experience during an appointment. Hall’s study

supports this with results showing a “high patient-centered style” was favorable over a “low

patient-centered style,” (Hall, 2015). Lastly, taking success of medical interactions into

consideration, Cichon and Masterson began their study examining the effectiveness as well as

the role expectations between the physician and the patient’s communication.  To determine if

the fulfillment of role expectations has significant impact on the relationship of the physician and

patient, Cichon and Masterson examined whether these role expectations are congruent or

discrepant. Yielding a 49% response rate from faculty and staff, 46% from physicians, and 27%
from medical students, the questionnaire examined the roles of a humanistic practitioner or

communicator of scientific information physician, or the roles of a consumer or sick role patient.

Cichon’s Hypothesis 1 predicted higher physician expectations for patients in the sick role than

patient expectations, and Hypothesis 2 and 2a both predicted a younger physician and younger

patients would have high consumer expectations for patients. Hypothesis 3 and 5 were both

rejected, that that patients' expectations for humanistic practitioners would be higher than that of

physicians, and that younger physicians would have higher expectations of humanistic

practitioners (Cichon et al., 1993).

Rationale and Research Question

According to social exchange theory, relationships are formed through a cost-benefit

analysis to determine if the relationship is worthwhile. If the costs, traits which are negatively

viewed, outweigh the benefits, then the relationship will be unsuccessful. In a physician-patient

relationship, the communication styles may vary depending on sex, therefore; the

communication satisfaction between the physician and patient’s sex may differ. Similarly,

because the communication styles are different, what is considered cost to one sex may be

inapplicable to the other sex.

We know that sex can potentially affect the topic divulgence and satisfaction in

physician-patient relationships. Sandhu et al. (2009) found that female-female dyads had longer

consultations with more personal discussions than any other pairing. Comparatively, Wang et al.

(2014) found that female providers were perceived as friendly equals, whereas male providers

were perceived as more authoritative. Although both of these studies investigated how the

behavioral tendencies of men and women, verbal communication styles can lead to similar

results. 
 Patient-centeredness, as defined by Hall (2015) is the level at which a physician shows

empathy to their patients, asks open-ended questions and provides information and resources.

Typically, patients favor a high patient-centered style over a low patient-centered style, as found

by Hall (2015). Similarly, Menz et al. (2008) found that female physicians and patients practice

more supportive conversational interruptions than men. This means conversations stay patient

focused and constructive rather than asking questions with little importance which deter the

patient from opening up to their physician. 

Medical jargon and understanding may also affect the divulgence and satisfaction of

physician-patient communication. To create a comfortable environment while discussing

personal medical concerns, a physician may use simple terminology or listen to their patient’s

concerns without interruption. Bertakis’ (2009) found that patients felt more comfortable with a

female physician due to the caring environment they created which allowed for more relationship

building and acknowledgement. Furthermore, Howard (2013) found that physicians tended to

use medical jargon when talking to their patients and did not have their patients repeat the

information back to them as often as they claimed. 

Previous research has shown that patients are more satisfied and divulge more personal

information with a same-sex physician-patient dyad. Alternatively, research has also shown

indifference in physician sex. Delgado et al. (2011) found that, when it comes to a general

practitioner, most patients did not have a preference. Depending on the type of experience a

patient was looking for, a female physician for more relational conversations, or a male

physician for technical conversations, there was little preference when it came to general medical

appointments. Therefore, in an attempt to explore the relationship between female and male

physician-patient relationships, the following question is proposed:

Research Question:  Do same-sex physician-patient dyads result in increased patient topic

divulgence and visit satisfaction?