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Roter DL, Hall JA, Aoki Y. Physician Gender Effects in Medical Communication: A Meta-analytic Review. JAMA. 2002;288(6):756–764. doi:10.1001/jama.288.6.756
Author Affiliations: Departments of Health Policy and Management (Dr Roter) and Environmental Health Sciences (Mr Aoki), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; and Department of Psychology, Northeastern University, Boston, Mass (Dr Hall).
The Patient-Physician Relationship Section Editor: Richard M. Glass, MD, Deputy Editor.
Context Physician gender has been viewed as a possible source of variation in
the interpersonal aspects of medical practice, with speculation that female
physicians facilitate more open and equal exchange and a different therapeutic
milieu from that of male physicians. However, studies in this area are generally
based on small samples, with conflicting results.
Objective To systematically review and quantify the effect of physician gender
on communication during medical visits.
Data Sources Online database searches of English-language abstracts for the years
1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and Bioethics); a hand search was
conducted of reprint files and the reference sections of review articles and
Study Selection Studies using a communication data source, such as audiotape, videotape,
or direct observation, and large national or regional studies in which physician
report was used to establish length of visit, were identified through bibliographic
and computerized searches. Twenty-three observational studies and 3 large
physician-report studies reported in 29 publications met inclusion criteria
and were rated.
Data Extraction The Cohen d was computed based on 2 reviewers'
(J.A.H. and Y.A.) independent extraction of quantitative information from
the publications. Study heterogeneity was tested using Q statistics and pooled
effect sizes were computed using the appropriate effects model. The characteristics
of the study populations were also extracted.
Data Synthesis Female physicians engage in significantly more active partnership behaviors,
positive talk, psychosocial counseling, psychosocial question asking, and
emotionally focused talk. There were no gender differences evident in the
amount, quality, or manner of biomedical information giving or social conversation.
Medical visits with female physicians are, on average, 2 minutes (10%) longer
than those with male physicians. Obstetrics and gynecology may present a different
pattern than that of primary care, with male physicians demonstrating higher
levels of emotionally focused talk than their female colleagues.
Conclusions Female primary care physicians engage in more
communication that can be considered patient centered and have longer
visits than their male colleagues. Limited studies exist outside of
primary care, and gender-related practice patterns in some
subspecialties may differ from those evident in primary
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