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
Studies have linked physicians' communication skills to a variety of
positive outcomes, including patient and physician satisfaction, higher levels
of adherence to therapeutic recommendations, improved physiological indicators
of disease control, and enhanced physical and mental health status.1-3 Within this context,
gender has stimulated a good deal of interest 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.4-7
Outside of the medical context, differences in the interpersonal style
of women compared with men are well documented.8-11
Women disclose more information about themselves in conversation,10 they have a warmer and more engaged style of nonverbal
communication,8 and they encourage and facilitate
others to talk to them more freely and in a warmer and more intimate way.8 There is also evidence that women take greater pains
to downplay their own status in an attempt to equalize status with a partner,
in contrast with men's tendency to assert status differences.11
Despite gender differences in routine conversation, it is not known whether
"female-linked" conversational styles are evident among medical students in
light of selection criteria and, if present, survive the long medical training
The purpose of this article is to quantitatively summarize empirical studies
relating physician gender to physicians' communication with patients during
Search Procedure and Criteria for Study Inclusion
To be included in the review, a study had to (1) involve physicians,
physicians in training (interns or residents), or medical students; (2) involve
actual or standardized patients; (3) measure communication using neutral observers
(including standardized patients as observers), audiotape, or videotape, with
the exception of inclusion of physician-reported length of the medical visit;
(4) test for an association between physician gender and at least 1 interpretable
physician communication variable; (5) deal with nonpsychiatric medical visits;
and (6) be published in an English-language book or journal.
Studies were identified through online database searches of MEDLINE
(1967-2001), AIDSLINE, PsycINFO, and Bioethics using the key words doctor-patient interaction, patient-interaction,
physician-patient interaction, and doctor-patient
relationship. These key words were combined with other key words: female, gender effects, female physicians, female doctors,
and effect of sex of doctor. In addition, a hand
search was conducted of our own reprint files and the reference sections of
review articles and other publications.
A systematic review of the studies produced more than 150 different
communication variables related to physician gender. Starting with a conceptual
framework developed in an earlier meta-analysis evaluating correlates of physician
communication in medical visits,2,16
the majority of variables were easily classified into several subsuming categories.
The remaining variables were assigned to groupings based on an agreement between
the first 2 authors, as reflected in the .
(A listing of the individual variables, the study citations from which the variables were drawn, their
assignment to each category, and a notation indicating the variables for which ≥1
studies showed a significant physician gender effect is available on request
from the authors.)
For measures reflecting differences in length of visit, effect size
was expressed as the mean difference between male and female physicians measured
in minutes. For the other communication variables, however, the scale of measurement
often varied across studies so that direct comparison of mean values across
studies, even when applied to conceptually equivalent variables, was not useful.
Consequently, gender differences were expressed as a Cohen d, defined as the difference between the male and female means divided
by their pooled within-group SD.17,18
For this measure of effect size, a positive Cohen d
value indicates that female physicians scored higher on the variable in question
than male physicians did, and a negative Cohen d
value indicates the reverse. In the studies summarized herein, the Cohen d was never reported directly but, rather, was calculated
from the published information using standard formulas (eg, means and SDs,
frequencies or percentages, correlation coefficients, or the χ2
test, t test, or F test).17
Two investigators (J.A.H. and Y.A.) independently abstracted the quantitative
information from the publications and calculated the Cohen d. If a study reported a result as nonsignificant and gave no other
useful data for calculation of the Cohen d, a conservative
approach was taken and a 0 was used in the calculation. A final consideration
in the presentation of results is the magnitude of the effect size. Cohen's
rule of thumb for effect size considers 0.2 as small, 0.5 as medium, and 0.8
or greater as large.19
When there was substantial heterogeneity (P>.10
for heterogeneity based on Q statistics) in the effect sizes within a given
category, a random-effects model was used in the calculation of the Cohen d (pooled effect size). When the test for heterogeneity
was nonsignificant, a fixed-effects model was used. In addition to the Cohen d, a standard normal deviate (z
score, the statistic associated with a P value; eg,
the z score associated with P
= .05 by a 2-tailed test is 1.96) was derived for each result, and these were
added and divided by the square root of the total number of studies to obtain
a z score and an associated combined P value (Stouffer method).17 If an author
reported a result as nonsignificant and gave no other useful data for calculation
of a z score, a z of 0 was
used in the calculation of the combined probability.17
Calculating a combined value that includes all studies captures information
that is often embedded in null results and generally lost, and provides a
commonly understood probability measure to compare results across variables
of interest. In this analysis, some studies provided more than 1 result for
a given communication category. For example, a hypothetical study might measure
"shared decision making," "lets patient state concerns," and "encourages patient
paraphrasing," all of which would have been placed in the category of partnership
building. Because of conceptual redundancy, only the strongest single association
for a given category in a given study was entered in summaries of effect size
and z score. STATA statistical software20
and user-written modules21 were used for all
analyses. Throughout this article, P<.05 is considered
Descriptive Summary of the Literature
Twenty-six studies, reported in 29 publications, were included in the
meta-analytic calculations; 23 of these were direct observation studies and
3 were based on physician report of visit length.5,22-49
(References 27 and 28 are publications reporting data from the same study.
This is also the case for references 43 and 44 as well as 45 and 46.)
As reflected in Table 1,
most studies were conducted in primary care settings, and physicians at all
levels of training were represented in the studies. The average number of
physicians in the observational studies was 40, with male physicians substantially
outnumbering female physicians (n = 25 and 15, respectively; Table 2). The average number of visits per study was 157; this reflected
an average of 97 visits to male physicians and 65 visits to female physicians
in each study. There was wide variation in the number of patients observed
by each physician; the average was 4, with a range of 1 to 32.
Three large databases were used to supplement the observational data
on length of visit by physician report. The US analysis was based on the National
Ambulatory Medical Care Survey and was used to derive separate estimates of
physician gender effects for length of visits in 5 specialties: general and
family practice, internal medicine, pediatrics, obstetrics and gynecology,
and dermatology.26 A similar Dutch analysis
derived estimates of length of visit from the Dutch National Study on Morbidity
and Interventions in General Practice for general practitioners, with a subanalysis
of general practitioners treating patients for "women's health problems".43,44 The third report represents a regional
The majority of studies were based on complete patient visits; however,
3 studies limited evaluation to a specific portion of the visit and 6 studies
were of a standardized patient interview. Ten of the studies were based on
all-female patient populations, which included mothers with their children
seeking pediatric care (children were of both sexes), standardized patients
(all of whom were female), and women seeking obstetrical care. There were
no studies of exclusively male patient populations.
Eighteen different systems were used to measure communication variables.
Only 2 of these systems were used in more than 1 study; the Beckman and Frankel
method for assessment of physician probing of patient concerns was used in
2 studies34,37 and the Roter Interaction
Analysis System was used in 5 studies.27,38,39,45,47
Eighteen of the 23 observational studies reported intercoder reliability;
all were in the mid to high range (0.59-1.0) based on Pearson correlation
coefficients or κ statistics.
Details of the results reviewed below relating effects of physician
gender to categories of patient-physician communication are displayed in Table 3. Figure 1 summarizes these results graphically.
Informational Content Nine studies addressed the relationship of biomedical information giving
and physician gender. Two of these studies reported significant results; one45,46 reported significantly higher levels
for male physicians, but the other reported the opposite.38
Neither the combined z score nor the Cohen d was statistically significant.
A more consistent picture of gender effect emerged for psychosocial
discussion. Five of the 10 studies addressing psychosocial discussion reported
significantly higher levels for female rather than male physicians23,24,40,41,45,46;
only 1 study (a study of gynecologists47) reported
higher (but nonsignificant) levels of psychosocial discussion for male physicians.
Both the combined z score and the pooled Cohen d were significant, as shown in Table 3.
Informational Manner Information can be given in a more or less directive manner; for instance,
giving specific instructions is an example of the former, while proposing
alternatives is an example of the latter.50
Nine studies assessed variables that could be considered directive; 2 of these
found higher levels of directiveness for male physicians35,39
and 1 reported higher levels for female pediatricians.22
Five studies assessed variables consistent with nondirective information giving.
Of these, only 1 study reported a significant result indicating higher levels
for female physicians.35 Neither the overall
combined z score summarizing these studies nor the
pooled effect size was significant.
Informational Quality Measures of information-giving quality include such variables as clear
communication and avoidance of jargon. Six studies investigated this issue
and none reported statistically significant results.
Question Content and Form
Questions are broadly concerned with data gathering and may reflect
general question asking (simply defined as requesting information) or content-specific
inquiries (questions with biomedical, psychosocial, compliance-related content).
Questions were sometimes also specified by form, either as open-ended or closed-ended.
(Questions with the intent of furthering patient introspection or clarifying
patient expectations were classified as partnership building and are discussed
There was little evidence of a gender effect for general question asking,
for biomedical questions, or for compliance-related questions. Five studies
identified questions generally; 2 of the 3 studies that reported significant
results reported significantly higher levels of question asking among female
physicians,22,41 while another
found the opposite,23 yielding a nonsignificant
pooled effect. For biomedical questions, 2 studies reported significant results;
one reported significantly higher levels of question asking among male physicians,47 while the other found the opposite,28
with a nonsignificant pooled effect. Two studies specified questions related
to patient compliance and neither reported a significant gender effect (results
As was evident in the content analysis of information giving, women
showed higher levels of psychosocial question asking than men; 3 of 6 studies
reported significant results indicating higher levels for female physicians.28,40,41 No studies reported
higher levels of psychosocial questioning by male physicians. The combined z score was statistically significant and the Cohen d showed a trend toward significance (P = .06).
One of 4 studies that assessed closed questions reported significantly
higher levels among women38 and none reported
higher levels for men. The pooled findings reflect a statistically significant
Cohen d and a trend toward a significant combined z score (P = .09). In contrast,
we found little evidence of gender effect on open-ended questions; 1 study
of 6 found significantly higher levels for female physicians,42
but neither the combined z score nor the Cohen d was statistically significant.
By our definition, partnership building occurs when a physician actively
facilitates patient participation in the medical visit or attempts to equalize
status by assuming a less dominating stance within the relationship. The 2
classes of partnering behavior can be distinguished as reflecting (1) an active
facilitation of partnership, or "enlistment," or (2) a more passive or "lowered-dominance"
approach to partnership (see the for examples). Twelve studies included
the active, enlistment-type variables in their assessments. Six of these studies
reported significantly higher levels of enlistment on the part of female physicians,24,28,32,38,41,47
and 2 studies showed the reverse.37,39
Heterogeneity analysis indicated substantial variation among the studies.
Both the combined z score and the pooled Cohen d were statistically significant, as shown in Table 3. (We became aware late in this
article's production of an overlooked study that examined communication elements
that would have been included in the active partnership category.51 The study assessed facilitative phrases with question
tags such as "isn't it?" and "don't you?" The study reported significantly
higher use of the question tag "don't you?" by female compared with male physicians
[P = .03; Cohen d = 0.32].
The question tag "isn't it?" did not show a significant gender effect.)
Five studies assessed variables reflecting the passive, lowered-dominance
approach and 1 of these reported a statistically significant result indicating
lowered dominance among female physicians.24
Neither the Cohen d nor the combined z score summarizing these studies was significant.
Social conversation is defined as nonmedical exchanges, largely social
pleasantries and greetings. Seven studies included measures of social conversation.
One study reported a statistically significant result reflecting higher levels
of social conversation by female pediatricians.22
The measures summarizing these studies were not significant, as shown in Table 3.
Positive talk assessment captures the generally positive atmosphere
created in the visit through verbal behaviors such as agreements, encouragement,
and reassurance. Social conversation was not included in this category, with
the exception of 2 studies in which it was embedded in a composite variable
composed of positive elements. Fourteen studies included some measure of positive
talk. Six of these studies reported significantly higher levels of positive
talk for female physicians.22,28,33,38,42,47
No studies reported higher levels of positive talk by male physicians. The
Cohen d was significant and the combined z score summarizing these studies was large, as shown in Table 3.
Eight of the studies measuring positive talk were based on exclusively
female patient populations, while 6 studies were based on both male and female
patients. Inspection of the pattern of results (data not shown) shows evidence
of a physician gender effect for all-female patient populations (pooled effect
size, 0.25; 95% confidence interval [CI], −0.01 to 0.52; P = .06) as well as mixed-gender populations (pooled effect size, 0.59;
95% CI, 0.41-0.77; P<.001). Comparison of the
pooled effect size estimates from these 2 populations suggests a significantly
greater effect in mixed-gender populations than in exclusively female populations
(P = .01).
The negative talk category included explicit verbal expressions of criticism
or disapproval. Nine studies assessed some element of negative talk. Two of
these studies reported a significant result, one of which indicated that female
physicians were more likely to avoid being critical of a patient than male
physicians41 and the other of which reflected
higher levels of disagreement by female compared with male obstetricians.39 Neither the Cohen d nor
the overall combined z score summarizing these studies
was significant, as shown in Table 3.
Emotionally focused talk included explicit inquiry about feelings and
emotions, exploration of emotional concerns, and statements of empathy and
concern. This category is distinguished from psychosocial exchange by its
direct link to feelings and emotions. Thirteen studies assessed emotional
talk in some manner; 4 of these found significantly higher levels for female
compared with male physicians.33,36,42,48
Both gynecology studies in the review found higher levels of emotional talk
for male physicians; one of these reported a significant result39
and the other was marginally significant (P = .06).47 The combined z score was
statistically significant but the pooled Cohen d
was not, as shown in Table 3.
The studies showed a high degree of heterogeneity, which was almost
entirely explained by the 2 obstetrics and gynecology studies. Estimates based
on the pooling of the 11 primary care studies showed a significant and consistent
gender effect favoring female physicians (effect size, 0.16; 95% CI, 0.04-0.29; P = .008), with a low degree of heterogeneity (P for heterogeneity = .19). Analysis of the 2 obstetrics and gynecology
studies showed a significant gender effect favoring male physicians (effect
size, −0.27; 95% CI, −0.49 to −0.07; P = .01), with a low degree of heterogeneity (P
= .41 for heterogeneity).
Nonverbal communication includes positive nonverbal behaviors (smiles,
nods, friendly voice tone, relaxed hands), and a variety of behaviors that
can have ambiguous, neutral, or negative meaning depending on the context
of use (eg, touches patient, folds hands, gestures while speaking, points
at the patient, speech is disturbed, voice tone reflects anxiety or boredom).
To avoid the difficulties associated with ambiguous interpretation, we limited
our analysis to positive nonverbal behaviors.
Six studies assessed positive nonverbal behavior in some manner, and
2 of these studies reported significant results showing that female physicians
demonstrate higher levels of smiling and head nods27
and awareness of nonverbal communication.41
No studies reported higher levels of positive nonverbal behavior for male
physicians. The combined z score was significant
(P = .02) and the Cohen d
trended toward significance (P = .07), as shown in Table 3.
Five of the 10 studies that directly measured length of visit reported
women to conduct significantly longer visits than men22,24,35,38,47
and only 1 found statistically longer visits for male physicians (a study
of obstetricians39). Length of visit averaged
21 minutes (range, 7.4-36.7 minutes) for male physicians and 23 minutes (range,
10.5-37.0 minutes) for female physicians. The 3 studies of physician-reported
length of visit similarly found that female physicians' visits were significantly
longer than male physicians' visits, with an average of 14.8 minutes for male
physicians and 17.0 minutes for female physicians. (Visits in the Netherlands
are substantially shorter than visits in the United States, regardless of
There was no statistically significant difference between the observational
and physician-reported estimates of length of visit attributed to physician
gender; based on the 10 observational studies, visits with female physicians
averaged 2.0 minutes longer than visits with male physicians (95% CI, 0.5-3.5)
and were 2.1 minutes longer (95% CI, −0.15 to 4.3) based on the 7 physician-reported
studies. The overall difference in length of visit attributed to physician
gender for all 17 studies was 2.05 minutes (95% CI, 0.65-3.4).
Despite widespread interest in the effects of physician gender on the
care process, the literature describing these effects is small. We identified
only 23 observational studies relating the communication process to physician
gender. Nevertheless, the pattern of results was almost entirely consistent
with what one might expect from the nonmedical literature regarding gender
differences in communication. Female physicians engage in communication that
more broadly relates to the larger life context of patients' conditions by
addressing psychosocial issues through related questioning and counseling,
greater use of emotional talk, more positive talk, and more active enlistment
of patient input. When taken together, these elements comprise a pattern that
can be broadly considered "patient-centered" interviewing.52
In contrast with the higher levels of psychosocial and socioemotional exchange,
there is little evidence that physician gender is related to the more task-specific
communication elements of care. Physician gender was not related to the provision
of biomedical information (including discussion of the diagnosis, prognosis,
and medical treatment), the manner in which information was given, or the
quality of the information that was given.
Behavioral differences in the communication styles of male and female
physicians would be especially important if they produce corresponding gender
differences in patients' behavior directed back at them. Indeed, a separate
meta-analysis investigating the effects of physician gender on patient communication
suggested that patient behavior largely reciprocates the gender-linked physician
behavior reported in the current analysis.53
Like female physicians, their patients talk more overall, make more positive
statements, discuss more psychosocial information, and express more partnership-building
than patients of male physicians. Patient behaviors that showed little or
no difference in relation to physician gender were patient questions, social
conversation, and negative statements. Some behaviors were indirectly reciprocated.
Even though male and female physicians did not differ in how much biomedical
information they provided to their patients, patients of female physicians
provided more biomedical information to them than to male physicians. Since
female physicians ask more psychosocial questions than their male counterparts,
it may be that this type of question stimulates more patient disclosure of
both a psychosocial and biomedical nature. More patient disclosure may also
be fostered by female physicians' more active efforts to build partnership
through inviting patients' opinions and through the use of facilitators and
back channels, such as saying "uh-huh" and "go on," and other indicators of
verbal attentiveness. Interestingly, though female physicians made more emotionally
focused statements than male physicians, patients did not direct more emotional
discussion to their female compared with male physicians. Patient and physician
gender concordance appears to strengthen many of the gender effects observed.
The 2 studies of which we are aware that have investigated the impact of gender
concordance on communication27,28
both found that female gender concordant visits were characterized by longer
length and more equal patient and physician contributions to the medical dialogue
than all other gender combinations. Hall et al27
also reported more positive statements, nodding, and back channels in female-concordant
visits compared with others.
Female physicians also spent more time with their patients than male
physicians did, an average difference of about 2 minutes, or 10%, per visit.
With the increasing time and productivity pressures that plague all physicians,
a 2-minute-per-visit increase represents a substantial burden, easily putting
a female physician an hour behind her male colleagues at the end of a busy
day. Mechanic et al54 have reported that the
average medical visit has increased by 1 to 2 minutes in the last 10 years.
Despite this increase, the widespread perception of a shrinking visit may
be fueled by the time-pressured atmosphere within which physicians may be
providing more preventive and counseling services than in the past.54-56 In this light, female
physicians may be at even greater risk of falling behind their male colleagues
in daily scheduling. The analysis by Henderson and Weisman57
of the Commonwealth survey of patient-reported screening and counseling services
concluded that female physicians provided more preventive counseling to both
their male and female patients, and more gender-specific screening to their
female patients than did male physicians.
Pressure to do more in limited time may act to further amplify the communication
differences between physicians of different genders. While male physicians
may respond to time pressures by dispensing with socioemotional and psychosocial
tasks, as suggested by Mechanic,58 female physicians
may find this more difficult to do.59 We suggest
this because female physicians currently record proportionately more diagnoses
of a psychosocial nature than their male colleagues do,26,44
and the demand for diagnosis and treatment of mental health problems in primary
care is expected to grow.60
The results from the 2 obstetrics and gynecology studies deviate from
those of the primary care studies. As several studies have documented especially
strong patient preferences for female physicians in gynecologic and obstetric
care,61,62 male physicians may
feel pressured to meet the increasing competitive challenge of growing numbers
of female physicians by enhancing their interpersonal skills.63
If this is the case, it would suggest that physicians are capable of modifying
their communication style given sufficient motivation and incentive. The training
literature is also optimistic in this regard; there is ample evidence that
instruction in communication skills is associated with improvement in skills,
with some studies showing these improvements to be long-lasting.64-66
The literature on which the current analysis depends is small and limited
to published studies raising the possibility that relevant, unpublished material
was missed. However, the fairly high number of null results in the review
indicates that many studies lacking statistically significant findings were
published. This is consistent with the fact that gender effects were often
of secondary and even tertiary importance in terms of the main theme of an
article, making it unlikely that unpublished studies would have produced a
different pattern of results.17 Furthermore,
we have no reason to believe that results favoring one gender over the other
would be preferentially published. It is also noteworthy that more than half
of the communication measures showed significant heterogeneity across studies.
While we do not know what the source of unmeasured variability may be, it
is likely to be some aspect of the institutional cultures of the study sites,
as well as case mix and delivery system.44,54
What can we conclude about the consequences of these gender-related
communication effects in terms of the variety of patient outcomes so valued
in health services research? The reviewed studies did not systematically address
patient outcomes, and no direct conclusion can be drawn. It seems likely that
the effects found are an indication of a relatively more health-promoting
therapeutic milieu produced by female physicians. Such a conclusion, however,
can only be speculative, since no study has directly investigated whether
patients of female physicians fare better on clinical measures. Furthermore,
while physician communication behaviors similar to those reviewed here have
been positively related to patient satisfaction, compliance, and patient recall
and comprehension of information,2 as well
as a variety of patient health outcomes,3 this
is not always the case. On average, female physicians do not win out in popularity,
as indicated by a review of studies that compare the satisfaction of patients
seeing male vs female physicians.67 Some studies
show patients to be more satisfied with male physicians, some show more satisfaction
with female physicians, and some show no difference. It is premature to offer
an explanation for this variation, and we can only speculate that patients'
satisfaction depends on what the physician actually does, as well as stereotypes
and expectations held by patients and differences in patient characteristics,
such as health status or sociodemographics. Future studies of physician gender
and communication will need to focus greater attention on the assessment of
patient health outcomes and other indices of care quality.
In summary, the review produced a pattern of effects associated with
physician gender that goes beyond a listing of individual elements of medical
exchange. Taken together, the differences reflect a patient-centered communication
style that inspires patient reciprocation and is likely to reflect a more
intimate therapeutic milieu of heightened engagement, comfort, and partnership.
Although the magnitude of the effects attributable to gender for any given
communication element were usually small, the effects are comparable with
those of many well-established medical, psychological, behavioral, and educational
What might these results mean for male physicians? We do not suggest
that all or even most female physicians are patient-centered and male physicians
are not; there is far more common ground than difference in the communication
behaviors of male and female physicians. Moreover, physicians, both male and
female, who are skillful communicators may achieve time efficiencies that
allow the delivery of quality, patient-centered care in even restricted time
frames.64 Physicians have the capacity to improve
their communication skills in meaningful ways through self-awareness, self-monitoring,
and training. The potentially powerful impact of patient reciprocation of
both communication style and affect in the medical visit is especially important
to recognize, as recognition could help create positive exchanges and defuse
negatively spiraling interaction patterns. Both male and female physicians,
as well as their patients, are entitled to no less.
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