The Psychology of Gender 4th Edition

Communication 235

fairly accurate. More recently, Hall (2006)

concluded that sex differences in nonverbal

behavior, in particular smiling and decoding,

are larger than most sex differences and larger

than most social psychological effects.

Like the other behaviors we have exam-

ined in this chapter, sex differences in non-

verbal behavior cannot be fully understood

without considering the sex of the person with

whom one is interacting. Again, women and

SIDEBAR 7.3:Physician–Patient Interactions

One particularly interesting interaction to study from a gender perspective is the interaction be-

tween a patient and a physician. The physician–patient interaction is by definition one of un-

equal status. When the physician is male and the patient is female, the status difference in roles

(physician vs. patient) is congruent with the status difference in sex (male vs. female). But today,

it is no longer the case that the physician is always male. Because physician and patient roles are

highly structured, with a clearly established hierarchy, female and male physicians might com-

municate similarly and female and male patients might respond similarly. In other words, the

clear-cut demands of these roles may override any sex differences in communication style previ-

ously discussed. Research, however, does not support this idea.

A meta-analytic review of patient–physician interaction studies, most of which were obser-

vational, showed that female physicians made more active partnership statements (i.e., enlisting

patient input, working together on a problem), asked more questions about psychosocial issues,

had more emotion-focused conversation, and used more positive talk (i.e., reassurance, agreement,

encouragement; Roter, Hall, & Aoki, 2002). In other words, female primary care physicians en-

gaged in more “patient-centered” communication. Visits with female physicians also lasted two

minutes longer, which was 10% of the visit. There was no sex difference in the number of general

questions asked or the amount of biomedical information provided. Recent studies have confirmed

these findings (Bertakis, 2009; Sandhu et al., 2009). A laboratory study demonstrated that female

sex more than our expectations about female sex influences physician communication (Nicolai &

Demmel, 2007). Adults were asked to evaluate transcripts of female and male physician interac-

tions with patients, half being told the correct physician sex and half being told the wrong physician

sex. Respondents rated the communication as more empathic when the physician was actually a

female than a male. There was no effect of perceived physician sex on respondent ratings.

There also is some evidence that there is greater patient-centered communication and

positive affect expressed in same-sex dyads than other-sex dyads (Bertakis, 2009; Sandhu et al.,

2009), and this finding extends to African American patients who have other-race physicians

(DiMatteo, Murray, & Williams, 2009). The male physician–female patient dyad seems to be the

least patient centered and most formal, and the female physician–male patient dyad seems to be

the least comfortable.

What are the implications of the differences between female and male physicians’ commu-

nications? A meta-analysis of patient responses (Hall & Roter, 2002) showed that patients talk

more, make more positive statements, discuss more psychosocial issues, and—most importantly—

provide more biomedical information to female than male physicians. In addition, patients of

female physicians are more satisfied (Sandhu et al., 2009). Thus female physicians may be more

successful than male physicians at making patients feel comfortable and eliciting information. The

extent to which these differences influence patient health outcomes, however, is unknown.

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