Physician gender effects in medical communication - A meta-analytic review
Physician gender effects in medical communication - A meta-analytic review
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DOI：
10.1001/jama.288.6.756
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发表时间：
2002-08-14
影响因子：
120.7
通讯作者：
Aoki, Y
中科院分区：
文献类型：
--
作者：
Roter, DL;Hall, JA;Aoki, Y
背景医生的性别已被视为一个可能的来源，在医疗实践中的人际方面的变化，与推测，女医生促进更开放和平等的交流和不同的治疗环境，从男性医生。然而，这一领域的研究一般都是基于小样本的，结果相互矛盾。目的系统地回顾和量化医生性别对医疗访问期间沟通的影响。数据来源1967年至2001年英语摘要在线数据库检索（MEDLINE、AIDSLINE、PsycINFO和生物伦理学）;对重印文件和综述文章及其他出版物的参考部分进行手工检索。资料来源，如录音带、录像带或直接观察，以及大型国家或地区研究，其中医生报告被用来确定访问时间，通过文献和计算机检索确定。在29篇出版物中报道的23项观察性研究和3项大型医生报告研究符合纳入标准并进行了评级。（Y.A.）从出版物中独立提取定量信息。使用Q统计量检验研究异质性，并使用适当的效应模型计算汇总效应量。研究人群的特征也被提取。数据合成女性医生从事显着更积极的伙伴关系行为，积极的谈话，心理咨询，心理社会问题的提问，和情绪集中的谈话。在提供生物医学信息或社会对话的数量、质量或方式上没有明显的性别差异。女医生的就诊时间平均比男医生长2分钟（10%）。产科和妇科可能会提出一个不同的模式比初级保健，男性医生表现出更高的水平，以情感为重点的谈话比他们的女colleages.Conclusions女性初级保健医生从事更多的沟通，可以被认为是以病人为中心，并有较长的访问比他们的男同事。有限的研究存在以外的初级保健，和性别相关的实践模式，在一些专科可能不同于那些明显的初级保健。
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 On line 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 other publications.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 care.