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ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 29-34

Does physicians' gender have any influence on patients' choice of their treating physicians?


1 Department of General Surgery, Airedale General Hospital, West Yorkshire, United Kingdome
2 Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
3 Medical Intern, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia
4 Department of Microbiology, Faculty of Medicine, Basic Medical Sciences, King Fahad Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Date of Web Publication7-Jan-2019

Correspondence Address:
Ghadah Alyahya
Department of General Surgery, Airedale General Hospital, West Yorkshire
United Kingdome
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNSM.JNSM_28_18

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  Abstract 


Objectives: The purpose of this study was to determine whether physicians' gender has any influence on patients' choice of their treating physician. Methods: A survey was conducted in different public places in Riyadh, Saudi Arabia, to determine preferences for the gender of a physician under various health-care aspects. Results: Three thousand and fifteen people participated in this cross-sectional survey. The majority of participants had no gender preference regarding their physician's attitude and professional competence. However, 49.8% of the female participants preferred a female physician and 37.4% of the male participants preferred a male physician when discussing family and psychological problems. Regarding general and genital examination, 65.8% and 86.4% of women and 53% and 67.5% of men, respectively, preferred to be examined by a physician of their same gender. The majority of women preferred a female physician during breast examination (90.1%) and delivery (71.4%). With regard to medical specialties, men preferred a male general surgeon (48.6%), male urologist (65.1%), and male orthopedic surgeon (54.4%). On the other hand, women preferred a female urologist (58.1%) and had no gender preference regarding their general surgeon (48.1%) and orthopedic surgeon (51.4%). Conclusion: Findings of this study highlight the difference in participants' choice for the gender of their treating physician in different medical specialties. Women participants preferred a female physician for psychosocial counseling and when visiting a gynecologist, obstetrician, or urologist. In addition, women of childbearing age favored a female physician during delivery. Men preferred a physician of the same gender when being treated by a urologist, general surgeon, or orthopedic surgeon.

Keywords: Doctor–patient relationship, patient's gender, patient's perception, patient's satisfaction, physician's attitudes, physician's gender, physician–patient communication


How to cite this article:
Alyahya G, Almohanna H, Alyahya A, Aldosari M, Mathkour L, Aldhibaib A, Al-Namshan Y, Al-Mously N. Does physicians' gender have any influence on patients' choice of their treating physicians?. J Nat Sci Med 2019;2:29-34

How to cite this URL:
Alyahya G, Almohanna H, Alyahya A, Aldosari M, Mathkour L, Aldhibaib A, Al-Namshan Y, Al-Mously N. Does physicians' gender have any influence on patients' choice of their treating physicians?. J Nat Sci Med [serial online] 2019 [cited 2019 May 25];2:29-34. Available from: http://www.jnsmonline.org/text.asp?2019/2/1/29/242161




  Introduction Top


The physician–patient interaction plays a critical role in health-care settings.[1] Both patient and doctor bring their beliefs, attitudes, communication styles, and expectations to the medical encounter.[1] Many factors might have an effect on the doctor–patient interaction including but not limited to gender, attitudes, values, and cultural differences.[1],[2] It has been reported widely that female and male physicians differ in their way of communicating with patients.[1],[2],[3],[4],[5] The communication between patient and doctor during medical care interactions may have several consequences involving patient recall, treatment adherence, satisfaction, and health outcomes.[5]

In a meta-analysis, it was shown that female physicians were more likely to exhibit rapport-building behaviors such as supporting, reinforcement, lowered dominance, and positive talk, and can reveal more affective behaviors such as concern, empathy, and sympathy than male physicians.[5] Another systematic review showed that patients preferred a female over a male gynecologist–obstetrician because they have a better patient-centered communication style and this preference increased from 6% to 14% if the visit required a physical examination.[6] Two studies in family practice showed that women like to consult female general practitioners, especially if they have women's health problems compared to male general practitioners.[7],[8] However, physician gender did not have a major influence on male patients' satisfaction compared to female patients when visiting the emergency department in a public hospital in the United States.[9]

Patients' preferences in selecting their doctors have been a subject of interest in previous research.[7],[8],[9],[10] Internationally, some studies have addressed the gender of the physician as being one of the major factors that may affect health-care outcomes.[7],[8],[9],[10] However, few research articles have focused on gender as a factor during medical consultation in the Middle East.[11] In Saudi Arabia, there was one study conducted at King Abdulaziz University Hospital in Jeddah that showed women preferred a female gynecologist–obstetrician.[11] As the proportion of females in medicine grows toward parity globally, there is a continuous question regarding whether female and male doctors communicate differently with patients.[5] The same observation was noticed locally in Saudi Arabia since medical education opportunities have been provided for both genders equally. The latest data from the Saudi Ministry of Health (MOH) in 2017 revealed that the number of female physicians in MOH increased from 4872 in 2006 to 13,239 in 2016.[12]

The nature of Saudi conservative society may influence the patient's decision when choosing a treating physician and gender is a consideration. It has been observed that some Saudis may prefer male physicians over female physicians in certain specialties. Therefore, in this study, we evaluated whether physicians' gender has an impact on Saudi patients' choice of their treating physicians.


  Methods Top


Ethical approval

Ethical approval was obtained from the Institutional Review Board at Prince Sultan Military Medical City (Reg. HAP-01-R-015).

Participants and setting

This was an observational study with a cross-sectional design targeting the Saudi population living in Riyadh who were at least 18 years of age. From March to July 2017, this study was carried out in different public places. People were personally invited to participate in the study and completed a questionnaire after given their verbal consent. All collected data was anonymously provided. Of 3115 individuales who were invited, 3015 agreed to participate in the study (response rate of 96.7%), of which 1650 (54.7%) were women, and 1365 (45.3%) were men. The men and women participants were different in the mean age; however, they were similar in marital status and educational level. The majority of women were 18–25 years old, whereas most men were age 26–35. The demographics of the participants are described in [Table 1].
Table 1: Demographic data of the study population

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Measure

The questionnaire consisted of three sections. Thefirst section asked for demographic information. The second section covered a variety of gender preference questions that were arranged under three topics including physician's attitude and professional competence, patient–physician interaction, and medical specialties.

Participants had three options for responding to the questions: “prefer female physician,” “prefer male physician,” and “no preference.” The third section had one question: “are sociocultural factors influencing your choice for the physician's gender?” Participants could respond with “Yes” or “No.”

This questionnaire was developed based on the literature and modified according to the local context.[8],[10] It was written in English then translated into Arabic by a professional translator. The validity of the questionnaire was evaluated using face validity. The questionnaire was pilot tested on a small group who completed the questionnaire two times, 3 weeks apart and provided feedback on the measure. Modifications were made according to the feedback received. The correlation coefficient for each item was ≥0.837, and the Cronbach's alpha coefficient was 0.93.

Data analysis

All statistical analyses were performed using the statistical package for the social sciences version 21 (SPSS IBM, New York, US). Simple descriptive statistics, Pearson correlations, Chi-squared test, t-test, and linear regression were used for data analysis. Preferences among subgroups of participants were analyzed using Chi-square tests, whereas the independent t-test was used to compare the influence of sociocultural factors between female and male participants. Statistical significance was determined by P < 0.05.


  Results Top


[Table 2] provides information on the participants' perceptions of physicians with regard gender and the physician's attitude and professional competence. Although the highest percentage of answers reported by participants was under “no gender preference,” differences between men and women could be detected with regard to all of the questions asked in this category (P < 0.05). Data revealed that 35.2% of the female participants believed that female physicians are more understanding of the patient's psychological issues, whereas 37.2% and 39.9% of the male participants believed that male physicians are more knowledgeable and skilful in their field, respectively.
Table 2: Participants' perception of attitude and professional competence of their treating physicians

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[Table 3] includes the results on preference for the gender of the physician with regard to patient–physician interaction in possible health-care scenarios. Data revealed that 49.8% of female participants favored a female physician during the discussion of family and psychological problems, while 37.4% of male participants favored a male physician. The majority of women preferred a female physician to perform a general examination (65.8%) and genital examination (86.4%). Similarly, men mostly preferred a male physician to perform general examination (53%) and genital examination (67.5%).
Table 3: Gender preference in patient-physician interaction in possible health-care scenario

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With regard to patient–physician interaction during a surgical procedure and operation, more than half (52.5%) of the male participants preferred male physicians, whereas 44.7% of female participants had no gender preference. Although questions regarding breast examination and delivery were targeting only the female participants, 1080 and 1244 of the men answered these two questions, respectively. Consequently, 71.5% and 72% of the men preferred a female physician for the breast examination and delivery for their female relative. Patient–physician gender concordance was a major influence for women as 90.1% and 71.4% preferred a female physician to do the breast examinations and delivery, respectively. Significant differences in the preferences of men and women can be seen with regard to the majority of questions (P < 0.05).

Participants were asked about their gender preference for physicians in certain medical specialties [Table 4]. Almost half of the men reported that they prefer a male physician for general surgery (48.6%), and more than half of them preferred a male urologist (65.1%) and orthopedic surgeon (54.4%). On the other hand, 36.9% and 39% of women would like to be managed by a male general surgeon and orthopedic surgeon, respectively. Of note, 58.1% of the women favored a female urologist. More than two-thirds of the female (76.2%) and male (70.8%) participants favored female obstetricians and gynecologists (although the question was intended for women participants only). In general, there were highly significant differences in responses between men and women (P < 0.001).
Table 4: Participants' preference toward gender of treating physicians according to medical specialties

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Participants were asked if the sociocultural factors could influence their choice of treating physician's gender. The highest response was “No” (65.8% men and 75.6% women). However, there was a statistically significant difference between the two groups (P < 0.05).

To investigate whether participants' gender predicted the preference for the physicians' gender as an answer for the different questions included in the questionnaire, linear regression analyses were conducted. Answers to the different questions were the dependent variable and gender was the independent variable. Results revealed that gender was a statistically significant predicator of participants' choices for most questions (P < 0.05). Gender had no statistically significant predictive effect on the following items: understanding the patient's psychological factor, a good listener to the patient, delivery, ophthalmology, plastic surgery, dermatology, pediatric, and neurology (P > 0.05).


  Discussion Top


Gender is one of several factors influencing the doctor–patient interaction.[1] There is growing research on the effect of gender on both patients and doctors and the delivery of medical care.[1] For instance, the amount of time spent with patients differs between female and male physicians.[1] Good communication between doctor and patient is crucial to improving the quality of health care.[1]

The result of this study revealed that gender concordance (defined as the patient and physician having the same gender) did not affect the participants' perception of their treating physician's attitude and professional competence. Most of the participants in this study had no preference for male or female physicians regarding physicians' credibility, knowledge and skills, best chatting, being more cooperative, and good listener. On the other hand, “understanding the patient's psychological factor” was the major quality among others for which the participants would prefer having a physician of the same gender. In another study, it was found that psychosocial pattern was more common in consultations with female patients.[2] It has been reported that female physicians are more likely to engage in counseling and in conversations about social and family issues.[1]

In the current study, patient–physician gender concordance had an impact on participants' preference for the gender of the physician during clinical encounters such as general, breast, and genital examinations. Our results are in agreement with another local study that showed the majority of female patients preferred a female doctor for a pelvic examination.[11] There was no physician gender preference with regard to taking a medical history or treating life-threatening conditions. The same findings were reported by Nolen et al. in the emergency department where the majority of the patients reported no physician gender preference for emergent visits or procedural visits.[13] Our results demonstrate that the majority of women preferred female physicians when discussing family or psychological problems and also during delivery. A meta-analysis revealed that female doctors have conversations that relate to the life context of patients' conditions by addressing psychosocial issues and greater use of emotional talk.[3],[4] Female physicians engage in communication that can be considered more patient-centered, and they exhibit more effective behaviors such as sympathy, empathy, and concern.[3],[5],[14],[15] Expressing empathy in communication can be seen as a feminine trait, while a confrontational conversation style is considered as a masculine trait.[15] Mast et al. reported that there was a significant main effect of the physician caring in female–female dyads showing that more satisfaction was expressed by women participants with female physicians who implemented a caring communication style.[16] On the other hand, the style of physicians' communication did not affect the level of satisfaction of the male participants in male–male dyads.[16] Our study showed similar results where the majority of the men had no predilection for physicians' gender when the conversation involves family or psychological issues. In contrast, most of the male participants in our study preferred physicians with the same gender for surgical procedures or operations; however, women participants had no gender preference.

Results of this study showed that patient–physician gender concordance strongly influenced participants' preference for their treating physician when consulting a urologist. In a study in Hong Kong, it was found that female patients' communication with male urologists was unpleasant and difficult, which can endanger treatment compliance and outcome.[17] Female–female dyads were preferred in our survey when seeing obstetricians and gynecologists. Shamrani reported the same results, indicating that women visiting obstetrics and gynecology clinics preferred a female physician.[11] Contrary to our findings, Janssen and Lagro-Janssen reported that about half of the females did not have any gender preference when consulting obstetricians and gynecologists.[6] Nonetheless, this discrepancy perhaps is due to cultural differences between the liberal Western world and our local conservative society. Our analysis revealed that spouse's also preferred a female physician for their partner when consulting a gynecologist or obstetrician. According to the previous findings, women and men prefer health-care providers of the same gender for medical conditions involving private areas of the body because they feel more comfortable and less embarrassed.

The results of this study revealed that there was no gender preference for the treating physician when consulting internists, emergency physicians, ophthalmologists, otolaryngologists, plastic surgeons, dermatologists, pediatricians, psychiatrists, and neurologists. Those who did express a gender preference preferred physicians with the same gender. The same findings were reported by Nolen et al. who found no significant difference in patient preference for physician's gender in an emergency situation in the setting of the emergency department.[13] Furthermore, other authors have reported that most of the female patients interested in plastic surgery have no gender preference.[18] Of those who do, nearly all female patients requested a female plastic surgeon.[18] Similarly, in our study, it was shown that most of the women had no gender preference for plastic surgeons. In the present study, male–male dyads had an impact on men when visiting a general or orthopedic surgeon, whereas women had no gender predilection when seeing a general or orthopedic surgeon. Abghari et al. found that the vast majority of patients had no preference for the gender, age, religion, or race of their orthopedic surgeon.[19]

It is well known that the Saudi population is a conservative society and that sociocultural values may affect different parts of people's lives. Our data revealed that the majority of participants believed that they were not influenced by sociocultural factors when indicating their preference for the gender of their treating physicians. This was an unexpected result that can be explained by the fact that most of the participants were of the young generation who could be less restricted by sociocultural factors. In addition, in recent years in Saudi Arabia, there were many changes, and shifts have been observed at all levels of society; especially the establishing of regulations that allowed for the inclusion of females in a variety of sectors in the labor market as well as accepting a large enrolment of women in postgraduate programs nationally and internationally.[20]

To the best of our knowledge, this is thefirst study at the national level to evaluate how physicians' gender influences patients' choice of their treating physician in different medical specialties. The current study may help to develop appropriate strategies to include gender (male/female ratio) as an important marker for physicians' placement in different clinical services. In addition, health education departments in health-care services should develop educational programs to raise patients' awareness and modify patients' misconceptions about the professional profile of females as treating physicians.

Each study has its limitations. A limitation of our study is that we did not have much data regarding participants' previous health issues and experiences with their physicians such as being an inpatient or having only outpatient visits. Therefore, we could not determine whether these factors may affect their preferences for the gender of treating physicians.


  Conclusion Top


The findings of this study highlight patients' preferences for the gender of their treating physician in different medical specialties. Our data suggest that women prefer a female physician during psychosocial counseling and when visiting a gynecologist, obstetrician, or urologist. In addition, women favored a physician of the same gender during delivery. Male–male dyads were strongly preferred when consulting a urologist, general surgeon, or orthopedic surgeon. Although Saudi Arabia is a conservative society, our findings showed that there is no effect of sociocultural norms on patients' choices for the gender of their treating physicians. Further investigations are needed to explore other possible factors that may affect patients' preferences for certain characteristics in their physicians.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Schmid Mast M, Hall JA, Roter DL. Disentangling physician sex and physician communication style: Their effects on patient satisfaction in a virtual medical visit. Patient Educ Couns 2007;68:16-22.  Back to cited text no. 16
    
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Siu JY. Communicating under medical patriarchy: Gendered doctor-patient communication between female patients with overactive bladder and male urologists in Hong Kong. BMC Womens Health 2015;15:44.  Back to cited text no. 17
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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