Objective: To describe patient-obstetrician communication during the first prenatal visit and its relationship to physician gender and patient satisfaction.
Methods: The first prenatal visit of 87 women with 21 obstetricians (11 male and ten female) was audiotaped and analyzed using the Roter Interaction Analysis System. Patient satisfaction was measured by postvisit questionnaire.
Results: Communication during first prenatal visits was largely biomedical, with little psychosocial or social discussion. Male physicians conducted longer visits than females (26 minutes versus 21.9 minutes, P < .05) and engaged in more facilitative communication (ie, making sure they were understood and providing direction and orientation) and explicit statements of concern and partnership (z > 1.96, P < .05). Female physicians devoted more communication to agreements, disagreements, and laughter than males (z > 1.96, P < .05). Satisfaction with physicians' emotional responsiveness and informational partnership was related to female physician gender and a variety of task-focused and affective communication variables.
Conclusion: Communication and satisfaction between women and obstetricians during initial prenatal visits is related to physician gender and patient satisfaction. Male physicians conducted longer visits but women were more satisfied with female physicians.
Previous studies found weak preferences for physician-patient gender synchronicity when presenting complaints were not gender-specific.1,2 Preferences for same-gender physicians became much stronger when subjects sought help for intimate health problems, including gynecologic and obstetric care.1,2
Although not linked directly to those preferences, communication studies of primary care visits found broad differences between physicians of different genders.3,4 Female physicians engaged in more partnership building, emotionally focused talk, positive talk, and psychosocial exchange than male physicians. Both male and female patients of female physicians also disclosed more biomedical and psychosocial information and were more positive in their talk than patients of male physicians.3,4
Communication behaviors associated with female physicians were generally valued by subjects and predictive of positive outcomes, including satisfaction, recall of medical information, compliance with medical recommendations,5 and health status improvements.6 The literature directly relating physician gender and patient satisfaction is mixed; some studies found higher satisfaction with female physicians7 and others the opposite.8,9
Although the dynamics of physician gender preferences and their consequences for communication and satisfaction are important to obstetric practices, none of the studies involved obstetricians.10 That was not surprising; most communication studies were conducted in primary care, and it is only recently that sufficient numbers of female physicians made such research practical.
As part of a larger study focused on prenatal genetic testing and counseling,11 we investigated the influence of physician gender on communication in obstetric visits. The present study of the routine process of care during first obstetric visit, based on audiotape analysis of male and female obstetricians, determined whether there were gender differences in style and content of obstetrician communication during prenatal visits and whether patient satisfaction with prenatal care was associated with obstetrician gender, even when controlling for communication and subject sociodemographic variables.
Content of obstetrician-patient communication during the first prenatal visit is related to physician gender and patient satisfaction.
Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
Address reprint requests to: Debra Roter, DrPH, Health Policy and Management, Johns Hopkins School of Public Health 624 North Broadway, Suite 750 Baltimore, MD 21209 E-mail: firstname.lastname@example.org
Supported by grant R01 HG00908 from the National Center for Human Genome Research, National Institutes of Health.
Received August 20, 1998. Received in revised form October 14, 1998. Accepted November 12, 1998.