Dominance and gender in the physician-patient interaction

Abstract

The goal of this review is to show that physician-patient interactions differ in the degree of dominance asymmetry between the physician and the patient, that physician's dominance behavior is related to negative patient outcomes, and that physician gender affects how physician dominance is perceived by patients. The article provides (1) an overview of existing findings on dominance in the physician-patient interaction, (2) a summary of gender differences in dominance with an emphasis on the physician-patient interaction, and (3) an explanation on why it might be more important for women doctors than for men doctors to adhere to a non-dominant interaction style. ß 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.The physician-patient interaction is inherently hierarchic in many different ways. First, the physician generally has more medical knowledge or expertise than the patient. The help-seeking position per se is one of low power, characterized by a lack of resources (e.g. information, physical integrity) and often accompanied by anxiety and uncertainty about prognosis and treatment and by discomfort or pain. Also in terms of social standing, most physician-patient interactions are encounters among unequals: The physician usually has higher socioeconomic status than the patient. Moreover, a physician can behave more or less dominantly during the medical visit and therefore either enhance or attenuate existing dominance differences between him/her and the patient. The present article focuses on the latter, the dominance asymmetry in the physician-patient interaction as it occurs during the medical visit through physician behavior.To clarify the terms, dominance is understood as having or striving for control or influence over another or as having privileged access to restricted resources. This broad definition encompasses status and power. Hierarchy is defined as dominance differences among people. Dominance in the physician-patient interactionAlthough the topic of dominance in the physician-patient interaction has been addressed in a theoretical way by many researchers [1-4], not much empirical evidence has been gathered to date. Roter and Hall [3] introduced a model of the physician-patient relationship based on high or low physician and patient power. They call a physician-patient relationship paternalistic if the physician's power is high and the patient's power is low. The physician sets the goals of the visit and the agenda, makes all the decisions and has more control over the interaction than the patient. Patient's values and preferences for treatment are not explored and the physician's role is the one of a guardian. This is the traditional form of the doctor-patient relationship, based on a biomedical understanding of medicine and health care. However, not all physician-patient relationships are characterized by such a pronounced power asymmetry in favor of the physician. The reverse of this relationship is the consumerist relationship in which the patient has high power and the physician has low pow...

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