When physician‐expressed uncertainty leads to patient dissatisfaction: a gender study. Issue 9 (11th August 2013)

• Record Type: Journal Article
• Authors: Cousin, Gaetan; Schmid Mast, Marianne; Jaunin‐Stalder, Nicole
• Is Part Of: Medical education. Volume 47:Issue 9(2013)
• Page Start: 923
• Page End: 931
• Publication Date: 2013-08-11
• Subjects: Medical education -- Periodicals; Medical education -- Great Britain -- Periodicals; 610.7
• DOI: 10.1111/medu.12237
• Languages: English
• ISSNs: 0308-0110

Abstract

<abstract abstract-type="main" id="medu12237-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="medu12237-sec-0001" sec-type="section"> <title>Context</title> <p>Communication guidelines often advise physicians to disclose to their patients medical uncertainty regarding the diagnosis, origin of the problem, and treatment. However, the effect of the expression of such uncertainty on patient outcomes (e.g. satisfaction) has produced conflicting results in the literature that indicate either no effect or a negative effect. The differences in the results of past studies may be explained by the fact that potential gender effects on the link between physician‐expressed uncertainty and patient outcomes have not been investigated systematically.</p> </sec> <sec id="medu12237-sec-0002" sec-type="section"> <title>Objectives</title> <p>On the basis of previous research documenting indications that patients may judge female physicians by more severe criteria than they do male physicians, and that men are more prejudiced than women towards women, we predicted that physician‐expressed uncertainty would have more of a negative impact on patient satisfaction when the physician in question was female rather than male, and especially when the patient was a man.</p> </sec> <sec id="medu12237-sec-0003" sec-type="section"> <title>Methods</title> <p>We conducted two studies with complementary designs. Study 1 was a randomised controlled trial conducted in a simulated setting (120 analogue patients Analogue patients are healthy participants asked to put themselves in the shoes of real medical patients by imagining being the patients of physicians shown on videos); Study 2 was a field study conducted in real medical interviews (36 physicians, 69 patients). In Study 1, participants were presented with vignettes that varied in terms of the physician's gender and physician‐expressed uncertainty (high versus low). In Study 2, physicians were filmed during real medical consultations and the level of uncertainty they expressed was coded by an independent rater according to the videos. In both studies, patient satisfaction was assessed using a questionnaire.</p> </sec> <sec id="medu12237-sec-0004" sec-type="section"> <title>Results</title> <p>The results confirmed that expressed uncertainty was negatively related to patient satisfaction only when the physician was a woman (Studies 1 and 2) and when the patient was a man (Study 2).</p> </sec> <sec id="medu12237-sec-0005" sec-type="section"> <title>Conclusions</title> <p>We believe that patients have the right to be fully informed of any medical uncertainties. If our results are confirmed in further research, the question of import will refer not to whether female physicians should communicate uncertainty, but to <italic>how</italic> they should communicate it. For instance, if it proves true that uncertainty negatively impacts on (male) patients' satisfaction, female physicians might want to counterbalance this impact by emphasizing other communication skills.</p> </sec> </abstract>