Rathnakar UP et al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE

Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)

Page 30




ijmps
Vol 03 issue 12
Section: Healthcare
Category: Research
Received on: 25/06/13
Revised on: 14/07/13
Accepted on: 03/08/13

DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER
AND ROLE

Rathnakar UP
1
, Anjali Ganesh
2
, Unnikrishnan B
3
, Srikanth D
1
, Ganesh K
4
,
Ashok Shenoy K
1
, Ashwin Kamath
1


1
Department of Pharmacology, Kasturba Medical College, Manipal University,
Mangalore, KA, India
2
Department of Business Administration, St. Joseph Engineering College, Vamanjoor,
Mangalore, KA, India
3
Department of Community Medicine, Kasturba Medical College, Manipal University,
Mangalore, KA, India
4
Department of Radiodiagnosis, AJ Institute of Medical Sciences, Mangalore, KA, India

E-mail of Corresponding Author: mailmaka@gmail.com

ABSTRACT
Background of study: The doctor-patient relationship is one of the most unique and privileged
relations. Intricately linked are several intervening factors such as gender, educational qualification as
well as the status of the patients in the society that might influence the quality of doctor-patient
relationship.
Objectives: Since Indian society is predominantly male dominated, a study in the Indian context with
respect to the influence of gender on the doctor patient relationship was carried out. Attempt was made
to understand the disparity between the responses of doctors and patients on various aspects of doctor-
patient relationship.
Research Methodology: Patients attending the clinics in a tertiary care hospital were administered a
Likerts 5-point rated structured questionnaire to record their responses regarding various aspects of
doctor-patient relationship. Also, a structured questionnaire was administered to 50 specialist doctors
who treated the selected respondent patients from the same hospital.
Results: Our study showed that physician gender could be a factor in forming a good doctor patient
relationship as more female patients preferred consulting doctor of same gender relative to males.
Although disagreed by the patients, doctors were more likely to mention that the patients do not adhere
to one doctor. Doctors also opined that power and status influence does affect the doctor patient
relationship.
Conclusion: The patients who rest their trust in their doctors, with due diligence, create a win-win
situation. Equally important is the holistic care and patient centered rather than disease centered
approach to treatment by the doctors.
Keywords: Doctor, Patient, Gender, Relationship

INTRODUCTION
The doctor-patient relationship is one of the most
unique and privileged relations. The quality of
doctor- patient liaison is vital to the practice of
doctors be it physicians, surgeons, radiologists or
dentists. It forms an important basis for the
delivery of high-quality health care, diagnosis and
treatment of the disease.
1
Intricately linked are
several intervening factors such as gender,
educational qualification as well as the status of
the patients in the society that might influence the
quality of doctor-patient relationship. This paper
analyses the influence of gender on the doctor-
Rathnakar UP et al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE


Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)
Page 31


patient affiliation. The perspectives of both
doctors and the patients are analyzed.
A high-value doctor-patient relationship is based
on a set of

parameters which include the
interpersonal relationship between

the patient and
the doctor.
2
Racial disparities in healthcare
outcome and an intergrative perspective on doctor-
patient communication and cultural competency
has been described by Perloff et al.
3
Use of the

Internet by individuals for finding health
information may

affect the relationship between
health professionals and patients.
4
Personal

relationship with the doctor has been shown to
influence the choice and course

of medical
interventions.
5
The context is important in any

medical treatment and the words and attitudes of
doctors

and nurses can have great impact on the
patient.
6


Besides specific technical skills, successful
encounters with

patients require an understanding
of the many ways in which

patients may express
themselves. The qualitative study by Hellstrom
et.al (1998) reported on the clinical experiences of
doctors when meeting patients

with fibromyalgia.
7

The analyses

indicated that doctors tried to comply
with the wishes and demands

of patients, and at
the same time avoided perceptions of personal

frustration. They were inclined to be objective and
to act instrumentally,

apparently in order to keep
in touch with what gave biomedical

meaning to an
otherwise incomprehensible phenomenon.

India is a multi-ethnic society with diverse
demographic profile comprising of extremely rich,
poor people belonging to different religions and
communities. Majority of the population comes
from lower middle class strata. Since Indian
society is predominantly male dominated, a study
in the Indian context with respect to the influence
of gender on the doctor patient relationship was
carried out. Attempt was made to understand the
disparity between the responses of doctors and
patients on various aspects of doctor-patient
relationship.

METHODOLOGY
The study was been confined to Mangalore region
of Dakshina Kannada District of Karnataka state,
India. Mangalore has five medical college
hospitals in private sector. As a result there is a
large pool of specialist doctors residing in this
region. Patient population is also large as they
float from whole of Karnataka, Goa and northern
Kerala, to avail of improved health care facility.
To fulfill the objectives of this study, the patients
attending the clinics of ten different disciplines,
viz., Medicine, Surgery, Radiology, Dermatology,
ENT, Gynecology, Orthopedics, Psychiatry,
Ophthalmology and Cardiology were chosen for
administering the Likerts 5-point rated structured
questionnaire and also for interaction (Table-1).
Stratified proportional sampling technique was
adopted and 20 patients from each of the above
category were selected from a tertiary care
teaching hospital leading to a sample size of 202.
The survey was conducted for a period of three
weeks. The tertiary care teaching hospital on an
average receives about 2000 patients in three
weeks time (as per the data provided by the
hospital administration office).Thus the sample
size comprised of 10 per cent of the population.
The study was confined to the patients attending
the clinics in the tertiary care teaching hospital. To
identify the opinion of the doctors regarding the
doctor-patient relationship, a structured
questionnaire was administered (Table-2) to about
50 specialist doctors in the chosen disciplines of
the study, who treated the selected respondent
patients from the same hospital that comprised 25
per cent of the patient sample chosen for the study.
An individual interaction session was held with
them to understand their stance to enhance doctor-
patient relationship. The means of the Likerts
scores were compared using Students t-test. SPSS
11.5 software was used for the statistical analysis.
P value <0.05 was considered statistically
significant.


Rathnakar UP et al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE


Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)
Page 32


RESULTS
A total of 202 patients answered the questionnaire
of which 77 were males and 125 were females. 50
doctors belonging to various clinical specialties
also answered the questionnaire. Table 1 shows
the gender difference with regards to the responses
to the various aspects of doctor patient
relationship. Female patients were more
comfortable consulting a doctor of the same
gender. Personal relationship with the doctor also
formed an important reason for consulting a
particular doctor among female patients. Female
patients were more likely to feel strong and
confident after treatment. Male patients disagreed
to a significantly greater extent to the statement
that they do not adhere to one doctor for treatment,
although both the genders strongly disagreed on
not adhering to one physician.
Table 2 shows the comparison of the responses
from doctors and patients. Doctors were
statistically less likely to agree to the following
responses in comparison to the patients the role
of personal relationship, patient satisfaction,
doctors skills, communicability with the doctor
etc. The following aspects were considered by the
doctors to have a greater influence on doctor
patient relationship good rapport with the
patients, power and status of the patient, long
waiting time in the clinics.

DISCUSSION
Influence of gender on perception of various
aspects of doctor patient relationship was studied.
There is difference between the genders with
respect to the comfort factor of the patients if the
doctor is of the same gender, i.e. female patients
are more comfortable with lady doctors. Indian
society is male dominated and women have
reservations and limitations due to subtle
confinements of the society. The mindset that
female feels comfortable with a lady is strongly
rooted in Indian society and has no significance
with the competence of the doctor. The study by
Garciaet al among outpatients of a university
clinic showed that even among women in all
English-proficient groups, gender concordance is
important to their relationships with primary care
physicians.
8
A study among final year medical
student showed that their interaction with the
patients is not gender neutral. Both genders were
more attuned to the concerns of patients of their
own gender and were uncomfortable in clinical
examination of the opposite gender.
9
There is also
a significant difference between the responses of
male and female patients with respect to feeling
of strength and confidence after the treatment. A
study by Sharma (2001) also stated very clearly
that the doctor needed to pay full attention towards
patients symptoms, his story and above all his
anguish and sufferings.
10
Listening to the patient
was very important as it promotes the feeling of
strength and confidence in the patients. However it
is also important to note that gender is a
characteristic that is associated with variation in
communication. Women disclose more
information about themselves in conversation,
they have a warmer and more engaged style of
nonverbal communication, and they encourage and
facilitate others to talk to them more freely and in
a warmer and more intimate way.
11
Similarly,
female patients strongly feel that personal
relationship with the treating doctor counts a lot in
taking treatment with both male and female
patients mean score on the higher side. It is
extremely important to foster this relationship
especially in the current scenario of rapid
penetration of managed care into the healthcare
market raising concerns for many patients and
doctors about the effects that different financial
and orgamizational features might have on the
doctor-patient relationship.
1
In our study, female
patients were also more likely to strongly disagree
of not having consulted the same physician for
their health problems. The reason for change of
physician could be lack of trust, connectedness
with the physician or long waiting time for
consultation. At the same time, the healthcare
system in India allows for specialist consultation
Rathnakar UP et al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE


Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)
Page 33


without the intermediacy of a general physician.
Patients tend to consult different doctors for
different ailments. This also allows for multiple
consultations with different doctors for the same
ailment which may lead to drug related problems
or unnecessary investigations if the information of
previous consultation is not shared by the patient
or elicited by the doctor. The comparison of the
responses from doctors and patients in our study
showed that the doctors were more likely to agree
that the patients do not stick to one doctor with
long waiting time being a reason for consulting a
different doctor. Doctors strongly feel that the
loyalty factor amongst the patients is declining due
to more affordability, long waiting hours with the
specific doctor, lack of patience amongst the
younger generation, lack of trust and also due to
unavoidable circumstances like geographical
barriers and time constraints. In his observations,
Pandya et al (1995) mentions that it is unethical
for a doctor to take over a patient already under
the care of another doctor without a note of
referral.
12
Dissolution of the doctor- patient
relationship also brings in its wake a major legal
handicap. Since the patient is consulting more than
one expert, each of whom is in ignorance of what
the other is doing, no one will accept
responsibility in the event of a mishap.
Both doctors and patients have agreed that good
rapport and patient satisfaction are important
aspect in doctor patient relationship. Patients these
days have a wide choice of doctors, treatment
including alternative medicines which they
consider to be harmless or have less side effects.
There is also increasing awareness among patients
about the management of common sickness such
as common cold, fever, headache, vomiting as
well as diarrhea. Therefore the patient delight
becomes essential to stick to a same doctor in the
long run. Medical field has become so competitive
these days as the doctors need to strategize their
practice with efficiency, effectiveness,
communication skill, listening skill, cost
consciousness, and curability of the disease.
Therefore doctors themselves have almost
disagreed that the doctors skill is a dominant
factor in doctor-patient relationship.
Statistical test was used to determine if there is any
difference between the responses of the doctors of
the ten different specialties viz., medicine, surgery,
ophthalmology, ENT, orthopedics, dermatology,
gynecology, radiology, cardiology, psychiatry.
There was no significant difference between the
responses of the specialists, giving equal treatment
to the patients.

CONCLUSION
Our study showed that physician gender could be a
factor in forming a good doctor patient
relationship as more female patients preferred
consulting doctor of same gender relative to males.
The responses obtained from the female patients
emphasizing the personal relationship and the
positive effect of treatment is in agreement with
the findings of similar studies. Although disagreed
by the patients, doctors were more likely to
mention that the patients do not stick to one
doctor. Doctors also opined that power and status
influence does affect the doctor patient
relationship.
The patients who rest their trust in their doctors,
with due diligence, create a win-win situation.
Equally important is the holistic care and patient
centered rather than disease centered approach to
treatment by the doctors. The safety net provided
by the official system of referral and transfer of
medical information in writing in both directions
between general practitioner and consultant or
consultant and consultant is now missing. Worst of
all, disregard for the relationship destroys the
traditional bond of affection between family and
general practitioner. The doctor needs to pay full
attention towards patients symptoms, his story
and above all his anguish and sufferings. This is
one of the failings which a doctor should avoid as
this would leave the patient dissatisfied. Human
beings, be it doctors or any other professionals
come with lot of precincts which hold liable the
Rathnakar UP et al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE


Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)
Page 34


patients as well. The awareness of the human
limitation becomes all the more important in
establishing the trust and faith between the doctors
and patients.

ACKNOWLEDGMENT
Authors acknowledge the great help received from
the scholars whose articles are cited and included
in references of this manuscript. The authors are
also grateful to authors / editors / publishers of all
those articles, journals and books from where the
literature for this article has been reviewed and
discussed. Authors are grateful to IJMPS editorial
board members and IJMPS team of reviewers who
have helped to bring quality to this manuscript.

REFERENCES
1. Goold SD, Lipkin M. The DoctorPatient
Relationship: Challenges, Opportunities, and
Strategies. J Gen Intern Med. 1999 ; 14(Suppl
1): S26S33.
2. Kirshner M. The role of information
technology and informatics research in the
dentist-patient relationship. Adv Dent Res.
2003 Dec;17:77-81.
3. Perloff RM, Bonder B, Ray GB, Ray EB,
Siminoff LA. Doctor-Patient Communication,
Cultural Competence, and Minority Health -
Theoretical and Empirical Perspectives.
American Behavioral Scientist.
2006;49(6):835-852 .
4. Kivits J. Informed Patients and the Internet , A
Mediated Context for Consultations with
Health Professionals. Journal of Health
Psychology 2006;11(2):269-282.
5. Arborelius E, Timpka T, Nyce JM. Patients
comment on video-recorded consultations
the "good" GP and the "bad". Scandinavian
Journal of Public Health 1992; 20(4):213-216.
6. Benedetti F. How the Doctors Words Affect
the Patients Brain. Evaluation & the Health
Professions 2002;25(4):369-386.
7. Hellstrom O, Bullington J, Karlsson G,
Lindqvist P, Mattsson B. Doctors' attitudes to
fibromyalgia: a phenomenological study.
Scandinavian Journal of Public Health
1998;26(3):232-237.
8. Garca JA, Paterniti DA, Romano PS, Kravitz
RL. Patient preferences for physician
characteristics in university-based primary
care clinics. Ethn Dis. 2003;13(2):259-67.
9. Zaharias G, Piterman L, Liddell M. Doctors
and patients: gender interaction in the
consultation. Acad Med. 2004 ;79(2):148-55.
10. B.K. Sharma. Trust is the basis of doctor-
patient relationship Spectrum. 2001. Available
online at
http://www.tribuneindia.com/2001/20011007/
spectrum/fitness.htm (Accessed on Jan 10,
2010).
11. Roter DL, Hall JA. Physician gender and
patient-centered communication: A Critical
Review of Empirical Research. Annu. Rev.
Public Health 2004;25:497519
12. Pandya S. Doctor-patient relationship. Indian
Journal of Med Ethics. 1995;3(2).









Rathnakar UP et al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE


Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)
Page 35


Table 1: Gender-wise representation of the patients response regarding various aspects of
doctor-patient relationship
Particular aspects of doctor-patient relationship
Mean of the Likerts score* according to
gender (Standard Deviation)
Males (n=77) Females (n=125)
Doctor spends enough time in educating about the disease 4.35 (0.84) 4.36 (0.71)
My doctor gives equal treatment to all the patients irrespective
of our background
4.27 (0.75) 4.22 (0.59)
I feel comfortable with the doctor belonging to the same gender 2.34 (1.33)
3.06 (1.33)
[p=0.001]
My doctor is a caring human who listens, understands and is
concerned with my health
4.32 (0.52) 4.37 (0.52)
The personal relationship with the treating doctor counts a lot
in taking treatment
4.01 (0.91)
4.37 (0.63)
[p=0.001]
I feel great psychological strength and confidence once my
doctor treats me
4.43 (0.70)
4.62 (0.53)
[p=0.026]
My doctor builds a good rapport with the patients irrespective
of their religion, caste and region
4.14 (0.87) 4.23 (0.65)
Power and status of an individual influences the doctor patient
relationship
2.23 (1.17) 2.06 (0.85)
Communication, health care facilities have enabled me to
understand my health conditions better
4.10 (0.87) 4.22 (0.52)
Telecommunication has given me an opportunity to contact my
doctor on real time basis
4.12 (0.69) 4.16 (0.68)
The waiting time is long and sometimes it becomes the reason
for changing the doctor
1.73 (0.97) 1.71 (1.01)
I do not stick to a single doctor for the treatment of my
identical sickness
1.77(1.13) 1.45 (0.80) [p=0.02]
Patient satisfaction is important for maintaining the strong
doctor patient relationship
4.44 (0.60) 4.37 (0.53)
Doctors skill is significant in sustaining doctor patient
relationship
4.40 (0.49) 4.46 (0.53)
Being the patient I should be allowed to ask as many questions
as I want about my disease
4.53 (0.60) 4.51 (0.50)
Doctor should not mind if patient requests for a second opinion 3.87 (0.78) 3.94 (0.85)
Irrespective of my affordability I should be offered the best
possible treatment options
4.40 (0.59) 4.35 (0.51)
Doctor always discusses with me different treatment options
available
4.13 (0.90) 4.3 (0.54)
Doctor encourages patient to learn from internet

1.32 (0.62) 1.42 (0.90)
Doctor does not mind if I communicate apart from regular
visits
3.90 (0.93) 4.06 (0.76)
Doctor always discusses the nature of seriousness of disease
with the patients
4.19 (0.83) 4.24 (0.72)
*Score of 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree
Rathnakar UP et al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE


Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)
Page 36


Table 2: Comparison of the responses from the doctors and patients regarding various aspects of
doctor patient relationship
Particular aspects of doctor-patient relationship
Mean of the Likerts score* (Standard
Deviation)
Patients (n=202) Doctors (n=50)
I spend enough time to educate my patient regarding his/her
disease
4.36 (0.76) 4.30 (0.79)
I give equal treatment to all the patients irrespective of their
background
4.24 (0.66) 4.32 (0.91)
I feel comfortable with the patient belonging to the same gender 2.78 (1.37) 3.18 (0.98)
I listen to all aspects concerned with my patients health 4.35 (0.52) 4.20 (0.61)
The personal relationship with the patients counts a lot in giving
treatment
4.23 (0.77)
[p=0.003]
3.84 (1.09)
I instill psychological strength and confidence in my patients
4.55 (0.61)
[p<0.001]
3.80 (0.93)
I build a good rapport with the patients irrespective of their
religion, caste and region
4.20 (0.74)
4.44 (0.58)
[p=0.032]
Influence of power and status of patients affects the doctor
patient relationship
2.12 (0.98)
3.48 (1.39)
[p<0.001]
Communication, health care facilities have enabled patients to
understand their health conditions better
4.17 (0.67)
[p=0.008]
3.88 (0.77)
Telecommunication has given an opportunity to my patients
contact me any time during an emergency
4.14 (0.68)
[p=0.021]
3.88 (0.85)
Long waiting time is a reason for the patient to frequently
change the doctor
1.72 (0.99)
3.42 (1.07)
[p<0.001]
Frequent change of doctors by patients adversely affects doctor
patient relationship
1.57 (0.95)
3.84 (0.89)
[p<0.001]
Patient satisfaction becomes the core factor for maintaining a
strong doctor patient relationship
4.40 (0.56)
[p=0.005]
4.14 (0.64)
Doctors skill is most important in sustaining doctor-patient
relationship
4.44 (0.52)
[p<0.001]
3.52 (1.16)
I do not mind if patient asks many questions about his disease
4.52 (0.54)
[p<0.001]
3.84 (0.84)
I do not mind if patient requests for a second opinion 3.91 (0.82) 3.98 (0.62)
Irrespective of the affordability I offer all the treatment options
to the patients
4.37 (0.54)
[p<0.001]
3.90 (0.93)
I encourage patients to learn from internet 1.39 (0.80)
2.72 (1.09)
[p<0.001]
I do not mind if patients communicate apart from regular visits
4.00 (0.83)
[p=0.004]
3.62 (0.85)
I patiently listen to patients complaints even when the diagnosis
is very obvious
4.23 (0.71) 4.06 (0.59)
I always discuss nature of seriousness of disease with the
patients
4.22 (0.76) 4.04 (0.70)
*Score of 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree