Research findings concerning the role of gender in patient-physician interactions can inform considerations about the role of gender in patient-dental care provider interactions. Medical research showed that gender differences in verbal and nonverbal communication in medical settings exist and that they affect the outcomes of these interactions. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the cultural complexity and diversity in which gender issues are embedded and the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers.
Key points
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Research concerning the role of gender in patient-physician interactions shows that gender differences exist both in verbal and nonverbal communication and that the issue of patient-provider concordance received a lot of attention. Earlier research on the effects of being in concordant versus discordant relationships focused mainly on demographic similarity, whereas newer research argues that perceived similarities are more predictive of treatment outcomes.
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Lessons learned from the findings in the medical field are that more research is needed and that this research needs to consider that gender identity does not exist in a vacuum but is affected by a person’s additional identities.
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Concerning the role of gender in communication in the dental office, research showed that perceptions of dentists and patients are influenced by gender: traditional gender stereotypes are applied to perceptions of dentists and also shape perceptions of patients.
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Pediatric dental patients prefer gender-concordant interactions with dentists and physicians. Adult dental patients in gender-concordant relationships differ in what they value about their dentist as well as in their self-perceptions from patients in gender-discordant relationships.
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The content of patient-dentist communication is affected by the fact that the prevalence of certain issues such as eating disorders, abuse, and the use of tobacco products differs for male and female patients. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers.
Introduction
Constructive communication between a patient and a dental care provider is crucial. Such communication affects whether a patient returns for a future visit, how the patient responds during the dental visit, whether a patient makes the best possible treatment decisions, and even how well the patient cooperates with treatment recommendations after the visit. Numerous studies provided support for the importance of good patient-provider communication for patients’ satisfaction with their provider, for reducing patients dental fear and anxiety, for increasing their confidence in their dentist, and for achieving more positive treatment outcomes.
One factor that crucially affects communication in general and patient-dental care provider communication specifically is the cultural background of the communication partners. Research on cross-cultural communication therefore focuses on gaining a better understanding of the dynamics of communication between persons from different cultural backgrounds. These investigations are of interest when considering interactions between patients and dental care providers and specifically when analyzing the role of gender in this context. A person’s gender identity as well as gender stereotypes and attitudes clearly affect interactions and communication. This situation is complicated by the fact that patients’ and providers’ gender is not the only significant cultural factor that will shape their communication. Other characteristics such as their socioeconomic, educational, and ethnic/racial background; sexual orientation; ability status; and religious denomination clearly affect the way patients and dentists and dental hygienists interact with each other. Although addressing the effects of this complex constellation of factors on patient-provider interactions would go beyond the scope of this article, it is important to keep this issue in mind when considering the role of gender in this context.
The first objective of this article is to consider the role of patients’ and medical care providers’ gender in their interactions in general (Part 1). Questions addressed in this section focus on whether gender concordance matters in medical settings and whether there are gender differences in verbal and nonverbal communication. Part 2 then analyzes how gender matters in interactions in the dental office. This analysis begins with the simple question how male and female patients differ in their use of dental care services and the reasons they have for seeking dental care. The next section focuses on gaining a better understanding of how patients perceive male versus female dentists and how dentists perceive male and female patients with different types of dental issues such as missing frontal incisors or malocclusion. Having a better understanding of the mutual perceptions will set the stage to explore if male and female pediatric and adult dental patients have gender preferences for their dentist and if so, if these gender concordance considerations affect patients’ responses to gender-consistent versus gender-inconsistent interactions. The final section of this article focuses on gender differences in patient-dental care provider interactions in general and specifically when communicating (1) about abuse and intimate partner violence and (2) with a patient who does not have a heterosexual orientation. The discussion and conclusion part addresses how the growing numbers of female dentists might affect dentists’ professional activities and community involvement and how dental and dental hygiene education as well as oral health-related research needs to become involved in exploring these issues.
Introduction
Constructive communication between a patient and a dental care provider is crucial. Such communication affects whether a patient returns for a future visit, how the patient responds during the dental visit, whether a patient makes the best possible treatment decisions, and even how well the patient cooperates with treatment recommendations after the visit. Numerous studies provided support for the importance of good patient-provider communication for patients’ satisfaction with their provider, for reducing patients dental fear and anxiety, for increasing their confidence in their dentist, and for achieving more positive treatment outcomes.
One factor that crucially affects communication in general and patient-dental care provider communication specifically is the cultural background of the communication partners. Research on cross-cultural communication therefore focuses on gaining a better understanding of the dynamics of communication between persons from different cultural backgrounds. These investigations are of interest when considering interactions between patients and dental care providers and specifically when analyzing the role of gender in this context. A person’s gender identity as well as gender stereotypes and attitudes clearly affect interactions and communication. This situation is complicated by the fact that patients’ and providers’ gender is not the only significant cultural factor that will shape their communication. Other characteristics such as their socioeconomic, educational, and ethnic/racial background; sexual orientation; ability status; and religious denomination clearly affect the way patients and dentists and dental hygienists interact with each other. Although addressing the effects of this complex constellation of factors on patient-provider interactions would go beyond the scope of this article, it is important to keep this issue in mind when considering the role of gender in this context.
The first objective of this article is to consider the role of patients’ and medical care providers’ gender in their interactions in general (Part 1). Questions addressed in this section focus on whether gender concordance matters in medical settings and whether there are gender differences in verbal and nonverbal communication. Part 2 then analyzes how gender matters in interactions in the dental office. This analysis begins with the simple question how male and female patients differ in their use of dental care services and the reasons they have for seeking dental care. The next section focuses on gaining a better understanding of how patients perceive male versus female dentists and how dentists perceive male and female patients with different types of dental issues such as missing frontal incisors or malocclusion. Having a better understanding of the mutual perceptions will set the stage to explore if male and female pediatric and adult dental patients have gender preferences for their dentist and if so, if these gender concordance considerations affect patients’ responses to gender-consistent versus gender-inconsistent interactions. The final section of this article focuses on gender differences in patient-dental care provider interactions in general and specifically when communicating (1) about abuse and intimate partner violence and (2) with a patient who does not have a heterosexual orientation. The discussion and conclusion part addresses how the growing numbers of female dentists might affect dentists’ professional activities and community involvement and how dental and dental hygiene education as well as oral health-related research needs to become involved in exploring these issues.
Part 1: Patient-provider interactions and gender: general considerations
Disparities in health and health care are no longer seen solely as a function of structural factors. Instead, attention has increasingly begun to move to analyzing how patient characteristics such as race and gender and the patient-doctor relationship are related to health care disparities. An earlier paradigm shift to focusing on patient-centered care brought additional attention to the role of such factors as gender and race. One aspect of the patient-centered interaction style is whether the patient and the provider are in “concordance,” meaning that they share the same characteristic. For example, gender concordance refers to a situation in which both the patient and the provider have the same gender. One interesting question is whether gender concordance has positive effects on patients’ responses to their interactions with their medical care providers.
Does Gender Concordance Matter?
Early studies exploring whether concordance matters in patient-physician relationships focused on one hand on the type of concordance, mainly on whether the relationship was for example race or gender concordant, and on the other hand on the consequences of concordant relationships. Some studies on the effects of race-concordant interactions showed positive effects such as increased patient satisfaction, trust, use of health care services, and joint decision making, whereas others found no significant effects or concluded that the evidence was inconclusive. More recent studies therefore moved away from defining concordance in terms of demographic characteristics to considering more subjective factors such as perceived similarity or informational versus interactional concordance.
Research on the meaning of perceived similarity showed that this concept consisted of 2 separate aspects, namely, (1) perceived similarity related to personal matters such as similar beliefs and values and (2) perceived similarity concerning social characteristics. The data showed that the degree of personal similarity (together with physicians’ patient-centered communication) was associated with higher ratings of trust, satisfaction, and intention to adhere.
Coran and colleagues approached unraveling the relevance of concordance in a slightly different way. The investigators differentiated perceptions of similarity as being related either to information or to the interaction per se. The investigators defined informational concordance as the extent to which physicians and patients agreed about patient information such as self-rated health and pain, whereas interactional concordance referred to the degree to which patients and physicians agreed on interaction characteristics such as the patients’ level of trust. It was shown that both discordances were associated with patients’ dissatisfaction with their physician.
The move from defining concordance as a similarity between patients’ and providers’ demographic characteristics to an assessment of perceptions of similarities or to a determination of similarities in perceptions of informational and interactional aspects raises an interesting question. This question is whether male and female patients and providers differ in their verbal and nonverbal communication. If such differences can be identified, they might shape perceptions of similarities, which in turn might affect patient satisfaction, trust, and cooperation with treatment recommendations.
Gender Differences in Communication Between Patients and Providers
Gender differences in verbal communication
As the percentage of female physicians increased, an interest seemed to arise in exploring whether male and female physicians differ in their interactions with their patients. Research in medical settings found several significant differences in the communication of male and female physicians as well as that of female and male patients.
Concerning physicians, research showed that female physicians had longer patient visits with more verbal exchanges. Female physicians also emphasized different aspects of care, paid more attention to psychosocial issues, and valued empathy more than their male colleagues.
Concerning gender differences in patients’ communication style, research showed that female patients received more information with less medical jargon, asked more questions, presented more symptoms, and gave more information in their medical history.
Gender differences in nonverbal communication
In addition to verbal communication, nonverbal communication plays an important role. Research showed that women differed in several aspects of nonverbal communication from men such as in smiling, facial expressiveness, and touching. Women also showed more back-channel responses such as nodding and responding with “I see” and so forth compared with men.
However, when Sandhu and colleagues conducted a systematic review of the impact of gender dyads on doctor-patient communication in 2009, they concluded that the evidence base was too small and that further research is needed.
Lessons Learned from Medical Research
What lessons can dental clinicians and researchers learn from the findings reported from medical research?
First, it is quite obvious that male and female physicians and patients differ in their verbal and nonverbal communication from their counterparts. However, as Sandhu and colleagues pointed out, more research is needed.
Second, analyzing the communication of male and female providers independent of the gender of their patients might not result in a sufficient understanding of the complexity of these issues. Studying the dynamics of gender-concordant and gender-discordant dyads and considering not only demographic concordance but also perceived similarities might result in a more comprehensive understanding.
Third, analyzing the role of gender in patient-provider interactions without considering physicians’ and patients’ intersecting identities might further limit our understanding of the complexity of these issues.
Part 2: Communication in the dental office: how does gender matter?
Male and Female Dental Patients: General Considerations
Before analyzing the gender effects in patient-provider interactions in dental offices, it is to be noted that national statistics show that women in the United States have been slightly more likely than men to report a dental visit during the past year. Research also showed that women were more likely to engage in oral-health-related behavior such as tooth brushing. In addition, differences in esthetic concerns related to oral health might exist already in young children and oral health issues such as malocclusion might be perceived by others differently depending on the patient’s gender.
Differences in the prevalence of specific issues related to oral health might shape the content of communication in dental offices. For example, eating disorders are much more prevalent among women, whereas the use of tobacco products is more common among men. However, both issues need to be addressed in oral health education.
Overall, it might be important to understand how male and female dentists are perceived by their patients and how patients with different oral health issues are perceived by others, because these stereotypes might shape expectations for interactions. Next, it will be interesting to explore whether pediatric and adult dental patients have preferences for male versus female dentists and whether these preferences are a function of their own gender. Once patients interact during a dental visit, it will be interesting to analyze if gender affects these interactions. Finally, 2 issues related to gender, domestic violence and the role of patients’ sexual orientation in patient-provider interactions, are also discussed.
How Does Gender Matter in Perceptions of Dentists and Patients?
Perceptions of male and female dentists
In 2008, Smith and Dundes assessed whether traditional gender stereotypes are applied to dentists. Traditionally, women tended to be characterized as more caring, submissive, and expressive than men, whereas men tended to be perceived as more competitive, assertive, and competent than women. The investigators therefore asked college and noncollege students whether certain traits were more characteristic of male dentists, female dentists, or neither gender. It was found that female dentists were perceived as more likely to make patients relaxed and to take more time to discuss issues than their male colleagues. On the other hand, male dentists were perceived as more likely to expect patients to endure pain without complaints, being more devoted to their career than their family, and as more likely to be attracted to the power of their profession than their female colleagues. In consideration of these findings, the investigators suggested to encourage dental students to consider how these preconceived stereotypes might affect their own patients’ perceptions and thus influence their rapport and communication with their patients.
Perceptions of male and female dental patients
One question is whether patients with different oral health issues are perceived differently as a function of their gender. Olsen and Inglehart explored this question in 2 contexts. In their first study, they assessed how adults perceived persons with normal occlusion or with different malocclusions (open bite, deep bite, under bite, overjet, crowding, and spacing). Specifically they explored how occlusion affected others’ perceptions of male and female target persons’ attractiveness, intelligence, personality, and the desire to interact in personal and professional settings with these persons. Overall, they found that persons with normal occlusion were rated as most attractive, intelligent, agreeable, and extraverted, whereas persons with an under bite were rated as least attractive, intelligent, and extraverted. Female targets were rated more positively than male targets.
In a second study, the investigators studied observers’ perceptions of male and female persons with normal occlusion versus those with a missing frontal incisor or with malocclusion and their willingness to potentially interact with these persons. Overall, Table 1 shows that persons with normal occlusion were evaluated as more attractive and intelligent, having a more positive personality and being more desirable to interact with than persons with a missing incisor or malocclusions. A female with a missing incisor was rated as least attractive, least intelligent, least conscientious and agreeable, and least extraverted. The only category in which males with a missing incisor received more negative responses than females with missing incisors was concerning behavioral intentions to interact with the depicted person in personal (eg, as a neighbor or friend) or professional settings (eg, as a colleague).
| Characteristic a | Photo Gender | Normal Occlusion | Missing Incisor | Malocclusion | P (gender) P (o by g) b |
|---|---|---|---|---|---|
| Attractiveness | Male | 5.19 | 4.11 | 4.61 | .298 .005 |
| Female | 5.68 | 3.59 | 5.07 | ||
| Intelligence | Male | 5.35 | 4.59 | 4.89 | .199 .039 |
| Female | 5.51 | 4.43 | 5.29 | ||
| Personality factors | |||||
| Conscientiousness | Male | 4.82 | 4.56 | 4.81 | <.001 .011 |
| Female | 5.58 | 4.57 | 5.30 | ||
| Agreeableness | Male | 4.17 | 3.13 | 3.89 | .339 .004 |
| Female | 4.58 | 2.71 | 4.19 | ||
| Neuroticism | Male | 2.63 | 3.04 | 2.82 | .065 .463 |
| Female | 2.36 | 3.04 | 2.54 | ||
| Lack of openness | Male | 3.55 | 3.92 | 3.67 | .172 .136 |
| Female | 3.29 | 4.07 | 3.37 | ||
| Extraversion | Male | 5.27 | 4.94 | 4.78 | .026 .007 |
| Female | 5.15 | 4.24 | 4.85 | ||
| Behavioral intention | |||||
| Index: desire to interact | Male | 4.45 | 3.47 | 4.11 | <.001 .305 |
| Female | 5.05 | 3.82 | 4.84 | ||
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