In studies of gender and language, men tend to talk more than women, successfully interrupt women, and control the topics of the conversation (24). As a result, male physicians may tend to take control, and this imbalance of power may be magnified in the field of obstetrics and gynecology, in which all the patients are women. Male physicians may be more assertive than female physicians. Men’s speech tends to be characterized by interruptions, command, and lectures, and women’s speech is characterized by silence, questions, and proposals (25,26). Some patients may feel more reticent in the presence of a male physician, whereas others may be more forthcoming with a male than a female physician (27). Women’s preference for a male or female physician may be based on gender as well as experience, competency, communication styles, and other skills (28,29). Although these generalizations clearly do not apply to all physicians, they can raise awareness about the various styles of communication and how they shape the physician–patient relationship (30,31). These patterns indicate that all physicians, regardless of their gender, need to be attentive to their style of speech because it may affect their ability to elicit open and candid responses from their patients (32–34). Women tend to express their feelings in order to validate, share, and establish an understanding of their concerns or establish a shared understanding of their concerns (22,24,25).
Different styles of communication may affect the physician’s ability to perceive the patient’s status and to achieve the goal of optimal assessment and successful treatment. The intimate and highly personal nature of many gynecologic conditions requires particular sensitivity to evoke an honest patient response.
Style The art of communication and persuasion is based on mutual respect and fosters the development of the patient’s understanding of the circumstances of her health. Insight is best achieved when the patient is encouraged to question her physician and when she is not pressured to make decisions. Patients who feel “backed into a corner” have the lowest compliance with recommended treatments (20).
Following are techniques to help achieve rapport with patients: 1.
Use positive language (e.g., agreement, approval, and humor).
2.
Build a partnership (e.g., acknowledgment of understanding, asking for opinions, paraphrasing, and interpreting the patient’s words).
3.
Ask rephrased questions.
4.
Give complete responses to the patient’s questions.
The manner in which a physician guides a discussion with a patient will determine the patient’s level of understanding and her ability to successfully complete therapy. The term compliance has long been used in medicine; it suggests that the patient will follow the physician’s recommendations or “orders.” The term is criticized as being overly paternalistic; an alternative term, adherence to therapy, was proposed (35–37). This term still implies that the physician will dictate the therapy. A more collaborative approach is suggested by the phrase successful use of therapy, which can be credited mutually to the physician and the patient. With this phrase, the ultimate success of the therapy appropriately accrues to the patient (38). If a directive is given to take a prescribed medication without a discussion of the rationale for its use, patients may not comply, particularly if the instructions are confusing or difficult to follow. Barriers to compliance may result from practical considerations: Nearly everyone finds a four times daily (qid) regimen more difficult than daily use. A major factor in successful compliance is the simplicity of the regimen (39,40). Practical factors that affect successful use include financial considerations, insurance coverage, and literacy (41). A discussion and comprehension of the rationale for therapy, along with the potential benefits and risks, are necessary components of successful use; but they may not be sufficient in the face of practical barriers. The specifics of when and how to take medication, including what to do when medication is missed, have an impact on successful use. Positive physician–patient communication is correlated with patient adherence to medical advice (42).