Gender plays a role in conversations between GPs and patients

What role does gender play in conversations between GPs and patients with everyday physical complaints, such as headaches and back pain? Language and communication researcher Ilona Plug studied language use and communication in these conversations and investigated the role that gender plays in them. 'It is important that we become more aware of gender-based assumptions and expectations so that they have less influence on our interpretations and judgements of what people do and say.'

Women's and men's health and healthcare often differ. They have different physical and mental symptoms, and receive different further examinations, specialist referrals, diagnoses and treatment options. These differences cannot be explained by biological sex alone. For this reason there has recently been increasing attention to the role of gender in health care.

Little was previously known about the role of gender in health. For her PhD research, language and communication scientist Ilona Plug investigated gender in medical interactions from a linguistic perspective, analysing hours of video material of conversations between GPs and patients. Previous research showed that there is little to no difference in the language used by women and men in one-on-one conversations. 'However, recent studies on male and female language use do show that, compared to male speakers, female speakers make more nodding head movements, indicate more explicitly that they are listening with 'yes' and 'hmhm' and use more supportive interruptions,' Plug explains. Plug's follow-up research into those supportive interruptions in the consulting room found that they are made by both men and women, and that such interruptions can actually contribute to the success of a consultation. [Read more]

Stereotypical ideas

Plug then investigated whether people could judge whether the patient was male or female after reading a written-out GP-patient consultation. 'They turned out to be very bad at that. But what did stand out: people have - subconsciously or not - many ideas about what is typically female or male language. Cautious and soothing words like 'a little bit' were seen as typical female language, and short answers like 'no' and 'yes' as typical male language.' The participants in the experiment used those biases for their estimation. Such biases can thus 'colour' our perception and assessment of others. So it is important to create more awareness about the existence and influence of these stereotypical ideas about how women and men talk.'

Moreover, Plug discovered that GPs sometimes (unconsciously) used stereotypes about gender roles to explain medical concepts. For example, a GP asked a female patient whether she experienced symptoms during 'exertion', such as 'when lugging a laundry basket up the stairs'. Plug: 'While it is also possible to use more neutral examples. This way, stereotypical ideas about gender roles are perpetuated, even when it is not medically relevant.'

Gender plays a role

Plug's research shows that stereotypical ideas about female and male language and gender roles may influence how male and female patients are seen and evaluated by GPs. Gender - and thus gender roles and stereotypes in particular - plays a role in the medical context. 'Gender differences in healthcare are therefore not related to how men and women talk, for instance when they describe their symptoms, but possibly to how their use of language is interpreted,' says Plug. 'Gender, like sex, affects both people's health and care trajectories. It is good to take this into account so that doctors can provide the most appropriate care. However, it is also important that we become more aware of assumptions and expectations based on gender so that they have less influence on our interpretations and judgements of what people do and say.'

This research is part of the larger research project Symptoms & Gender. Based on the research, Plug and her colleagues have developed two innovative methods to raise awareness about the role of gender in health: an e-learning for junior doctors, in which they learn about the role of gender and sex in health and medical interactions, and a comic book for health professionals and researchers, which creatively explains the influence of gender on health. In honour of her PhD, a quartets game was also developed, which explains research findings in simple language and challenges players to (critically) scrutinise their own stereotypes.

Ilona Plug's PhD thesis is available via the Radboud Repository. Want to know more? Send an e-mail to Ilona Plug, ilona.plug@ru.nl (from 1 April i.plug@vu.nl)