Whereas the current veterinarian workforce is comprised of approximately equal numbers of male and female clinicians, a 2010 study found that 80% of students enrolled in veterinary colleges are female.1 Given the increasing gender shift in the veterinary profession toward female practitioners, it is timely and relevant to develop an understanding of gender differences in veterinarian-client-patient communication. The study reported here is part of a larger cross-sectional study of veterinarian-client-patient communication in companion animal practitioners. Four related papers have been published, and findings describe veterinarian use of communication skills,2 veterinarian communication styles,3 communication differences in wellness and problem visits,4 and the association of veterinarian-client-patient communication to veterinarian satisfaction.5 Building upon these descriptive findings, the study reported here explored the relationship between veterinarian and client genders and veterinarian-client-patient communication.
Research in veterinary communication is growing2; there is substantial literature on physician-patient communication, and multiple studies have investigated physician gender differences.6–9 In popular literature and day-to-day conversation, it is recognized that men and women communicate differently.10 In general, male conversation is task oriented with displays of power, status, or competition, whereas female conversation is relationship oriented with emotional content, partnership building, self-revealing information, and attention to feelings of others.11
In the office, men and women display different leadership styles. Women tend to be more democratic and participative, whereas men tend to be more autocratic and directive.12 Women use a transformational style of leadership, achieved through gaining trust, providing mentorship, and empowering their colleagues, whereas men's style of leadership has been identified as transactional, achieved through clarifying objectives and using a system of reward and corrections.12
These findings transfer to the medical setting where male and female physicians demonstrate different communication behaviors.6 In a study13 of primary care physicians, male physicians were more likely to use the biomedical communication pattern, reflective of paternalism, whereas female physicians used relationship-centered care, representative of a collaborative partnership irrespective of patient gender. In a meta-analytic review6 of physician gender effects in medical communication, female physicians conducted more patient-centered encounters characterized by longer visits, engaged in active partnership, expressed positive talk, asked psychosocial questions, provided psychosocial information, and fostered emotionally concerned conversation.
Reciprocity theory supports that people respond differently to men and women in conversation, and aspects of nonverbal and verbal communication are typically matched in social interactions.14 In a meta-analytic review of patient and physician gender effects, patients of female physicians mirrored the communication behaviors of their female physicians.8 Patients of female physicians spoke more, disclosed more biomedical and psychosocial information, made more positive statements, and displayed more assertive, participatory, and partnership behaviors. These differences can be summarized as characterizing female physicians as more patient centered.7,8
There is evidence that people view behaviors and set expectations of professionals on the basis of their gender. Leaders were most effective when they assumed leadership roles that were congruent with social and gender role expectations in their work environment.15 Ratings of patient-centered communication differed on the basis of provider gender; analogue patients rated male physician patient-centered behaviors as more competent than those of female physicians.16 Patient satisfaction was enhanced when physicians displayed stereotypical gender nonverbal behavior.17 Dominant behavior in female physicians was perceived more negatively than in male physicians.18 These findings in human medicine highlight the challenges that veterinarians may face interacting with same- and different-gender clients.
Few studies have investigated the effect of gender concordance of physician and patient on medical communication. However, there is evidence that communication effects are strengthened in same-gender pairs. In a systematic review9 of the impact of gender dyads on doctor-patient communication, same-gender dyads were characterized by relative ease and equality between doctor and patient, whereas in different-gender dyads, there was evidence of tension around power and status. Interactions between male doctors and male patients were described as calm and focused on the patient's social agenda and health promotion with a biopsychosocial pattern of communication, reflective of a partnership. In conversations with female doctors and female patients, there was more psychosocial and biomedical talk in a patient-centered environment, encouraging patient input with positive statements, calm voice tone, and head nodding. The longest encounters were with female physician–female patient consultations, compared with any other combinations.
The primary objective of the study reported here was to describe the relationship between veterinarian and client genders and veterinarian-client-patient communication, specifically in regard to the influences of veterinarian gender, client gender, gender concordance, and factors that contribute to gender differences in communication.
Materials and Methods
Videotapes of veterinarian-client-patient interactions in companion animal practice were used in the present study. Details of the study design, including sampling strategy and data collection, were previously described.2 Briefly, a random sample of 50 veterinarians was recruited from the population of companion animal practitioners in Southern Ontario, Canada. Participants were contacted by one of the authors (JRS) to inform them of the project, obtain consent, and arrange a site visit. All clients who arrived for a scheduled appointment during the site visit were invited to participate in the study. Fifty veterinarians and 300 veterinary medical appointments were videotaped. For each veterinarian, a minimum of 6 appointments was videotaped, including at least 3 wellness appointments and 3 appointments related to a health problem. Potential contributors to gender differences in communication were investigated, including practice, veterinarian, client, and pet demographic variables; measures of veterinarian-client-patient communication; and appointment type and length. The Human Ethics Committee at the University of Guelph approved this research protocol, and Johns Hopkins University Institutional Review Board approval was also obtained for analysis of the visit videotapes.
Demographic data—A brief survey was administered to veterinarians and clients to obtain information on demographic traits of participating practices, veterinarians, clients, and pets. Veterinary practice data included the number of veterinarians in the practice, appointment duration, practice type (ie, exclusively small animal or mixed-animal practice), and location of the practice (ie, rural, suburban, or urban). Data collected regarding practicing veterinarians included age, gender, and ethnicity. Data on participating clients included how long they had known the veterinarian, number of visits per year to the veterinarian, age, gender, educational background, and household income. Clients were also asked to report the species, breed, sex, and age of their pet and the number of pets in the household.
Appointment type—A wellness appointment was defined as a veterinary encounter with a presumably healthy juvenile, adult, or geriatric dog, cat, or small mammal that had been brought to the veterinary clinic for an annual examination. A problem appointment was defined as a veterinary encounter with a dog, cat, or small mammal experiencing a health-related issue.
Veterinarian-client-patient communication—Videotapes of the 300 medical appointments were analyzed by coders trained to reliably apply the RIAS. A detailed description of the RIAS methodology as used in veterinary medicine was previously published.2 In brief, the unit of analysis is the smallest segment of speech expressed that conveys a complete thought, usually a simple sentence, a sentence clause, or a single word. Application of codes is exclusive and exhaustive so that every statement is assigned to a single code and all statements by all speakers are coded. Interactions were analyzed in 3 directions: veterinarian to client, client to veterinarian, and veterinarian to patient. A list of the RIAS variables and associated examples in veterinary medicine was previously published.2
Evaluation of communication dynamics—Two measures of communication dynamics, the verbal dominance score and the relationship-centered care score, were used to describe communication control (ie, the power relationship between the veterinarian and the client). The verbal dominance score13 assessed the balance of the dialogue between the veterinarian and client and was calculated as the total count of veterinarian statements divided by the total count of client statements.
The relationship-centered care score was calculated as a reflection of the balance of the veterinarian-client dialogue within the 4 tasks of the medical appointment (ie, data gathering, client education and counseling, relationship building, and activation and partnership). The formula for calculating this score has been described previously in human medicine and is referred to as the patient-centered score.19 Briefly, the relationship-centered score represents the ratio of client-centered talk to veterinarian-centered talk. Client-centered talk was defined as the sum of the following communication composites: veterinarian questions, client education and counseling regarding lifestyle-social topics, veterinarian partnership and rapport building, and client questions, including biomedical and lifestyle-social topics. Veterinarian-centered talk was defined as the sum of the following communication composites: veterinarian biomedical data gathering and information giving, veterinarian orientation (ie, indicators of what is about to happen), and client biomedical information giving. By definition, appointments with high relationship-centered care scores were characterized by veterinarian conversation with a broad focus, including lifestyle-social topics, time spent building rapport and establishing a partnership with the client, and encouragement of client questions.
Defining communication composites—The individual communication variables were grouped into communication composites to reflect the 4 functions of the clinical interview and the content of the medical dialogue. These functions reflect data gathering, client education, responding to emotion, and establishing a working partnership.20 In the veterinary medicine context, the content is classified into 4 areas: biomedical factors, lifestyle activities, social interactions, and anticipatory guidance topics, reflecting the content-based RIAS codes.2 The biomedical content area incorporated discussion of the medical condition, diagnosis, treatment, and prognosis. The lifestyle activities content area comprised discussion of the pet's exercise regimen, environment, diet, and sleeping habits. The social interactions content area encompassed discussion of the pet's personality, temperament, or behavior, and human-animal and animal-animal interactions. Because of the low frequency of discussion of lifestyle and social topics, these categories were combined. The content area of anticipatory guidance topics incorporated discussion of expectations for normal development or care of an animal throughout its life stages. Examples of topics include changes in behavior, nutritional and feeding requirements, sleeping habits, exercise routine, and socialization with people and other animals.
Determining emotional tone—Coders rated the emotional tone of the veterinarians and clients on the basis of ratings of positive affect, which include interest, friendliness, responsiveness, sympathy, and respectfulness (veterinarian and client), and negative affect, which include irritation, anxiety, dominance (veterinarian and client), emotional distress (client only), and hurriedness (veterinarian only), on a scale from 1 (low) to 5 (high).20
Statistical analysis—Multilevel analysis was used to account for the data structure, which was hierarchical and divided into 2 levels: veterinarian (n = 50) and appointment (300). In the present study, the focus was on both veterinarian and client factors, so analysis was conducted at the appointment level. Linear regression was used to study the relationship between demographic factors, appointment characteristics, and differences in communication across gender. Prior to modeling, variables were evaluated for distribution. Generalized linear mixed models with commercial statistical software were used, specifically macro softwarea for count-based or Likert-scale21 outcome variables and statistical softwareb for ratio and binary variables. For all outcomes with an association with any gender variable at P < 0.10, further models were created to examine any influence of demographic variables (ie, client, veterinarian, and pet). The 3 gender variables (ie, veterinarian gender, client gender, and veterinarian × client gender interaction term) were included in all models, and backward elimination was used with final models, including only main effects for demographic variables (P < 0.05). Standard softwarea was used.
Results
Demographic data—The demographic characteristics of the study population were previously published.2 In summary, 43 veterinarians (86%) were Caucasian. Mean veterinarian age was 41 years (range, 26 to 68 years; SD, 8.15 years). Thirty-nine (78%) of the participating veterinarians worked in multi-veterinarian practices. Twenty-four of the 48 (50%) veterinary practices were located in suburban regions. Mean age of all 300 clients was 43 years (range, 14 to 86 years; SD, 14.09 years), and the clients came from a variety of socioeconomic and educational backgrounds. Of the 418 pets, 158 (38%) were cats, 255 (61%) were dogs, and 5 (1%) were small mammals (2 rabbits, 1 guinea pig, 1 ferret, and 1 rat); all animals were of various ages and either sex. Forty-five of the 300 (15%) appointments were first-time interactions with the veterinarian.
Gender distribution—Slightly more than half of the participating veterinarians (26/50 [52%]) were female, and 77% (230/300) of participating clients were female (Table 1). Consequently, female veterinarian–female client gender dyads were far more common than any other combination (126/300 [42%]), followed by male veterinarian–female client interactions (104/300 [35%]), and interactions with male clients being least frequent (with male veterinarians, 40/300 [13%]; with female veterinarians, 30/300 [10%]).
Gender distribution in sample veterinary visits (n = 300 visits) in Southern Ontario, Canada.
| Male veterinarians (n = 24) | Female veterinarians (n = 26) | Total (n = 50) | |
|---|---|---|---|
| Male clients | 40 | 30 | 70 (23%) |
| Female clients | 104 | 126 | 230 (77%) |
| Total | 144 (48%) | 156 (52%) | 300 |
Influence of veterinarian gender
Veterinarian-client communication: Female veterinarians displayed a more relationship-centered communication style reflective of a collaborative partnership, compared with male veterinarians (female vs male relationship-centered care score, 0.98 and 0.79, respectively; P = 0.03). There was no significant difference in other communication dynamics, including overall appointment length, total talk to the client, or verbal dominance. Female veterinarians expressed significantly (P < 0.01) more positive and facilitative statements and tended to spend more time rapport building with clients, compared with male veterinarians (Table 2). How long the client knew the veterinarian was a covariate in the positive talk model, with slightly less positive talk when the client and veterinarian were more familiar with each other.
Simple comparison of veterinarian-to-client talk during visits conducted by male (n = 144) and female (n = 156) veterinarians.
| Composite | Male veterinarian statements (n = 144 visits) | Female veterinarian statements (n = 156 visits) | P value* | ||||
|---|---|---|---|---|---|---|---|
| Mean | Range | SD | Mean | Range | SD | ||
| Data gathering | |||||||
| Biomedical | 10 | 0–39 | 8 | 11 | 0–42 | 9 | 0.20 |
| Lifestyle and social | 4 | 0–28 | 5 | 5 | 0–22 | 5 | 0.27 |
| Anticipatory guidance | 0.22 | 0–7 | 1 | 0.17 | 0–9 | 1 | 0.54 |
| Client education | |||||||
| Biomedical | 74 | 5–402 | 67 | 69 | 0–419 | 56 | 0.88 |
| Lifestyle and social | 16 | 0–105 | 20 | 17 | 0–147 | 24 | 0.53 |
| Anticipatory guidance | 2 | 0–62 | 6 | 2 | 0–40 | 6 | 0.66 |
| Building relationship | |||||||
| Positive talk | 27 | 3–122 | 21 | 37 | 1–131 | 23 | < 0.01 |
| Negative talk | 0 | 0–2 | 0 | 0 | 0–4 | 1 | 0.76 |
| Social talk | 4 | 0–69 | 10 | 4 | 0–52 | 7 | 0.45 |
| Rapport building | 15 | 1–116 | 17 | 17 | 0–112 | 13 | 0.07 |
| Establishing partnership | |||||||
| Facilitation | 11 | 0–56 | 9 | 14 | 0–56 | 10 | 0.04 |
| Orientation | 12 | 0–60 | 12 | 10 | 1–52 | 8 | 0.64 |
| Total statements | 176 | 34–812 | 125 | 187 | 35–939 | 115 | 0.30 |
P value tests the difference in mean number of statements between male and female veterinarians.
Client-veterinarian communication: Simple differences in client communication were initially noted (Table 3) and were further supported by modeling. Although constituting a very small portion of client conversation, clients of male veterinarians asked more questions (communication composite score 0.14 vs 0.03; P < 0.01) and provided information (2.0 vs 0.10; P < 0.01) in the area of anticipatory guidance during problem visits, compared with female veterinarians. Clients of female veterinarians gave more lifestyle and social information about the pet to female compared with male veterinarians (mean number of client statements to female veterinarians vs male veterinarians, 23 and 15, respectively; P < 0.03) in problem appointments.
Simple comparison of client-to-veterinarian talk during visits conducted by male (n = 144) and female (n = 156) veterinarians.
| Composite | Male veterinarian statements (n = 144 visits) | Female veterinarian statements (n = 156 visits) | P value* | ||||
|---|---|---|---|---|---|---|---|
| Mean | Range | SD | Mean | Range | SD | ||
| Question asking | |||||||
| Biomedical | 5 | 0–34 | 5 | 4 | 0–24 | 4 | 0.69 |
| Lifestyle and social | 1 | 0–8 | 2 | 1 | 0–5 | 1 | 0.97 |
| Anticipatory guidance | 0.03 | 0–1 | — | 0.13 | 0–4 | — | < 0.03 |
| Providing information | |||||||
| Biomedical | 35 | 0–170 | 33 | 36 | 0–190 | 31 | 0.36 |
| Lifestyle and social | 19 | 1–115 | 19 | 25 | 0–119 | 21 | < 0.02 |
| Anticipatory guidance | 1 | 0–35 | 4 | 1 | 0–36 | 5 | 0.63 |
| Building relationship | |||||||
| Positive talk | 42 | 3–208 | 31 | 46 | 8–213 | 31 | 0.22 |
| Negative talk | 0 | 0–10 | 1 | 0 | 0–4 | 1 | 0.66 |
| Social talk | 4 | 0–93 | 11 | 4 | 0–41 | 7 | 0.73 |
| Rapport building | 7 | 0–38 | 7 | 7 | 0–31 | 6 | 0.09 |
| Establishing partnership | |||||||
| Facilitation | 3 | 0–24 | 4 | 3 | 0–21 | 4 | 0.90 |
| Orientation | 2 | 0–11 | 2 | 1 | 0–12 | 2 | 0.19 |
| Total statements | 121 | 17–401 | 80 | 132 | 23–402 | 79 | 0.20 |
— = Not available.
See Table 2 for remainder of key.
Veterinarian-pet communication: Overall, female veterinarians talked more to patients in almost every category of talk, including biomedical information, positive talk, rapport building, and facilitative and orientation statements (Table 4).
Simple comparison of veterinarian-to-patient talk during visits conducted by male (n = 144) and female (156) veterinarians.
| Composite | Male veterinarians statements (n = 144 visits) | Female veterinarians statements (n = 156 visits) | P value* | ||||
|---|---|---|---|---|---|---|---|
| Mean | Range | SD | Mean | Range | SD | ||
| Client education | |||||||
| Biomedical | 1 | 0–8 | 1 | 1 | 0–13 | 2 | < 0.01 |
| Lifestyle and social | 0 | 0–5 | 1 | 0 | 0–6 | 1 | 0.43 |
| Anticipatory guidance | 0.01 | 0–1 | — | 0.01 | 0–2 | — | 0.87 |
| Building relationship | |||||||
| Positive talk | 5 | 0–46 | 7 | 7 | 0–35 | 7 | < 0.01 |
| Negative talk | 0 | 0–20 | 2 | 0 | 0–3 | 0 | 0.88 |
| Social talk | 0 | 0–5 | 1 | 0 | 0–5 | 1 | 0.88 |
| Rapport building | 5 | 0–37 | 7 | 6 | 0–50 | 6 | 0.04 |
| Establishing partnership | |||||||
| Facilitation | 6 | 0–49 | 9 | 9 | 0–44 | 8 | < 0.01 |
| Orientation | 4 | 0–26 | 5 | 5 | 0–34 | 5 | 0.04 |
| Total statements | 21 | 0–126 | 24 | 29 | 2–137 | 22 | < 0.01 |
See Table 2 for key.
Emotional tone: Male veterinarians were rated (on a Likert scale from 1 (low) to 5 (high) as sounding more hurried (male vs female Likert score 2.29 vs 2.16; P = 0.04), compared with female veterinarians, and veterinarian age and number of annual visits were covariates in the model. Visits were more likely to seem hurried with older veterinarians and with clients who made multiple visits per year to the veterinarian. In addition to seeming hurried, male veterinarians tended to sound less friendly (male vs female Likert score 3.78 vs 3.91; P < 0.09). Clients of female veterinarians (41% of visits) were rated as sounding more engaging, compared with clients of male veterinarians (17% of visits; P = 0.03), and type of appointment and the number of annual visits were covariates in the model. The greater the number of visits the client made to the veterinarian on an annual basis, the warmer the client was perceived in problem visits.
Influence of client gender
Veterinarian-pet communication: Relative risk RR, is the ratio of the frequency of the communication variable when interacting with a female versus a male client. Overall, veterinarians talked more to the pets of male clients (mean number of statements made to pets of male clients vs pets of female clients, 22 and 16, respectively; RR, 1.4; P = 0.02) and provided more positive talk (mean number of statements made to pets of male clients vs pets of female clients, 5 and 3, respectively; RR, 1.6; P < 0.01), compared with the pets of female clients in problem appointments. The opposite relationship was found in wellness appointments where veterinarians expressed more positive talk to pets of female clients, compared with male clients (mean number of statements made to pets of female clients vs pets of male clients, 6 and 4, respectively; RR, 1.5; P = 0.03).
Emotional tone: Male clients were rated (on a Likert scale from 1 [low] to 5 [high]) as sounding more anxious, compared with female clients (male vs female Likert score, 1.27 and 1.11, respectively; P < 0.01). Female clients were perceived to be more respectful, compared with male clients (female vs male Likert score, 3.44 and 3.33, respectively; P = 0.05).
Influence of gender concordance
Veterinarian-client communication: There was no difference between relationship-centered care scores of same-gender dyads (0.93) and different-gender dyads (0.87; P = 0.26). The mean relationship-centered care score was 0.88 for male veterinarian–male client dyads, 0.76 for male veterinarian–female client dyads, 0.98 for female veterinarian–male client dyads, and 0.98 for female veterinarian–female client dyads. The least relationship-centered interaction was between male veterinarians and female clients. There was a significant (P < 0.01) difference in relationship-centered care scores between male veterinarians and female clients (0.76) and female veterinarians and female clients (0.98).
Client-veterinarian communication: Clients provided 1.4 times as much lifestyle-social information when the client and veterinarian were the same gender, compared with when the client and veterinarian were different genders (mean number of client statements made in same-gender dyads vs different-gender dyads, 33 and 25, respectively; P = 0.03), and type of appointment and the length of the relationship were covariates in the model. Client provision of lifestyle-social information was inversely related to the duration of the client's relationship with the veterinarian in wellness appointments.
Emotional tone: Female veterinarians were perceived by the coders (on a Likert scale from 1 (low) to 5 (high)) to be more engaged with female clients than with male clients (0.38 increase in the Likert scale; P = 0.02). Female veterinarians were perceived to be more engaged with female clients than were male veterinarians (0.39 increase in the Likert scale; P < 0.01), and type of appointment was a covariate in the model, with more engagement in wellness appointments. Female veterinarians were perceived to be more sympathetic with female clients than with male clients (0.45 increase in the Likert scale; P = 0.03). Female veterinarians were perceived to be more sympathetic with female clients than were male veterinarians (0.47 increase in the Likert scale; P < 0.01), and type of appointment was a covariate in the model, with more sympathy in wellness appointments.
Clients were perceived by the coders to be more respectful in different-gender visits than when the client and veterinarian were the same gender (RR, 6.7; P < 0.01), and type of appointment was a covariate in the model, with more respect in problem appointments. The percentages of visits in which a client was perceived as showing higher respect were as follows: female client–male veterinarian (54%), male client–female veterinarian (31%), female client–female veterinarian (24%), and male client–male veterinarian pairs (11%). Veterinarians were also perceived to be more respectful in different gender, compared with same-gender visits (RR, 2.4; P = 0.05), and type of appointment was a covariate in the model, with more respect in problem appointments.
Discussion
The present study represents the first quantitative study of gender differences in veterinarian-client-patient communication. We found, overall, that the same gender-linked communication differences documented in human medicine were evident in veterinary medicine. Although we detected gender differences, there were more similarities than differences between male and female veterinarian communication. Task-oriented communication behaviors were the same for both genders, and the greatest differences were in female contributions to socio-emotional conversation that fosters relationship building. Gender differences were found at the level of the veterinarian, client, and veterinarian-client dyad. Few demographic covariates were identified as contributors to gender differences in communication.
One task of the present study was to describe the influence of veterinarian gender on veterinarian-client-patient communication. Considering our results overall, female veterinarians conducted more relationship-centered appointments, provided more positive and rapport-building statements to their clients, talked more to the pet, and were perceived as less hurried or rushed. These findings mirror those in human medicine, in which female physicians conducted more patient-centered encounters, expressed positive talk, and fostered emotionally concerned conversation.6 Some findings in human medicine were not replicated in the present study. We did not find that female veterinarians conducted longer visits, engaged in more active partnership with their clients, posed more lifestyle-social questions, or conducted more lifestyle-social counseling, as were evident in the communication studies of physicians.6 Clients were more likely to provide lifestyle-social information to female veterinarians and were perceived as warm and engaging. Similarly, in human medicine, patients of female physicians spoke more, disclosed more biomedical and psychosocial information, and expressed positive statements reflecting the patient-centered atmosphere created by their female physician.7,8
In relationship-centered care, the relationship between the veterinarian and client is characterized by negotiation between partners, resulting in the creation of a joint venture to promote animal healthcare.4 A collaborative relationship represents a balance of power between the veterinarian and client and is based on mutuality. The principles of relationship-centered care include broadening the explanatory perspective of disease to incorporate lifestyle and social factors, building a strong veterinarian-client-patient relationship, and encouraging participation, negotiation, and shared decision making.
Within this context, female veterinarians built relationships with their clients and patients through expressing positive statements, providing compliments, agreeing with the client, approving of their contributions, and laughing. In the present study, statements of rapport strengthened the relationship as well, including expressions of empathy, partnership, concern, reassurance, and self-disclosure. Although female veterinarians did not explicitly elicit more lifestyle-social information, they created a setting that fostered client sharing of more lifestyle-social information, including discussion of the pet's exercise regimen, environment, diet and sleeping habits, personality, temperament or behavior, and human-animal and animal-animal interactions.
Another task of the present study was to describe the influence of client gender on veterinarian-client-patient communication. There were very few communication variables impacted by client gender, and those that were identified related to veterinarian conversation with the pet. Veterinarians talked more overall and provided more positive statements to the pets of male clients than to pets of female clients. Much of the communication directed to the pet was affective in nature (ie, approval, reassurance, laughter, joking, and baby talk) to establish rapport with the pet and to foster patient comfort. In doing so, such statements may have an indirect impact on building rapport with the client as well. We suggest that in working with male clients, veterinarians may feel more comfortable building a relationship indirectly through speaking with the pet, rather than expressing direct rapport-building statements to the client.
The final task of the present study was to describe the influence of gender concordance on veterinarian-client-patient communication. Relationship-centered care reflective of a partnership was more prevalent in same-gender interactions in this study, including client provision of more lifestyle-social information. The atmosphere was most engaged and sympathetic with female veterinarian–female client conversations and most respectful with male veterinarian–female client discussions. Research evidence suggests that interactions within same-gender dyads strengthen the communication effects9; specifically, reciprocity theory supports that nonverbal and verbal communication are typically matched in social interactions.14 These findings are comparable to those in human medicine, in which same-gender dyads were characterized by relative ease and equality between doctor and patient.9 In conversations between female doctors and female patients or male doctors and male patients, there was more biopsychosocial and psychosocial talk with a calm voice tone.
In human medicine with different-gender dyads, there was evidence of tension around establishing power and status.9 Patients were also found to be more assertive with female than male physicians.7 In the present study, both veterinarians and clients were rated as more respectful when interacting with the opposite sex. The RIAS coding of emotional tone of respect reflects courteous or formal communication, and in different-gender interactions, veterinarians and clients, like figurative dance partners, seem to be mindful of stepping on each other's toes.
As reported previously,4 veterinarian-client-patient communication differed in wellness and problem appointments, and differences in gender communication paralleled these findings. Wellness appointments were characterized as relationship centered with a broad discussion of topics, more social talk, laughter, statements of reassurance and compliments directed toward the client, and twice as much conversation with the pet in a relaxed atmosphere.4 Problem appointments were described as paternalistic with the focus on biomedical data gathering and information, with veterinarians perceived as hurried and clients as anxious and emotionally distressed in a tense atmosphere.4
The following demographic covariates influenced gender differences in veterinarian-client-patient communication: veterinarian age and years in practice, duration of the veterinarian-client relationship, and number of client visits to the veterinarian on an annual basis. In the present study, for clients with a longstanding relationship with the veterinarian, there seemed to be less need for veterinarian positive talk, which contributes to relationship building, and clients provided less lifestyle-social information, as this data may already be known to the veterinarian. Older veterinarians demonstrated a more traditional paternalistic approach with decreased relationship-centered care scores, and they were perceived to be hurried. The more visits the client made to the veterinarian on an annual basis, the warmer the client was perceived, whereas the veterinarian seemed hurried.
The first limitation of the present study relates to the sampling strategy. We caution generalizing these findings to the veterinary profession as a whole. The participants in this study were companion animal veterinarians in Southern Ontario, and it is likely that the findings differ for veterinarians in other regions and areas of practice. In future studies, larger sample sizes or purposive sampling may be required to achieve greater distribution of gender dyads. One challenge for the statistical modeling was the lack of power that resulted from stratifying the visits by gender, which resulted in few male veterinarian–male client visits and female veterinarian–male client visits, since there were so few male clients visits in the original sample (n = 70 male clients). Only 6 appointments were videotaped for each veterinarian, in the larger cross-sectional study,2 and the greatest source of variation in communication was within each veterinarian and between each of their clients. Thus, in future studies, sampling and data collection techniques should incorporate a larger number of visits per veterinarian to more accurately capture performance.
In the present study, a quantitative technique was used to study gender differences in veterinarian-client-patient communication. The strength of a quantitative approach is the ability to identify discrete variables and code, categorize, and count behaviors. The challenge is the loss of nuances, subtleties, and context that can be captured with a qualitative method. Gender interactions and communication are complex processes. Gender is just one of the clinician characteristics that can impact communication, albeit the one that has attracted the most research, whereas other factors such as physician age, social class, political ideology, attitude, and personality are infrequently assessed.14 In this study, we included demographic characteristics in the statistical models; however, attitudinal factors were not measured, and these may very well affect communication.22 It may have been useful to assess client's gender-based perceptions, as gender preferences vary as a function of the gender of the patient, of provider, the gender of previous providers and the nature of the health problem.23
Veterinarians bring their own educational, economic, political, and cultural backgrounds; traits such as ethnicity, age, and gender; and life experiences to their clinical encounters. Taken together, female veterinarians used a relationship-centered communication style, establishing a collaborative partnership with their clients. Inferences could be drawn from studies in human medicine that relationship-centered care is associated with increased patient13,24 and physician satisfaction,13 adherence,24 improved patient health outcomes,25 and a reduction in malpractice risk.26
Because “one shoe doesn't fit all,”27 it is recognized that the veterinarian-client-patient relationship varies because of client expectations, veterinarian style, personality of the pet, and the nature of the problem. Therefore, it is important for veterinarians to master a repertoire of communication styles to meet the needs and expectations of their clients and patients and to respond to diverse clientele and interactions. As defined in human medicine, being patient centered is providing care that is “respectful and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”28 In veterinary medicine, this means fostering a collaborative partnership, creating a joint venture to promote animal healthcare, and focusing on an orientation toward the client's needs and agenda.29 Relationship-centered care is not limited to 1 gender; these behaviors can be defined, observed and measured, and shaped with training.29 These communication skills can be learned through constructive feedback, video recording and review, opportunities to practice, and individual coaching.29 With increasing feminization of the veterinary profession, client expectations and the perceived social and gender roles of veterinarians may change, requiring adaptation of veterinarians' communication over time to serve people, animals, and greater societal needs.
ABBREVIATIONS
| RIAS | Roter interaction analysis system |
| RR | Relative risk |
PROC MIXED, SAS, version 8.2, SAS Institute Inc, Cary, NC.
GLIMMIX, SAS, SAS Institute Inc, Cary, NC.
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