Tuesday, March 13, 2012

Gender, Healthcare and Communication

Last night on RN.FM Radio during a discussion with Beth Boynton, the nurse author of "Confident Voices: The Nurses' Guide to Improving Communication and Creating Positive Workplaces", we touched on the subject of gender and its effects on communication. Countless books on communication between the sexes have been written---the ones most readily coming to mind being those by Deborah Tannen, including "You Just Don't Understand" and "That's Not What I Meant"---and I am keen to point out that there is currently no book on the market of which I am aware that specifically discusses the gender aspects of communication within healthcare.

While Ms. Boyton's excellent book vigorously conveys the most salient points of workplace communication for nurses, it does not address gender differences in communication style, something that I pointed out in my review published several months ago.

I am not an expert in communication by any stretch of the imagination, but I have observed over the course of my career as a nurse that gender-specific methods of communicating are extremely important to take into consideration within the healthcare milieu, and this discussion is worthy of more attention and scrutiny.

Several decades ago, the vast majority of physicians were men and the overwhelming majority of nurses were women. Nurses' roles were, of course, quite narrowly defined in years past, and nurses played a wholly subservient yet important role under the paternalistic oversight of doctors.

In the 21st century, female physicians and surgeons are the readily accepted norm, and while male nurses still account for less than 8% of the nursing workforce, the notion of a nurse who happens to be a man is also widely accepted.

Taking into account these gender trends in healthcare, it is my hypothesis that communication between various health professionals of different gender combinations pose an interesting and ripe area for research.

Consider these scenarios:

A male nurse approaches a female physician about a patient's situation. This same physician is also approached by a female nurse. Is there a difference in the way that these conversations play out based on the gender of the protagonists? 

A male physician's orders are questioned by a female nurse. Would this physician respond similarly to a male nurse's suggestions or feedback?

A male charge nurse is supervising a team of nurses during the course of a shift. How do the dynamics differ when the nurses being supervised are male rather than female, or when the charge nurse is female rather than male?

During the course of several years when I was a clinic-based outpatient nurse care manager, I had hospital privileges and would round on my patients when they were hospitalized. Over time, I noticed that my entrance onto a unit was readily accepted and welcomed, especially when I was wearing business casual clothing and a stethoscope. Although my name tag easily identified me as a nurse, I was frequently mistaken for a doctor, and while I did not consciously try to take advantage of that perception, it did afford me a level of access that I am not sure my female counterparts enjoyed to the same extent. While this was more a matter of perception rather than communication, per se, I believe that the perception of me by others as a male physician figure greased certain wheels that I may otherwise have found less than smooth.

So, what does this all mean? Does it have an effect on patient care? Are there subtle---or not so subtle---aspects of communication between healthcare providers that are directly or indirectly impacted by the gender of the communicators in question? I believe that communication in the healthcare setting is indeed impacted by gender, whether it be the gender of the patient, the patient's family, the nurse, the physician, or other members of the team.

In the context of this blog post, I offer no solutions or quick fixes, but I offer the challenge for those working in healthcare to be aware of gender biases in communication, and for those of us who already have this awareness to bring it to the awareness of others, albeit gently and skillfully. As I said on Twitter last night, male nurses can be examples of communication and respect in terms of their relationships with their female counterparts. Additionally, male doctors can model excellent communication with their female coworkers by adapting their communication styles to fit the situation at hand.

We all carry responsibility for our communication style and the biases with which we operate in the world, yet we can also unlearn those biases, improve our style of communication, and learn new skills that will not only improve our own experience at work, but it will also improve others' experience of us. Awareness of the ways in which we react to, communicate with, or otherwise interact with those of the other gender is a big step towards rectifying the ways in which we fall short, and my hope is that research will eventually be done on how these biases and ways of communicating manifest in the world of healthcare.


GRC - Greg said...

For years this topic has fascinated me, as i too am man, and a Nurse, frequently mistaken for a physician, even on the phone, etc.
I trained for a few years with Social Workers, who stressed the notion that You as a person are your most important clinical tool. I make use of some of the stereotypes about men to make certain interactions as a Psych Nurse more effective, and I shy away from those that rely on female stereotypes. I've told people countless times that I'm a Nurse, although I give up form time to time, as it gets tiring saying the same thing over & over - esp. to the same people! Assumptions often overpower evidence. So it goes...
I must say, though, that none of the concerns I once had about being a guy wading into female land have come to pass - other than innocent mistakes mostly by patients, I have had very few even remotely unpleasant experiences that I could attribute to gender or gender. Nurses on the whole have been welcoming on that count, or at the least no more hostile than they might be to everyone else.
Thanks for the great piece, Keith!

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Greg, what a thoughtful comment. Thank you for sharing your thoughts and experiences.

Can you give an example of how you have used stereotypes about men in a positive way in the psych area? I'm interested to hear more!

Andrew from LPN training said...

many people still believe that nurses should be female,but male nurses are there too and are equally good as the female nurses.This is an interesting story and the issue about stereotypes and gender bias it will be there for some time before people get completely used to male nurses.

Michael Ortiz Hill said...

I sometimes teach The Craft of Compassion with my friend Kjersten Gmeiner MD who I met at the American Holistic Medical Association conference in Albuquerque a few years ago.. My wife Deena Metzger was doing a keynote talk where she OUTED me as designated patient what with my MS diagnosis before several hundred MDs of both genders. Truth is before that hullaballoo I didnt mix much with MDs -- as peers! -- much less rockout! And that also was "gendered" -- Docs were BIG MEN after all. OYYYY!!!! And I was a mere interloper in a womans profession. A hopelessly heterosexual sissy.
Kjersten attended one of my early workshops on the craft and I was honored that she felt it transformed her practice as a GP. When we teach together the running joke is, "OK -- whose FRED and whose GINGER?" "What you think I can dance backwards in high heals" we simultaneously croon.
Neither of us gives a rats ass for the prison of gender -- and yet it did play a deep role in me becoming a nurse if only that the womans "role"allows much more for simple kindness. And yes I smile when I remember a RN coworker at UCLA asked me what country I was from -- she a Brit. I told her I was from a mountain Kingdom north of Chihuahua Mexico."You're not macho like Americans. Bless the mojo of nursing -- it healed me of the disease of machismo. Michael Ortiz Hill