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PhD thesis: a PhD thesis.
KADJI Kéou Kambiwa
Schmid Mast Marianne
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Université de Lausanne, Faculté des hautes études commerciales
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Paper 1: Physician Self-Disclosure During Medical Encounters: A Gender Study
In the first paper, my co-authors and I investigate physician self-disclosure during medical consultations through two different studies. The aim of this research is to investigate which, how, and when physicians use self-disclosure during medical encounters and how physician self-disclosure relates to physician and patient characteristics and to consultation outcomes, based on two studies in general practices in the French speaking part of Switzerland.
In both studies we measured patient satisfaction and trust. We chose to study patient satisfaction because it is an important and commonly used indicator for measuring the quality of health care (Prakash, 2010) and patient trust because according to the literature there seems to be a general consensus that there is a relationship between trust and self-disclosure (Cozby, 1973; Pearce & Sharp, 1973). Despite the fact that many investigators of self-disclosure have argued that some relationship exists, little empirical research has confirmed this notion and we would like to investigate this relationship in a medical context.
Study 1: Thirty-six physicians (20 men and 16 women) were videotaped during their usual practice with 2 patients each (one man and one woman) and both patients and physicians answered a series of questionnaires. Each videotaped physician-patient consultation was coded for self-disclosure following the same procedure used by Beach et al., (2004). Self-disclosure was coded into 8 different types (reassurance-short/long, counselling, rapport humor, rapport empathy, casual, intimacy, and extended narratives). During this investigation, we also examined consultation segments in which there was more self-disclosure than others. At the end of the consultation, patients were asked to evaluate the consultation (satisfaction, trust, adherence, patient perceived physician professional competence) and to report socio- demographic information such as age and gender.
Study 2: Sixty physicians (34 men and 27 women) were videotaped during their usual practice with 4 patients each (two men and two women) and both patients and physicians answered a series of questionnaires. Self-disclosure was also coded into 8 different types (reassurance-short/long, counselling, rapport humour, rapport empathy, casual, intimacy, and extended narratives) At the end of the consultation, patients were asked to evaluate the consultation (satisfaction, trust, and enablement) and to report socio-demographic information such as age and gender.
Our results suggest that self-disclosure is a communication strategy used during medical encounters. Gender differences do exist when it comes to self-disclosure in patient- physician interactions. On the one hand, male physicians who cared about their patients and were interpersonally oriented used more self-disclosure. Male physicians also showed more self-disclosure than female physicians when faced with potentially vulnerable patients or patients they knew well. On the other hand, female physicians self-disclosed more than their male colleagues, but we had less understanding as to which female physicians do so and to which patients.
Paper 2: The Effect of Physician Self-disclosure on Patient Self-disclosure and Patient Perceptions of the Physician
In the second paper, my co-author and I empirically investigate the role of physician gender and physician self-disclosure on consultation outcomes, on how patients perceive the physician and how they react to the physician (i.e., disclosure reciprocity). We introduce two different theories to guide this paper. The first is a classic congruity model of gender discrimination, which is the “lack of fit” model (Heilman, 1983). We drew on this model because it has been tailored to understand gender discrimination (Heilman & Caleo, 2018) and it considers gender stereotypes, which portray men as agentic and women as communal (Haines, Deaux, & Lofaro, 2016). According to this model, outcomes that are discriminatory against women come from an incongruity between the attributes that women are thought to possess, and the attributes seen as necessary for success in male-typed positions and fields. Medicine has been considered a male dominated field for a long time ( Standley et al, 1974; Ward, 2008) thus my expectation for this study was for female physicians to be perceived more negatively, and have more negative outcomes than male physicians when they self-disclose because self- disclosure is a communication tool generally attributed to women whilst the profession of physician is male dominant.
Another theory we looked at in this paper is disclosure reciprocity (Valerian J. Derlega & Berg, 1987), which refers to the process by which one person's self-disclosure elicits another person's self-disclosure (Jourard, 1971). It is an important aspect of self-disclosing behavior and has been thoroughly investigated in psychology, yet overlooked when it comes to physician-patient relationships
For this experimental study, 207 participants (113 men and 94 women) were recruited through a university subject pool and were invited to answer two questionnaires. They were asked to put themselves in the shoes of real patients (analogue patient design). One questionnaire was given to them before looking at the physician-patient dialogue and one questionnaire was given to them after the dialogue. We manipulated the gender of the physician (male or female) and the amount of self-disclosure during the conversation (with self- disclosure and without self-disclosure).
Results reveal that physician gender and physician self-disclosure did not affect patient outcomes and only slightly altered the perception of the physician. However, physician self- disclosure had an effect on the behavioral intentions of the patients (i.e., willingness to self- disclose) and this was moderated by physician gender. Patients were more willing to self- disclose to female than to male physicians who self-disclosed.
Paper 3: Subordinate Perception of Supervisor Self-disclosure: A Gender Study
In the third paper, I empirically investigate the relationship between supervisor gender, supervisor self-disclosure and subordinates’ perception of their supervisor. In this paper, on top of theories introduced in paper 2, I draw on a third theory which is the leader-member exchange theory. Leader–member exchange (LMX) theory is a relationship-based, dyadic theory of leadership. Compared to other behavioral leadership theories, LMX does not focus on what leaders do, but on how leaders influence employees through the quality of the relationships they develop with them (Bauer & Erdogan, 2015).
For this study, I recruited 280 participants (156 men and 121 women) through Mturk. Participants filled in a survey with various measures about their supervisor self-disclosure characteristics (depth, breath, valence, perceived honesty, and appropriateness) and outcomes from their supervisor-subordinate relationship (trust, perceived supervisor warmth & competence, commitment to supervisor). The previously mentioned measures were highly correlated and were thus grouped under one measure called positive perception of supervisor.
Results suggested that there were no gender differences in how subordinates perceived supervisor self-disclosure However, supervisor self-disclosure characteristics did relate differently to subordinate perceptions of the supervisor as a function of supervisor gender. When men supervisors self-disclosed, this had positive effects and when women supervisors self-disclosed, this had negative or no effects with the exception of when the self-disclosure was perceived as honest, in which case it was also positive for female supervisors. My results underscore the relevance of taking gender roles into account in the relationship between supervisors and their subordinates within organizations.
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08/03/2021 13:29
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