Personal values of male and female doctors: gender aspects

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  • Personal values of male and female doctors: gender aspects

    Liisa Neittaanmaki a, *, Edith B. Gross b, Irma Virjo c, Harri Hyppola d,Esko Kumpusalod

    aSocial and Health Care, Pohjois-Savo Polytechnic, P.O. Box 72, 74101 Iisalmi, FinlandbBeaver College, USA

    cUniversity of Tampere, Tampere, FinlanddUniversity of Kuopio, Kuopio, Finland

    Abstract

    The aim of this study was to elucidate the personal values of physicians. It was part of the Physician 93 Study,

    the purpose of which was to shed light on the life situation, career and future plans of young doctors and theirviews on medical education. The survey population included all the medical doctors registered during the years19821991 in Finland (N= 4671). In the spring of 1993 a postal questionnaire was sent to a random sample of2341 doctors. After two reminder letters, 1818 questionnaires (78%) were returned. 59% of the respondents were

    women. Subjects were asked to rate on a 4-point scale each of a set of 17 potentially important values listed in thequestionnaire, five of which were seen by the majority of physicians as very important. These values were: familylife, health, close friends, success in work or in studies and childrens success. The potentially important values were

    conceptualized as indicative of eight important dimensions of the values of physicians: close friends, health, selfactualization, success, universal values, well-being, family and ideology. Women doctors rated close friends, health,success, universalism and ideology as more important than men doctors. # 1998 Elsevier Science Ltd. All rightsreserved.

    Keywords: Values; Physicians; Gender; Finland

    1. Introduction

    Personal values of physicians have not been much

    studied although physicians values are crucial to

    health care practice, and have come under scrutiny

    during recent years, especially regarding priorities in

    health care. Research has focused upon decisions con-

    cerning pharmaceuticals and patient care (Orr and

    Vickery, 1983; Self and Lyon-Loftus, 1983; Segal and

    Hepler, 1985), interaction between patient and doctor

    (West, 1984; Kurtz et al., 1985), choice of a profession

    (Furnham, 1988; Taylor et al., 1990, Eliason and

    Schubot, 1995; Xu et al., 1995), attitudes toward

    health risks (Carlo et al., 1992) and ethical questions

    in general (Pellegrino et al., 1985; Kipnis, 1990). There

    have been studies also of political attitudes of medical

    students (Maheux et al., 1988).

    Despite the fact that research regarding personal

    values of physicians is sparse, values and their distri-

    bution among various types of population have been

    thoroughly studied (Schwartz, 1992, 1994; Puohiniemi,

    1995). Most researchers utilize Rokeachs definition of

    human values as desirable goals that vary in import-

    ance and guide people in their lives (Kluckhohn, 1951;

    Rokeach, 1973; Schwartz and Sagiv, 1995). Values,

    once internalized, serve as a standard for guiding

    action, for developing attitudes toward various issues

    and objects, for making moral judgments of oneself

    and others and for comparing oneself with others.

    Social Science & Medicine 48 (1999) 559568

    0277-9536/98/$ - see front matter # 1998 Elsevier Science Ltd. All rights reserved.PII: S0277-9536(98 )00375-X

    PERGAMON

    * Corresponding author. Social and Health Care, Tisalmi,

    Pohjois-Savo Polytechnic, P.O. Box 72, 74101 Tisalmi, Finland,

    Fax: +358 17 5506644; e-mail: liisa.neittaanmaki@pspt.fi.

  • Values are also transcendant, providing criteria by

    which people adopt more ultimate, long-term goals,according to Rokeach (1968). Thus, values provide aframework in which the decision making process takes

    place, a process that is applied routinely and is crucialin the practice of medicine (Grundstein-Amado, 1995).

    Based on Rokeachs definition, values have beenoperationalized in two categories: instrumental values,

    which refer to behavior and terminal values, which arethose concerning end-states of existence (Rokeach,1973). Both instrumental values and terminal values

    may have either a personal or a socially directed focus.For example, instrumental values of a personal nature

    may be related to competence, sometimes referred toas self-actualization. Thus, behaving logically, intelli-

    gently or imaginatively would be valued. On the otherhand, moral values, which have an interpersonal focus,would be classified as instrumental values with social

    intent. Behaving honestly and responsibly leads one tofeel that one is behaving morally.

    Terminal values also can be either self-centered ormore socially directed. Examples of values that are

    more personally directed would be salvation or peaceof mind. Society centered values would include suchgoals as world peace and brotherhood. The values in

    this study fall into the four classes mentioned above:terminal values, both personal and social and instru-

    mental values, personal and social.What is the source of our values? How do we

    acquire them? Social factors, especially the value sys-tem of the culture in which an individual is located,contribute strongly to the formation of individual

    values. Cultural values reflect the dierent ways so-

    cieties have developed to regulate human activities andthus they influence the content of individual socializa-tion. Cultural values also determine the methods of

    social control that individuals experience in pursuit oftheir values. Because institutions must be structured

    according to the psychological requirements of individ-uals, cultural and individual value levels are concep-

    tually related (Schwartz, 1994). Other major factorsinfluential in shaping the value system of individualsare social class, occupation, education, sex, age, reli-

    gious and political upbringing.Individual value systems may vary, according to

    Rokeach (1973), depending upon the degree to whichcultural and institutional values have been internalized

    and the degree to which identification with sex roleshas occurred. Personality factors and life experiencesalso contribute to variance among individual values.

    Such variation will be limited, however, by cultural, in-stitutional and other social factors mentioned above

    (Rokeach, 1968).Similarities or dierences in male and female phys-

    ician attitudes and behavior are often explained interms of either their professional socialization or theirgender-role socialization. The relative contribution of

    each has not been widely researched (Martin et al.,1988). During medical school and training, aspiring

    doctors acquire not only the knowledge and skills ofmedicine, but also the attitudes, feelings and values of

    members of the profession. Researchers have foundthat professional socialization tends to inculcate similarvalues and behavior among male and female phys-

    Table 1

    The variables ranked in order of importance with mean, standard deviation and skewness values

    (range 14)

    Variable Mean Standard

    deviation

    Skewness

    Family life 3.7 0.5 2.2Health 3.7 0.5 1.6Close friends 3.7 0.5 1.4Success in work or studies 3.5 0.5 0.3Childrens success 3.4 0.8 0.6Good job 3.3 0.6 0.3Opportunities to pursue hobbies 3.3 0.6 0.5Unpolluted environment 3.3 0.7 0.7World peace 3.2 0.8 0.6Respect from others 3.0 0.6 0.3Vacationing 3.0 0.7 0.3Fatherland 2.9 0.8 0.4Contact with interesting people 2.9 0.7 0.3Possibility of making new acquaintances 2.8 0.7 0.1Long life 2.8 0.5 1.4High standard of living 2.6 0.6 0.1Faith in God 2.4 1.1 0.2

    L. Neittaanmaki et al. / Social Science & Medicine 48 (1999) 559568560

  • icians. Similarities in practice style, knowledge, clinicaldecision making, referrals and handling of dying

    patients have been observed and the source is usuallylocated in professional socialization (Margolis et al.,1983; Gross, 1985; Lorber, 1985; Tolle et al., 1985;

    Dickinson and Ashley-Cameron, 1986; Maheux et al.,1988).However, the extent to which medical training fully

    homogenizes gender dierences in mens and womensattitudes is not known (Maheux et al., 1988). Gendersocialization, upon which professional socialization is

    overlaid, helps us understand the dierences in certainaspects of male and female physicians values andbehavior. After reviewing the literature, for example,Martin et al. (1988) concluded that there were many

    similarities in the practice styles of male and femalephysicians. Practice styles were defined as includingattitudes toward patient care, knowledge and clinical

    behavior. The one area in which men and women werefound to be dierent was in physicianpatient com-munication. In another study, gender dierences sur-

    faced in regard to occupational stress, i.e. thoseaspects of the profession that were viewed as moststressful. Male physicians reported doctorpatient re-

    lationships as a stressor, while female physicians foundthe responsibility of the role and career/family conflictto be greater stressors. These dierences were attribu-ted to wider cultural values regarding gender and the

    nature of gender role socialization (Gross, 1992).Both studies concluded that while medical socializa-

    tion may determine most aspects of practice style, gen-

    der also has an important influence on medicalpractice. This rationale applies in regard to personalvalues of male and female physicians. Where there are

    dierences, these may be attributable to the underlyinggender socialization that precedes inculcation of thevalues of the profession in medical training.The purpose of the Physician 93 Study, was to shed

    light on the life situation, career and future plans ofyoung doctors and their views on medical education.This article deals specifically with the personal values

    of young physicians, particularly the most importantvalues in their lives and the dierences that existbetween men and women as to their values.

    2. Subjects and methods

    The study population included all the doctors who

    were registered in Finland during the years 19821991(N= 4671). A random sample of 2341 doctors (50%)was drawn from the population. A postal question-

    naire was sent to all of them in spring 1993. After tworeminder letters, 1818 questionnaires (78%) werereturned.

    The population included 1970 men and 2701 womenand the sample 987 men and 1354 women. Altogether

    742 men (75%) and 1069 women (79%) responded tothe survey, representing the study population withrespect to sex. Six respondents did not report their sex.

    The mean age of the men was 35 years and that of thewomen 34 years.The questionnaire for the larger study included a set

    of questions pertaining to personal values. Subjectswere asked to rate on a 4-point scale (1 = not at allimportant, 2 = not very important, 3 = quite import-

    ant, 4 = very important) each of a set of 17 potentiallyimportant values (Table 1).Principal component factor analysis with varimax

    rotation was used to examine the structure of the value

    measure (Kim and Mueller, 1985). Two items, healthand close friends, based on a Spearman correlationmatrix were excluded (the correlation between the item

    and any other item was 0.30 or less) and the other 15items were subjected to a principal component factoranalysis with varimax rotation (Table 2). The main cri-

    terion used to determine the number of factors was themagnitude of eigenvalues. On the basis of eigenvaluesof 1.00 or more, six factors were produced and this

    six-factor solution accounted for 64% of the variance.The relationships between value dimensions and gen-

    der were analysed by the one-way analysis of variances(Siegel and Castellan, 1988).

    3. Results

    16 of the 17 potentially important values presented

    in the questionnaire were seen by the majority ofdoctors as very important or quite important (Fig. 1).Faith in God was the exception with only 44% of thedoctors ranking it as an important value. Of those

    values ranked very important, the following fivereceived the highest ratings (in order): (1) family life;(2) health, (3) close friends; (4) success in work or stu-

    dies and (5) childrens success.Altogether eight dimensions of doctors values were

    conceptualized from the 17 potential values (Table 3).

    Two variables, close friends and health, were examinedseparately, based upon a Spearman correlation matrix.Six factor-based scales were constructed from theremaining 15 values. The first factor, self-actualization

    (20% of variance), contained three items: contact withinteresting people. The possibility of making newacquaintances and opportunities to pursue hobbies,

    which were summed to create a self actualization scale(alpha reliability r= 0.70). The second factor, success(11% of variance), was a function of three items: suc-

    cess in work or studies, good job, respect from others.The success scale was created by summing these threeitems (alpha reliability r= 0.55). The third factor, uni-

    L. Neittaanmaki et al. / Social Science & Medicine 48 (1999) 559568 561

  • versalism (10% of variance), contained two items:

    unpolluted environment and world peace and

    measured the physicians universal values. These two

    items were summed to create a universal value scale

    (alpha reliability r= 0.69). The fourth factor, well-

    being (8% of variance), containing three items: long

    life, high standard of living, vacationing, measured

    physicians values in regard to well-being. Three items

    were summed to create a well-being scale (alpha re-

    liability r= 0.51). The fifth factor, family (8% of var-

    iance), was a function of two items: family life and

    childrens success. These two items were summed to

    create a family scale (alpha reliability r= 0.58). The

    sixth factor was a function of two items: faith in God

    and fatherland (7% of variance) and was related to the

    ideologies physicians valued. The ideology scale was

    created by summing these two items (alpha reliability

    r= 0.50). Each scale was standardized by using the

    mean sum (the range was 04).

    Breaking down these eight value dimensions accord-

    ing to sex, we find that while male and female phys-

    icians rank similarly several values as important, they

    also rate some dierently. They agree closely on the

    importance of self-actualization (possibility of making

    new acquaintances, contact with interesting people,

    and opportunities to pursue hobbies), family (family

    life and childrens success) and well-being (long life,

    high standard of living and vacationing). However,

    more female than male physicians placed greater

    emphasis on close friends, health, success (success in

    work or studies, respect from others, good job), uni-versal values (world peace and unpolluted environ-

    ment) and ideologies (faith in God, fatherland).

    4. Discussion

    According to our data, family, health and closefriends are the three most important values in phys-icians lives. These values have also been found to beimportant to the Finnish population generally

    (Suhonen, 1988). Studies done both in Finland and inother countries indicate that family life, human re-lations and health, in addition to work, are important

    values in human life (Harding et al., 1986; Suhonen,1988; Bowling, 1995; Hanninen, 1997). Finnish culture,with its emphasis on collectivism (Puohiniemi, 1995)

    and egalitar...

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