This study aimed to explore the communication in consultations between patients and health care staff from a gender perspective. We used 23 tape-recorded consultations between patients with Atrial Fibrillation and 5 nurses and 5 physicians at cardiac outpatient clinics at 6 different hospitals in southern Sweden during autumn 2009 to explore the verbal gendered constructions of patients. Through critical discourse analysis, we revealed that the male patients tended to describe their ailments with performance-oriented statements, whereas the female patients usually used emotional-oriented statements. The staff downplayed the male patients' questions and statements, while they acknowledged concern toward the female patients. Both the patients and the staff made conclusions according to a mutual construction. Male patients were constructed as competent, and female patients as fragile through gender-stereotypical communication. Open-ended statements and questions enabled consultations to be less limited by gender stereotypes.

In this paper, we examine patient-centered care through analyzing communicative constructions of patients, on the basis of their native language, in consultations with physicians. Whereas patient-centered care is of current interest in health care, research has not addressed its implications in this dimension. Previous studies indicate that non-native Swedish speaking patients, experience substandard interpersonal treatment far more than native Swedish speaking patients. Our findings show that the non-native Swedish speaking patients presented themselves as participating, whereas the native Swedish speaking patients presented themselves as amenable. The physicians responded in two different ways, argumentatively towards the non-native Swedish speaking patients and acknowledging vis-à-vis the native Swedish speaking patients. When decisions and conclusions were made by the patients and physicians, this resulted in preservation of the status quo in the consultations with the non-native Swedish speaking patients, while the corresponding result with the native Swedish speaking patients was monitoring of their health status. So, whereas the non-native Swedish speaking patients actually were model patient-centered care patients, physicians were more amenable towards the native Swedish speaking patients. We suggest that patient-centered care is desirable, but its practical application must be more thoroughly scrutinized from both a patient and a health care worker perspective.

Purpose – The purpose of this paper is to propose a theoretical framework for researching gender equality implications of Clinical Microsystems, a new public management-based model for multi-professional collaboration and improvement of health care delivery.

Design/methodology/approach – The paper draws on literature from gender in organizations, new public management, multi-professional collaboration and organizational control to critically analyze the Clinical Microsystem model.

Findings – While on the surface an egalitarian and consensus-based model, it nevertheless risks reinforcing a gendered hierarchical order. The explicit emphasis on social competencies, on being collaborative and amenable to change risks, paradoxically, disfavoring women. A major reason is that control becomes more opaque, which favors those already in power.

Practical implications – The paper calls for researchers as well as practitioners to incorporate concerns of equality in the work place when introducing new work practices in health care. For research, the authors propose a useful theoretical framework for empirical research. For practice, the paper calls for more transparent conditions for multi-professional collaboration, such as formalized merit and advancement systems, precisely formulated performance expectations and selection of team members based strictly on formal merits.

Originality/value – A gender analysis of a seemingly anti-hierarchical management model is an original contribution, adding to the literature on Clinical Microsystem in particular but also to critical studies on new public management. Moreover, the paper makes a valuable practical contribution in suggesting ways of avoiding the reproduction of gender inequalities otherwise implied in the model.