Response: Re: Better Doctor-Patient Relationships Are Associated with Men Choosing More Active Depression Treatment

To the Editor: We thank Dr. Otufowora for commenting on our work regarding the doctor-patient relationship and men's choice of depression treatment¹ and for raising concerns about the potential role of the physician's gender and the specialist status of the treatment provider.

Rather than address the abovementioned questions, our study focused on men's overall experience of the quality of their relationship with their family physician. Although female physicians may be perceived as more caring with regard to depression management,² some research suggests complex interactions between patient and physician gender and whether the physician adopts a patient-centered orientation.³ Thus, although gender matters, the nature of the doctor-patient communication is also important. We suspect similar interactions regarding the treatment context—whether primary care physician or mental health specialist—in that the quality of the relationship would remain influential. Indeed, research has shown considerable “provider effects” among psychiatrists, with some achieving superior outcomes prescribing placebo to others prescribing antidepressants.⁴

Considering the risks for suicide and atypical depression presentations among men,⁵ a better understanding of men's treatment engagement—including the role of the doctor-patient relationship in different treatment contexts—is urgently needed.⁶ Our study indicated that the degree to which men feel their family physician cares for and understands them is associated with their motivation to pursue treatment. We hope this finding will stimulate further interest in investigating men's experience of the doctor-patient relationship, while bolstering family physicians' confidence in the time-honored practice of forging responsive therapeutic relationships.