Direct or rude? Micromanaging or particular? Why do we interpret the same professional behavior differently depending on the gender of the person delivering it? I often wonder why I'm punctuating with smiley faces and hearts. Am I a jack-in-the-box or a professional? Are women expected to communicate directives and criticism more softly than men to avoid being perceived as harsh, difficult, or unkind?

Authority and the gendered interpretation of directness

Statements that are not inherently hostile but ordinary components of professional management, such as “I need this corrected before the next patient,” may require a spoonful of sugar or at least a big smile when spoken by a woman versus a man due to the gendered burden of being “nice.”

For example, a male clinician who says “I need this corrected before the next patient” may be perceived as exercising managerial authority, while a female clinician delivering the same message may be concerned that the communication will be interpreted as being bossy, harsh, controlling, or mean. Why?

Research on gender and workplace behavior suggests that women's displays of direction and dominance can be interpreted differently than men's comparable behavior. Role congruity theory suggests that women may face prejudice when leadership traits conflict with stereotypically feminine expectations of warmth and communal behavior.¹

In short, women are expected to deliver with empathy and warmth. When they don’t—and perhaps instead deliver it with a straight face—they are more likely to be asked directly if something is wrong or to have their “mood” talked about among peers. This creates a potential dilemma for women clinicians in leadership positions when interacting with staff and patients.

The workplace “likeability” penalty

A meta-analysis found that women experienced a slight relative penalty in likability when displaying dominance compared with men.² Importantly, the researchers found no corresponding gender difference in perceived competence.

So, dropping the emoji may mean a woman can be seen as competent while still being perceived as less likable when she communicates in a highly dominant manner. For a female clinician who works closely with the same team every day, that distinction can create considerable pressure to communicate in a softer, more time-consuming style.

Consider a female clinician addressing a scheduling issue. A direct version might be: “This procedure cannot continue to be scheduled in this time block. I need you to follow the scheduling protocol we discussed.”

A softened version might be: “I completely understand that things get busy, and I know you're doing your best. I want to make sure we're following the protocol consistently because I'm concerned about what could happen if we don't.”

The concern is whether women disproportionately feel they must wrap ordinary managerial directives in emotional reassurance to preserve relationships with employees and avoid office friction.

Emotional labor in the dental practice

This phenomenon can also be understood through the concept of emotional labor. Emotional labor involves managing one's emotional expression and interpersonal presentation as part of their job. Is warmth part of our job? In a dental practice, it sure feels like it. We constantly engage in emotional labor in patient care when delivering diagnoses and recommending treatment. In interpersonal relations, leaders may manage staff morale, conflict, disappointment, and workplace tension. The goal isn't to eliminate warmth, but to distinguish empathetic communication from the emotional labor stereotypes demand.

For example, a female clinician may not simply communicate “We're changing this protocol”; she may feel compelled to explain why, reassure staff that she values them, acknowledge how difficult the transition might be, invite questions, and soften the directive. This is because women's direction and feedback may be filtered through expectations about femininity.

A male clinician may provide the same level of explanation, but social expectations around his communication may differ. Patients and staff don't hold him to the same expectations of emotional labor because they expect men to just be direct.

Patients can also behave differently toward female physicians. A meta-analysis of patient-physician communication found that while patients generally talked more with female physicians, disclosed more information, and made more positive statements to them, they also rated female physicians as more assertive and tended to interrupt them.³

So, a female dentist may be expected to be the relational professional—the one who listens, reassures, explains, and accommodates—but when she tries to take control of the conversation, set a boundary, or give an unequivocal recommendation, she may be moving outside the behavioral expectations patients have unconsciously set for her, resulting in a subtle form of role friction.

Patients, like colleagues, may experience the same sentence differently depending on who says it. It’s a tough day for a competent woman with straight-face energy.

Correcting staff without being labeled “mean” or “catty”

If there is one motto I’ve had working in female-dominated fields, it's that being a woman doesn't handicap me from being a professional. The antiquated adage that our emotions rule us and that working among other women may result in cattiness must stop for women to step out of this bin. Operating in a firm and professional manner does not make one “catty.” Being direct does not make one “mean.” Saying it with a straight face does not mean something is wrong with you today.

This is consistent with the broader literature suggesting that women can face social penalties for behavior that violates expectations of warmth or agreeableness.¹

The point is that such observations should not automatically be treated as evidence of discrimination. The evidence does not mean male dentists have it easy. Patient gender, physician gender, clinical specialty, culture, age, context, and the specific communication behavior all matter.

Research on physician communication has found that gender effects vary across specialties and patient-provider combinations.⁴ The point is not that men can be rude and women cannot, but that the same behavior can be interpreted through different gendered expectations.

A staff member may genuinely experience a communication style as unpleasant, regardless of the dentist's gender. The question is whether the threshold for perceiving behavior as unpleasant differs systematically according to the gender of the person communicating it. Can we be treated like human beings while doing our jobs competently and pleasantly, without being expected to smile at every corner and entertain you in every free moment? Can I disagree with you or offer a correction without delivering it in a sugar sandwich? Or is that liberty reserved for our male counterparts?

Solving a culture problem disguised as a communication problem

Because gender stereotypes are social expectations rather than simply interactions between men and women, a female clinician can face pressure from colleagues who expect her to be more emotionally accessible or to offer more relational support than a male. This could be because the very qualities that help women build trusting relationships can also create expectations that those relationships should remain highly accommodating. Once that expectation is established, boundary-setting can feel like a departure from the relationship, but it’s simply business and it can’t hinder necessary boundaries. An equitable approach doesn't require women to be less warm. Instead, we recognize that warmth and authority are independent dimensions of professional behavior.

Both genders can be highly empathetic and highly direct. Neither should be required to sacrifice one characteristic to demonstrate the other. An ideal communication model is clear, respectful, empathetic, and accountable, while recognizing that being firm is not being “mean.” We cannot expect clinicians in leadership roles with staff or during interactions with patients to diminish their authority to show kindness.

Relationships in dentistry require empathy and collaboration, but they also require authority, accountability, correction, delegation, and boundary-setting. If a female clinician has learned to soften every difficult message, add reassurance to every boundary, apologize before every recommendation, and carefully manage whether she might be perceived as “mean,” the problem may not be her communication skills, but the unequal social price attached to professional directness.

Yes, women may face a particular interpersonal tension when exercising that authority. Women in dentistry may need to balance authority with warmth—not because women are inherently less authoritative or men are inherently more direct, but because gender expectations can shape how identical professional behaviors are socially interpreted. And let’s face it, dentistry is an unusually emotional health-care environment. Patients present with fear and anxiety, while behind the scenes among staff can be high stress. This makes warmth a highly valuable trait for any leader in dentistry. See this as a strength versus a weakness.

Dentistry should not require women to choose between being respected as clinicians and being perceived as nice people. A good clinician should be allowed to be both kind and unequivocal, and she should not have to prove she is kind first. She can say that with a straight face.

More “Asking for a Friend” articles:

• The perio-general correspondence—are we working together?
• How do I “dental” with low emotional capacity?

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. Eagly AH, Karau SJ. Role congruity theory of prejudice toward female leaders. Psychol Rev. 2002;109(3):573-598. doi:10.1037/0033-295x.109.3.573
2. Williams MJ, Tiedens LZ. The subtle suspension of backlash: a meta-analysis of penalties for women's implicit and explicit dominance behavior. Psychol Bull. 2016;142(2):165-197. doi:10.1037/bul0000039
3. Hall JA, Roter DL. Do patients talk differently to male and female physicians? A meta-analytic review. Patient Educ Couns. 2002;48(3):217-224. doi:10.1016/s0738-3991(02)00174-x
4. Roter DL, Hall JA. Physician gender and patient-centered communication: a critical review of empirical research. Annu Rev Public Health. 2004;25:497-519. doi:10.1146/annurev.publhealth.25.101802.123134