An analysis of video recordings of routine patient-physician checkups and physicals reveals that subtle and unspoken clues influence medical care.
University of Michigan Health System researchers determined each party sends and receives unspoken messages. Investigators believe a review of the often unconscious exchanges will help physicians improve their medical decision-making and allow them to understand the messages they may be unintentionally conveying to patients.
Researchers discovered patients often rate the encounter based upon non-verbal clues that convey whether the physician appears hurried or at ease.
Doctors, on the other hand, reported that patients’ unstated clues influenced their medical judgments.
“Our findings show that both doctors and patients identified tacit clues involving the behavior or appearance of the other, but they were not always able to articulate precisely how these clues informed their judgments and assessments,” said lead author Stephen G. Henry, M.D.
“Not surprisingly, patients and doctors discussed these clues very differently.”
Examples of tacit clues include non-verbal behaviors such as body language, eye contact, physical appearance, and tone of voice. Other factors, such as how frequently the patient was seen in the clinic, might also inform judgments.
In the study, some physicians were more attuned to the perception or non-verbal message they send to patients.
Just five of the 18 southeast Michigan doctors who participated in the study contributed 64 percent of all the comments, which were given while reviewing a recording of the interaction.
One doctor was particularly attuned to how non-verbal communication spoke to patients, the authors note. “I use my body a lot,” the doctor reported. “It’s nice to see that I don’t look rushed in the room. Although in my mind, I’m whirling. OK, so I sit down, I try to relax and look relaxed.”
On the flip side, doctors report using their power of observation to aid in diagnosing a patient, says Henry. They discussed observing the patient in a general way for signs that they might be depressed or that they were not revealing the whole of their concerns.
“It’s mostly looking at the patient. Do they look healthy?” one doctor said.
Another doctor noted this ability to put together the puzzle pieces of a patient’s verbal and non-verbal communication becomes intuitive: “How do you know what Aunt Martha looks like? Because you know what she looks like, you’ve seen her lots of times. I can’t detail as to why I know that, but I’ve been down the road long enough to know…”
The way a patient presents himself may give a doctor clues as to whether non-specific symptoms like weight gain, fatigue and high blood pressure are signals of depression or whether something else may be responsible, like a rare condition such as Cushing syndrome, which may indicate an adrenal tumor, the authors note.
Patients, on the other hand, were mainly concerned with clues that indicated their place within the doctor-patient relationship. For instance, Did the doctor make them feel comfortable? Did the doctor seem like she was in a hurry? Did she put them at ease? Was the doctor a good listener? Did he make eye contact?
While doctors and patients keyed in on particular examples in many of the examinations, sometimes they were unsure of precisely how they arrived at an opinion.
“Our findings are consistent with research from the social sciences suggesting that doctors’ and patients’ judgments in the examining room are often complicated and take into account many subtle, unspoken clues,” said senior author Michael Fetters, M.D., M.P.H., M.A..
“In the future, we hope this method of recording and reviewing these types of interactions can inform interventions designed to improve medical decision-making and doctor-patient interaction by providing a more complete understanding of the kind of signals upon which doctors and patients rely.”
The research findings have been published in the Journal of Evaluation in Clinical Practice.