How Do You Know What Aunt Martha Looks Like?

A Video Elicitation Study Exploring Tacit Cues in Doctor-Patient Interactions

Doctors and patients may not be explicitly aware of non-verbal communications that occur during clinical interactions. Yet tacit clues—body language, eye contact, tone of voice and physical appearance—affect patients’ and providers’ thoughts and actions.

These researchers analyzed video recordings of routine checkups. Videos were shown to doctors and patients separately and then each participant was interviewed and asked to comment on what had occurred in the videos.

Patients mostly discussed judgments based on tacit clues that related to the doctor–patient relationship. For example, patients talked about whether they thought the doctor took enough time with them and whether they felt comfortable with the doctor. Doctors consciously used nonverbal clues to establish and maintain good rapport, for example, sitting down to talk with a patient and using eye contact.

When it came to medical decision-making, several doctors mentioned that they commonly relied on gestalt judgments about patients. “It’s mostly looking at a patient. Do they look healthy?” one said. “I kinda cue in on some things I am not even conscious of,” another commented.

Both patients and doctors had difficulty articulating the reasons for some of their judgments—doctors on whether a patient was depressed and patients on why they felt comfortable.

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