Communication of affect between patient and physician

The purpose of this research was to identify patterns of patient-provider communication, in particular combinations of verbal and nonverbal (vocal) expression during the medical visit, that are associated with patient contentment with the visit and appointment-keeping. The data used in the analyses were tape recordings of 50 patient-physician interactions during routine medical visits for chronic disease. The interactions, which were rated by 144 judges, were assessed in three conditions: electronically filtered speech (voice only), original speech (voice and words), and transcripts (words only). Among the affective aspects rated were anger, anxiety, dominance, sympathy, assertiveness, and businesslike manner. Findings indicate that the patient's contentment with the medical visit is related to ratings of the physician's communication, but that the relationship for the physician's verbal communication is opposite that for the physician's nonverbal communication. When the physician sounds (in filtered speech) more negative-more angry, more anxious, and less as though the patient would return-the patients are more content. But when the physician utters words (judged in transcripts) that are less anxious and more sympathetic, patients are more content. The patient's return for subsequent appointments is also associated with the physician's expression of anger and anxiety in original (unfiltered) speech. Patients who return for appointments express mixed affects in the different conditions - more satisfied and less anxious in words and original speech, but less satisfied in voice tone. Since affect, in this study, appears to be reciprocated, we suggest that negative physician affect expressed in voice tone with positive affect communicated through words is interpreted by patients in an overall positive manner, as probably reflecting perceived seriousness and concern on the part of the physician.