Two studies examined vocal affect in medical providers’ and patients’ content-filtered (CF) speech. A digital methodology for content-filtering and a set of reliable global affect rating scales for CF voice were developed. In Study 1, ratings of affect in physicians’ CF voice correlated with patients’ satisfaction, perceptions of choice/control, medication adherence, mental and physical health, and physicians’ satisfaction. In Study 2, ratings of affect in the CF voices of physicians and nurses correlated with their patients’ satisfaction, and the CF voices of nurses and patients reflected their satisfaction. Voice tone ratings of providers and patients were intercorrelated, suggesting reciprocity in their vocal affective communication.
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Ambady, N., Hallahan, M., & Rosenthal, R. (1995). On judging and being judged accurately in zero-acquaintance situations. Journal of Personality and Social Psychology, 69, 518–529.
Ambady, N., Koo, J., Rosenthal, R., & Winograd, C. H. (2002). Physical therapists’ nonverbal communication predicts geriatric patients’ health outcomes. Psychology and Aging, 17, 443–452.
Ambady, N., LaPlante, D., Nguyen, T., Rosenthal, R., Chaumeton, N., & Levinson, W. (2002). Surgeons’ tone of voice: A clue to malpractice history. Surgery, 132, 5–9.
Ambady, N., & Rosenthal, R. (1992). Thin slices of expressive behavior as predictors of interpersonal consequences: A meta-analysis. Psychological Bulletin, 111, 256–274.
Ballard-Reisch, D. (1990). A model of participative decision making for physician-patient interaction. Health Communication, 2, 91–104.
Bugental, D. E., Kaswan, J. W., & Love, L. R. (1970). Perception of contradictory meanings conveyed by verbal and nonverbal channels. Journal of Personality and Social Psychology, 16, 647–655.
Cairns, R. B., & Green, J. A. (1979). How to assess personality and social patterns: Observations or ratings? In R. Cairns (Ed.), The analysis of social interactions: Methods, issues, and illustrations (pp. 209–226). Hillsdale: Lawrence Erlbaum.
Charon, R., Greene, M. G., & Adelman, R. D. (1994). Multi-dimensional interaction analysis: A collaborative approach to the study of medical discourse. Social Science and Medicine, 39, 955–965.
Choi, S. V., Gray, H. M., & Ambady, N. (2005). The glimpsed world: Unintended communication and unintended perception. In R. R. Hassin, J. S. Uleman, & J. A. Bargh (Eds.), The new unconscious (pp. 309–333). New York: Oxford University Press.
Coats, E. J., & Feldman, R. S. (1996). Gender differences in nonverbal correlates of social status. Personality and Social Psychology Bulletin, 22, 1014–1022.
Davitz, J. R. (1964). The communication of emotional meaning. New York: McGraw-Hill.
Deckard, G., Meterko, M., & Field, D. (1994). Physician burnout: An examination of personal, professional, and organizational relationships. Medical Care, 32, 745–754.
DePaulo, B., & Friedman, H. S. (1998). Nonverbal communication. In D. T. Gilbert, S. T. Fiske, & G. Lindzey (Eds.), The handbook of social psychology (4th ed., Vol. 2, pp. 3–40). New York: McGraw-Hill.
DePaulo, B. M., & Rosenthal, R. (1979). Ambivalence, discrepancy, and deception in nonverbal communication. In R. Rosenthal (Ed.), Skill in nonverbal communication: Individual differences (pp. 204–248). Cambridge: Oelgeschlager, Gunn, & Hain.
DiMatteo, M. R., Hays, R. D., & Prince, L. M. (1986). Relationship of physicians’ nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload. Health Psychology, 5, 581–594.
DiMatteo, M. R., Reiter, R. C., & Gambone, J. G. (1994). Enhancing medication adherence through communication and informed collaborative choice. Health Communication, 6, 253–265.
DiMatteo, M. R., Robinson, J. D., Heritage, J., Tabbarah, M., & Fox, S. A. (2003). Correspondence among patients’ self-reports, chart records, and audio/videotapes of medical visits. Health Communication, 15, 393–413.
DiMatteo, M. R., Sherbourne, C. D., Hays, R. D., Ordway, L., Kravitz, R. L., McGlynn, E. A., et al. (1993). Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychology, 12, 93–102.
DiMatteo, M. R., Taranta, A., Friedman, H. S., & Prince, L. M. (1980). Predicting patient satisfaction from physicians’ nonverbal communication skills. Medical Care, 18, 376–387.
Duncan, S. (1972). Some signals and rules for taking turns and speaking in conversations. Journal of Personality and Social Psychology, 23, 283–292.
Ekman, P. (1989). The argument and evidence about universals in facial expressions of emotion. In H. Wagner, & A. Manstead (Eds.), Handbook of psychophysiology: The biological psychology of emotions and social processes (pp. 143–164). London: Wiley.
Fallowfield, L., Jenkins, V., Farewell, V., & Solis-Trapala, I. (2003). Enduring impact of communication skills training: Results of a 12-month follow-up. British Journal of Cancer, 89, 1445–1449.
Frankel, R. M. (1995). Emotion and the physician-patient relationship. Motivation and Emotion, 19, 163–173.
Friedman, H. S. (1982). Nonverbal communication in medical interaction. In H. S. Friedman, & M. R. DiMatteo (Eds.), Interpersonal issues in healthcare (pp. 51–66). New York: Academic Press.
Griffith, C. H., 3rd, Wilson, J. F., Langer, S., & Haist, S. A. (2003). House staff nonverbal communication skills and standardized patient satisfaction. Journal of General Internal Medicine, 18, 170–174.
Grossman, T., Stiano, T., & Friederici, A. D. (2005). Infants’ electric brain responses to emotional prosody. Neuroreport: For Rapid Communication of Neuroscience Research, 16, 1825–1828.
Guilford, J. P. (1954). Psychometric methods (2nd ed., p. 407). New York: McGraw Hill.
Hall, J. A. (1978). Gender effects in decoding nonverbal cues. Psychological Bulletin, 85, 845–857.
Hall, J. A., Harrigan, J. A., & Rosenthal, R. (1995). Nonverbal behavior in clinician patient interaction. Applied & Preventive Psychology, 4, 21–37.
Hall, J. A., Irish, J. T., Roter, D. L., Ehrlich, C. M., & Miller, L. H. (1994). Satisfaction, gender, and communication in medical visits. Medical Care, 32, 1216–1231.
Hall, J. A., & Levin, S. (1980). Affect and verbal-nonverbal discrepancy in schizophrenic and non-schizophrenic family communication. British Journal of Psychiatry, 137, 78–92.
Hall, J. A., Roter, D. L., & Katz, N. R. (1987). Task versus socioemotional behaviors in physicians. Medical Care, 25, 399–412.
Hall, J. A., Roter, D. L., Milburn, M. A., & Daltroy, L. H. (1996). Patients’ health as a predictor of physician and patient behavior in medical visits. A synthesis of four studies. Medical Care, 34, 1205–1218.
Hall, J. A., Roter, D. L., & Rand, C. S. (1981). Communication of affect between patient and physician. Journal of Health and Social Behavior, 22, 18–30.
Harrigan, J. A., Oxman, T. E., Rosenthal, R. (1985). Rapport expressed through nonverbal behavior. Journal of Nonverbal Behavior, 9, 95–100.
Kaplan, S. H., Gandek, B., Greenfield, S., Rogers, W., & Ware, J. E. (1995). Patient and visit characteristics related to physicians’ participatory decision-making style: Results from the Medical Outcomes Study. Medical Care, 33, 1176–1187.
Koss, T., & Rosenthal, R. (1997). Interactional synchrony, positivity, and patient satisfaction in the physician-patient relationship. Medical Care, 35, 1158–1163.
Marsh, A. A., Elfenbein, H. A., & Ambady, N. (2003). Nonverbal “accents”: Cultural differences in facial expressions of emotion. Psychological Science, 14, 373–376.
Marshall, G., & Hays, R. (1994). The patient satisfaction questionnaire short-form (PSQ-18). Santa Monica: RAND.
Martin, L. R., DiMatteo, M. R., & Lepper, H. S. (2001). Physician facilitation of patient involvement in care: Development and validation of a scale. Behavioral Medicine, 27, 111–120.
Martin, L. R., Jahng, K. H., Golin, C. E., & DiMatteo, M. R. (2003). Physician facilitation of patient involvement in care: Correspondence between patient and observer reports. Behavioral Medicine, 28, 159–164.
Milmoe, S., Rosenthal, R., Blane, H. T., Chafetz, M. E., & Wolf, I. (1967). The doctor’s voice: Postdictor of successful referral of alcoholic patients. Journal of Abnormal Psychology, 72, 78–84.
National Committee for Quality Assurance (NCQA). (2000). Diabetes quality improvement project survey items.
O’Malley, A. S., Forrest, C. B., & Mandelblatt, J. (2002). Adherence of low-income of women to cancer screening recommendations. Journal of General Internal Medicine, 17, 144–154.
Ong, L. M., de Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: A review of the literature. Social Science and Medicine, 40, 903–918.
Osgood, C., Suci, G., & Tannenbaum, P. (1957). The measurement of meaning. Urbana: The University of Illinois Press.
Pittenger, R., Hockett, C., & Danehy, J. (1960). The first five minutes. New York: Paul Martineau.
Ray, E. B., & Ray, G. B. (1990). The relationship of paralinguistic cues to impression formation and the recall of medical messages. Health Communication, 2, 47–57.
Riggio, R. E., & Feldman, R. S. (2005). Applications of nonverbal communication. Mahwah: Lawrence Erlbaum.
Robinson, J. D. (1998). Getting down to business: Talk, gaze, and body orientation during openings of doctor-patient consultations. Human Communication Research, 25, 97–123.
Robinson, J. D. (2006). Nonverbal communication and physician-patient interaction: Review and new directions. In V. M. Manusov, & M. L. Patterson (Eds.), The SAGE handbook of nonverbal communication (pp. 437–460). Thousand Oaks: Sage.
Rogers, P. L., Scherer, K. R., & Rosenthal, R. (1971). Content filtering human speech: A simple electronic system. Behavior, Research Methods, & Instruments, 3, 16–18.
Rosenthal, R. (1966). Experimenter effects in behavioral research. East Norwalk: Appleton-Century-Crofts.
Rosenthal, R. (2005). Conducting judgment studies: Some methodological issues. In J. A. Harrigan, R. Rosenthal, & K. R. Scherer (Eds.), The handbook of methods in nonverbal behavior research (pp. 199–234). New York: Oxford University Press.
Rosenthal, R., Blanck, P. D., & Vannicelli, M. (1984). Speaking to and about patients: Predicting therapists’ tone of voice. Journal of Consulting and Clinical Psychology, 52, 679–686.
Rosenthal, R., Hall, J. A., DiMatteo, M. R., Rogers, P. L., & Archer, D. (1979). Sensitivity to nonverbal communication: The PONS test. Baltimore: Johns Hopkins University Press.
Roter, D. L., Frankel, R. M., Hall, J. A., & Sluyter, D. (2006). The expression of emotion through nonverbal behavior in medical visits. Mechanisms and outcomes. Journal of General Internal Medicine, 21(Suppl.1), S28–S34.
Roter, D. L., & Hall, J. A. (1992). Doctors talking with patients/Patients talking with doctors. Westport: Auburn House.
Roter, D. L., Stewart, M., Putnam, S. M., Lipkin, M., Jr., Stiles, W., & Inui, T. S. (1997). Communication patterns of primary care physicians. Journal of the American Medical Association, 277, 350–356.
Safran, D. G., Taira, D. A., Rogers, W. H., Kosinski, M., Ware, J. E., & Tarlov, A. R. (1998). Linking primary care performance to outcomes of care. Journal of Family Practice, 47, 213–220.
Scherer, K. R. (1986). Vocal affect expression: a review and a model for future research. Psychological Bulletin, 99, 143–165.
Soskin, W. F., & Kauffman, P. E. (1961). Judgment of emotion in word-free samples. Journal of Communication, 11, 73–80.
Starkweather, J. A. (1956a). Content-free speech as a source of information about the speaker. Journal of Abnormal Psychology, 52, 394–402.
Starkweather, J. A. (1956b). The communication-value of content-free speech. American Journal of Psychology, 69, 121–123.
Stewart, A. L., & Ware, J. E., Jr. (1992). Measuring functioning and well-being: The Medical Outcomes Study approach. Durham: Duke University Press.
Street, R. L., & Buller, D. B. (1987). Nonverbal behavior patterns in physician-patient interactions: A functional analysis. Journal of Nonverbal Behavior, 11, 234–253.
Suchman, A. L., Roter, D., Green, M., & Lipkin, M., Jr. (1993). Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Medical Care, 31, 1083–1092.
Tickle-Degnen, L., & Gavett, E. (2003). Changes in nonverbal behavior during the development of therapeutic relationships. In P. Phillippot (Ed.), Nonverbal behavior in clinical settings (pp. 75–110). New York: Oxford University Press.
Visser, R. M., Smets, E. M. A., Oort, F. J., & de Haes, H. C. (2003). Stress, satisfaction, and burnout among Dutch medical specialists. Canadian Medical Association Journal, 168, 271–275.
Ware, J. E. (1993). SF-36 health survey: Manual and interpretation guide. Boston: The Health Institute, New England Medical Center.
The authors would like to acknowledge the following sources of support and funding: Grant No: 1 RO1-8HS10922, “Communication and Satisfaction in Primary Care Teams” (John Heritage: PI), the Bayer Institute for Health Care Communication, the Robert Wood Johnson Foundation Investigator Award in Health Policy Research (M. Robin DiMatteo: PI), and the Committee on Research of the U.C. Riverside Academic Senate. The views expressed in this paper are those of the authors alone, and do not imply endorsement by these sources. The authors thank Pat Giordani, Suzy O’Donnell, and Jan Scott for their contributions to the development of the content-filtered technologies reported here.
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Haskard, K.B., Williams, S.L., DiMatteo, M.R. et al. The Provider’s Voice: Patient Satisfaction and the Content-filtered Speech of Nurses and Physicians in Primary Medical Care. J Nonverbal Behav 32, 1–20 (2008). https://doi.org/10.1007/s10919-007-0038-2
- Voice tone
- Provider-patient communication
- Content-filtered speech
- Patient satisfaction