Skip to main content
SpringerLink
Log in

First Impressions of Physicians According to Their Physical and Social Group Characteristics

Journal of Nonverbal Behavior volume 44, pages 279–299 (2020)Cite this article

Abstract

People often make inferences about others from the physical appearance and social group characteristics revealed through their photographs. Because physicians’ photographs are routinely displayed to prospective patients in websites, print media, and direct mail, it is possible that this practice triggers conscious or unconscious biases in potential patients. We investigated first impressions of physicians based on seeing their photographs. In two studies (Study 1 N = 59; Study 2 N = 99), we used an experimentally composed set of physician photographs that varied their gender, age, nationality (USA vs. India), and smiling; their physical attractiveness was also measured. Analogue patients rated the physicians’ patient centeredness, technical competence, and their desire to see the physician again. For patient centeredness, the data revealed bias against older (especially if older and male), Indian, less attractive, and non-smiling physicians, and for competence there was bias against younger physicians (especially if younger and female). For desire to see the physician again, the bias was against Indian, less attractive, and non-smiling physicians. These biases may impact how patients select physicians and may persist to shape their interactions with them.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Reproduced with consent of the photographed physician

References

  • Abel, M. H. (Ed.). (2002). An empirical reflection on the smile. New York: Edwin Mellen Press.

    Google Scholar 

  • Ambady, N., & Rosenthal, R. (1993). Half a minute: Predicting teacher evaluations from thin slices of nonverbal behavior and physical attractiveness. Journal of Personality and Social Psychology,64, 431–441.

    Google Scholar 

  • Beach, M. C., Inui, T., & the Relationship-Centered Care Research Network. (2006). Relationship-centered care: A constructive reframing. Journal of General Internal Medicine,21, 53–58.

    Google Scholar 

  • Bird, C. P., & Fisher, T. D. (1986). Thirty years later: Attitudes toward the employment of older workers. Journal of Applied Psychology,71, 515–517.

    Google Scholar 

  • Blanch-Hartigan, D., Hall, J. A., Krupat, E., & Irish, J. T. (2013). Can naive viewers put themselves in the patients’ shoes? Reliability and validity of the analogue patient methodology. Medical Care,51, e16–e21.

    PubMed  Google Scholar 

  • Brase, G. L., & Richmond, J. (2004). The white-coat effect: Physician attire and perceived authority, friendliness, and attractiveness. Journal of Applied Social Psychology,34, 2469–2481.

    Google Scholar 

  • Briton, N. J., & Hall, J. A. (1995). Beliefs about female and male nonverbal communication. Sex Roles,32, 79–90.

    Google Scholar 

  • Chang, C.-T., & Chen, C.-X. (2015). Babyface effects: A double-edged sword in healthcare service evaluations. Asian Journal of Social Psychology,18, 325–336.

    Google Scholar 

  • Charlesworth, T. E. S., Hudson, S.-K. T. J., Cogsdill, E. J., Spelke, E. S., & Banaji, M. R. (2019). Children use targets’ facial appearance to guide and predict social behavior. Developmental Psychology, 55(7), 1400–1413.

    PubMed  Google Scholar 

  • Chou, C., & Cooley, L. (Eds.). (2018). Communication Rx: Transforming healthcare through relationship-centered communication. New York: McGraw Hill.

    Google Scholar 

  • Cuddy, A. J. C., & Fiske, S. T. (2004). Doddering but dear: Process, content, and function in stereotyping of older persons. In T. D. Nelson (Ed.), Ageism: Stereotyping and prejudice against older persons (pp. 3–26). Cambridge: MIT Press.

    Google Scholar 

  • Denrell, J. (2005). Why most people disapprove of me: Experience sampling in impression formation. Psychological Review,112, 951–978.

    PubMed  Google Scholar 

  • Eagly, A. H., Ashmore, R. D., Makhijani, M. G., & Longo, L. C. (1991). What is beautiful is good, but…: A meta-analytic review of research on the physical attractiveness stereotype. Psychological Bulletin,110, 109–128.

    Google Scholar 

  • Fiske, S. T., Cuddy, A. J., & Glick, P. (2007). Universal dimensions of social cognition: Warmth and competence. Trends in Cognitive Sciences,11, 77–83.

    PubMed  Google Scholar 

  • Fiske, S. T., Cuddy, A. J. C., Glick, P., & Xu, J. (2002). A model of stereotype content as often mixed: Separate dimensions of competence and warmth respectively follow from status and competition. Journal of Personality and Social Psychology,82, 878–902.

    PubMed  Google Scholar 

  • Fiske, S. T., Xu, J., Cuddy, A. C., & Glick, P. (1999). (Dis) respecting versus (dis) liking: Status and interdependence predict ambivalent stereotypes of competence and warmth. Journal of Social Issues,55, 473–489.

    Google Scholar 

  • Gheorghiu, A. I., Callan, M. J., & Skylark, W. J. (2017). Facial appearance affects science communication. PNAS Proceedings of the National Academy of Sciences of the United States of America,114, 5970–5975.

    Google Scholar 

  • Gordon, R. A., & Arvey, R. D. (2004). Age bias in laboratory and field settings: A meta-analytic investigation. Journal of Applied Social Psychology,34, 468–492.

    Google Scholar 

  • Gross, T. F. (2007). Developmental changes in the perception of adult facial age. The Journal of Genetic Psychology: Research and Theory on Human Development,168, 443–464.

    Google Scholar 

  • Günaydin, G., Selcuk, E., & Zayas, V. (2017). Impressions based on a portrait predict, 1-month later, impressions following a live interaction. Social Psychological and Personality Science,8, 36–44.

    Google Scholar 

  • Hall, J. A., Blanch-Hartigan, D., & Roter, D. L. (2011). Patients’ satisfaction with male versus female physicians: A meta-analysis. Medical Care,49, 611–617.

    PubMed  Google Scholar 

  • Hall, J. A., Coats, E. J., & Smith LeBeau, L. (2005). Nonverbal behavior and the vertical dimension of social relations: A meta-analysis. Psychological Bulletin,131(6), 898–924.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Haskard-Zolnierek, K. B., & Williams, S. L. (2016). Patient-physician communication and patient satisfaction. In Y. Benyamini, M. Johnston, & E. C. Karademas (Eds.), Psychological assessment—Science and practice: Assessment in health psychology (Vol. 2, pp. 73–85). Boston: Hogrefe Publishing.

    Google Scholar 

  • Heckhausen, J., Dixon, R. A., & Baltes, P. B. (1989). Gains and losses in development throughout adulthood as perceived by different adult age groups. Developmental Psychology,25, 109–121.

    Google Scholar 

  • Henry, S. G., Penner, L. A., & Eggly, S. (2017). Associations between thin slice ratings of affect and rapport and perceived patient-centeredness in primary care: Comparison of audio and video recordings. Patient Education and Counseling,100, 1128–1135.

    PubMed  Google Scholar 

  • Institute of Medicine. (2001). Crossing the quality chasm: A new health system. Washington, DC: National Academies Press.

    Google Scholar 

  • Jang, Y., Yoon, H., Kim, M. T., Park, N. S., & Chiriboga, D. A. (2018). Preference for patient-provider ethnic concordance in Asian Americans. Ethnicity & Health, 25, 1–12.

    Google Scholar 

  • Kaufmann, M. C., Krings, F., & Sczesny, S. (2016). Looking too old? How an older age appearance reduces chances of being hired. British Journal of Management,27, 727–739.

    Google Scholar 

  • Kite, M. E., Deaux, K., & Miele, M. (1991). Stereotypes of young and old: Does age outweigh gender? Psychology and Aging,6, 19–27.

    PubMed  Google Scholar 

  • Kraus, M. W., & Keltner, D. (2009). Signs of socioeconomic status: A thin-slicing approach. Psychological Science,20, 99–106.

    PubMed  Google Scholar 

  • Krys, K., Vauclair, C.-M., Capaldi, C. A., Lun, V. M.-C., Bond, M. H., Domínguez-Espinosa, A., et al. (2016). Be careful where you smile: Culture shapes judgments of intelligence and honesty of smiling individuals. Journal of Nonverbal Behavior,40, 101–116.

    PubMed  Google Scholar 

  • Levine, C. S., & Ambady, N. (2013). The role of non-verbal behaviour in racial disparities in health care: Implications and solutions. Medical Education,47, 867–876.

    PubMed  Google Scholar 

  • Lill, M. M., & Wilkinson, T. J. (2005). Judging a book by its cover: Descriptive survey of patients’ preferences for doctors’ appearance and mode of address. BMJ: British Medical Journal,331, 1524–1527.

    PubMed  Google Scholar 

  • Louis, W. R., Lalonde, R. N., & Esses, V. M. (2010). Bias against foreign-born or foreign-trained doctors: Experimental evidence. Medical Education,44, 1241–1247.

    PubMed  Google Scholar 

  • Maddox, K. B., & Dukes, K. N. (2008). Social categorization and beyond: How facial features impact social judgment. In N. Ambady & J. J. Skowronski (Eds.), First impressions (pp. 205–233). New York: Guilford.

    Google Scholar 

  • Maina, I. W., Belton, T. D., Ginzberg, S., Singh, A., & Johnson, T. J. (2018). A decade of studying implicit racial/ethnic bias in healthcare providers using the Implicit Association Test. Social Science and Medicine,199, 219–229.

    PubMed  Google Scholar 

  • Makoul, G., & Zeldow, P. B. (2010). Communicating with patients. In D. Wedding & M. L. Stuber (Eds.), Behavior and medicine (pp. 199–216). Cambridge, MA: Hogrefe Publishing.

    Google Scholar 

  • Mangini, M. C., & Biederman, I. (2004). Making the ineffable explicit: Estimating the information employed for face classifications. Cognitive Science,28, 209–226.

    Google Scholar 

  • Martin, L. R., & DiMatteo, M. R. (2013). Clinical interactions. In J. A. Hall & M. L. Knapp (Eds.), Handbooks of communication science. Nonverbal communication (pp. 833–858). Boston: De Gruyter Mouton.

    Google Scholar 

  • Matsumoto, D., LeRoux, J., Wilson-Cohn, C., Raroque, J., Kooken, K., Ekman, P., et al. (2000). A new test to measure emotion recognition ability: Matsumoto and Ekman’s Japanese and Caucasian Brief Affect Recognition Test (JACBART). Journal of Nonverbal Behavior,24, 179–209.

    Google Scholar 

  • McCarthy, J. J., McCarthy, M. C., & Eilert, R. E. (1999). Children’s and parents’ visual perception of physicians. Clinical Pediatrics,38, 145–152.

    PubMed  Google Scholar 

  • Mead, N., & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science and Medicine,51, 1087–1110.

    PubMed  Google Scholar 

  • Mullan, F. (2005). The metrics of the physician brain drain. New England Journal of Medicine,353, 1810–1818.

    PubMed  Google Scholar 

  • Naumann, L. P., Vazire, S., Rentfrow, P. J., & Gosling, S. D. (2009). Personality judgments based on physical appearance. Personality and Social Psychology Bulletin,35, 1661–1671.

    Google Scholar 

  • Nunez-Smith, M., Pilgrim, N., Wynia, M., Desai, M. M., Jones, B. A., Bright, C., et al. (2009). Race/ethnicity and workplace discrimination: Results of a national survey of physicians. Journal of General Internal Medicine,24, 1198–1204.

    PubMed  PubMed Central  Google Scholar 

  • Perrault, E. K., & Smreker, K. C. (2013). What can we learn from physicians’ online biographies to help in choosing a doctor? Not much. A content analysis of primary care physician biographies. Journal of Communication in Healthcare,6, 122–127.

    Google Scholar 

  • Ranasinghe, P. D. (2015). International medical graduates in the US physician workforce. Journal of the American Osteopathic Association,115, 236–241.

    PubMed  Google Scholar 

  • Re, D. E., & Rule, N. O. (2016). Appearance and physiognomy. In D. Matsumoto, H. C. Hwang, & M. G. Frank (Eds.), APA handbooks in psychology. APA handbook of nonverbal communication (pp. 221–256). Washington, DC: American Psychological Association.

    Google Scholar 

  • Redman, T., & Snape, E. (2002). Ageism in teaching: Stereotypical beliefs and discriminatory attitudes towards the over-50s. Work, Employment & Society,16, 355–371.

    Google Scholar 

  • Riniolo, T. C., Johnson, K. C., Sherman, T. R., & Misso, J. A. (2006). Hot or not: Do professors perceived as physically attractive receive higher student evaluations? Journal of General Psychology,133, 19–35.

    PubMed  Google Scholar 

  • Rosenthal, R. (1991). Meta-analytic procedures for social research (rev ed.). Thousand Oaks: Sage.

    Google Scholar 

  • Roter, D. L., & Hall, J. A. (2006). Doctors talking with patients/patients talking with doctors: Improving communication in medical visits (2nd ed.). Westport: Praeger.

    Google Scholar 

  • Roter, D., & Larson, S. (2002). The Roter interaction analysis system (RIAS): Utility and flexibility for analysis of medical interactions. Patient Education and Counseling,46, 243–251.

    PubMed  Google Scholar 

  • Ruben, M. A., Hall, J. A., & Schmid Mast, M. (2015). Smiling in a job interview: When less is more. Journal of Social Psychology,155, 107–126.

    PubMed  Google Scholar 

  • Rule, N. O., & Ambady, N. (2008a). Brief exposures: Male sexual orientation is accurately perceived at 50 ms. Journal of Experimental Social Psychology,44, 1100–1105.

    Google Scholar 

  • Rule, N. O., & Ambady, N. (2008b). The face of success: Inferences from chief executive officers’ appearance predict company profits. Psychological Science,19, 109–111.

    PubMed  Google Scholar 

  • Schmid Mast, M. (2007). On the importance of nonverbal communication in the physician-patient interaction. Patient Education and Counseling,67, 315–318.

    Google Scholar 

  • Shah, R., & Ogden, J. (2006). ‘What’s in a face?’ The role of doctor ethnicity, age and gender in the formation of patients’ judgements: An experimental study. Patient Education and Counseling,60, 136–141.

    PubMed  Google Scholar 

  • Snyder, M., Tanke, E. D., & Berscheid, E. (1977). Social perception and interpersonal behavior: On the self-fulfilling nature of social stereotypes. Journal of Personality and Social Psychology,35, 656–666.

    Google Scholar 

  • Sofer, C., Dotsch, R., Wigboldus, D. H. J., & Todorov, A. (2015). What is typical is good: The influence of face typicality on perceived trustworthiness. Psychological Science,26, 39–47.

    PubMed  Google Scholar 

  • Street, R. J., Jr., O’Malley, K. J., Cooper, L. A., & Haidet, P. (2008). Understanding concordance in patient-physician relationships: Personal and ethnic dimensions of shared identity. Annals of Family Medicine,6, 198–205.

    PubMed  PubMed Central  Google Scholar 

  • Todorov, A. (2017). Face value: The irresistible influence of first impressions. Princeton: Princeton University Press.

    Google Scholar 

  • Todorov, A., Mandisodza, A. N., Goren, A., & Hall, C. C. (2005). Inferences of competence from faces predict election outcomes. Science,308, 1623–1626.

    PubMed  Google Scholar 

  • Tskhay, K. O., & Rule, N. O. (2013). Accuracy in categorizing perceptually ambiguous groups: A review and meta-analysis. Personality and Social Psychology Review,17, 72–86.

    Google Scholar 

  • Van Vliet, L. M., Van Der Wall, E., Albada, A., Spreeuwenberg, P. M., Verheul, W., & Bensing, J. M. (2012). The validity of using analogue patients in practitioner–patient communication research: Systematic review and meta-analysis. Journal of General Internal Medicine,27, 1528–1543.

    PubMed  PubMed Central  Google Scholar 

  • Zebrowitz, L., & Lee, S. Y. (1999). Appearance, stereotype-incongruent behavior, and social relationships. Personality and Social Psychology Bulletin,25, 569–584.

    Google Scholar 

  • Zebrowitz, L. A., & McDonald, S. M. (1991). The impact of litigants’ baby-facedness and attractiveness on adjudications in small claims courts. Law and Human Behavior,15, 603–623.

    Google Scholar 

Download references

Acknowledgement

We thank Leigh Nesky, Donna Appiah, Henry Garland, Shanyu Kates, Marina Wilson, Alissa Yap, Jackson Doerr, and Gabriela Rushi for their work as research assistants, and Dr. Vanessa Castro for consultation on data analysis. In addition, we sincerely thank our friends and colleagues who agreed to pose as physicians.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of the Department of Veterans Affairs or the United States Government.

Author information

Authors and Affiliations

  1. Department of Psychology, 125 NI, Northeastern University, Boston, MA, 02115, USA

    Judith A. Hall

  2. University of Maine, Orono, ME, USA

    Mollie A. Ruben

  3. Center for Healthcare Organization and Implementation Research, US Department of Veterans Affairs, Boston, MA, USA

    Mollie A. Ruben

  4. Indian Institute of Management Indore, Indore, India

    Swatantra

Authors
  1. Judith A. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mollie A. Ruben
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Swatantra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Judith A. Hall.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hall, J.A., Ruben, M.A. & Swatantra First Impressions of Physicians According to Their Physical and Social Group Characteristics. J Nonverbal Behav 44, 279–299 (2020). https://doi.org/10.1007/s10919-019-00329-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10919-019-00329-8

Keywords

search

Navigation