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.
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Abel, M. H. (Ed.). (2002). An empirical reflection on the smile. New York: Edwin Mellen Press.
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.
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.
Bird, C. P., & Fisher, T. D. (1986). Thirty years later: Attitudes toward the employment of older workers. Journal of Applied Psychology,71, 515–517.
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.
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.
Briton, N. J., & Hall, J. A. (1995). Beliefs about female and male nonverbal communication. Sex Roles,32, 79–90.
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.
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.
Chou, C., & Cooley, L. (Eds.). (2018). Communication Rx: Transforming healthcare through relationship-centered communication. New York: McGraw Hill.
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.
Denrell, J. (2005). Why most people disapprove of me: Experience sampling in impression formation. Psychological Review,112, 951–978.
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.
Fiske, S. T., Cuddy, A. J., & Glick, P. (2007). Universal dimensions of social cognition: Warmth and competence. Trends in Cognitive Sciences,11, 77–83.
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.
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.
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.
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.
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.
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.
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.
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.
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., Roter, D. L., & Rand, C. S. (1981). Communication of affect between patient and physician. Journal of Health and Social Behavior,22, 18–30.
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.
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.
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.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system. Washington, DC: National Academies Press.
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.
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.
Kite, M. E., Deaux, K., & Miele, M. (1991). Stereotypes of young and old: Does age outweigh gender? Psychology and Aging,6, 19–27.
Kraus, M. W., & Keltner, D. (2009). Signs of socioeconomic status: A thin-slicing approach. Psychological Science,20, 99–106.
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.
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.
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.
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.
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.
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.
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.
Mangini, M. C., & Biederman, I. (2004). Making the ineffable explicit: Estimating the information employed for face classifications. Cognitive Science,28, 209–226.
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.
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.
McCarthy, J. J., McCarthy, M. C., & Eilert, R. E. (1999). Children’s and parents’ visual perception of physicians. Clinical Pediatrics,38, 145–152.
Mead, N., & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science and Medicine,51, 1087–1110.
Mullan, F. (2005). The metrics of the physician brain drain. New England Journal of Medicine,353, 1810–1818.
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.
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.
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.
Ranasinghe, P. D. (2015). International medical graduates in the US physician workforce. Journal of the American Osteopathic Association,115, 236–241.
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.
Redman, T., & Snape, E. (2002). Ageism in teaching: Stereotypical beliefs and discriminatory attitudes towards the over-50s. Work, Employment & Society,16, 355–371.
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.
Rosenthal, R. (1991). Meta-analytic procedures for social research (rev ed.). Thousand Oaks: Sage.
Roter, D. L., & Hall, J. A. (2006). Doctors talking with patients/patients talking with doctors: Improving communication in medical visits (2nd ed.). Westport: Praeger.
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.
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.
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.
Rule, N. O., & Ambady, N. (2008b). The face of success: Inferences from chief executive officers’ appearance predict company profits. Psychological Science,19, 109–111.
Schmid Mast, M. (2007). On the importance of nonverbal communication in the physician-patient interaction. Patient Education and Counseling,67, 315–318.
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.
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.
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.
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.
Todorov, A. (2017). Face value: The irresistible influence of first impressions. Princeton: Princeton University Press.
Todorov, A., Mandisodza, A. N., Goren, A., & Hall, C. C. (2005). Inferences of competence from faces predict election outcomes. Science,308, 1623–1626.
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.
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.
Zebrowitz, L., & Lee, S. Y. (1999). Appearance, stereotype-incongruent behavior, and social relationships. Personality and Social Psychology Bulletin,25, 569–584.
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.
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.
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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