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Caring and Dominance Affect Participants’ Perceptions and Behaviors During a Virtual Medical Visit

Journal of General Internal Medicine volume 23, pages 523–527 (2008)Cite this article

Abstract

BACKGROUND

Physician communication style affects patients’ perceptions and behaviors. Two aspects of physician communication style, caring and dominance, are often related in that a high caring physician is usually not dominant and vice versa.

OBJECTIVE

This research was aimed at testing the sole or joint impact of physician caring and physician dominance on participant perceptions and behavior during the medical visit.

PARTICIPANTS AND DESIGN

In an experimental design, analog patients (APs) (167 university students) interacted with a computer-generated virtual physician on a computer screen. Participants were randomly assigned to 1 of 4 experimental conditions (physician communication style: high dominance and low caring, high dominance and high caring, low dominance and low caring, or low dominance and high caring). The APs’ verbal and nonverbal behavior during the visit as well as their perception of the virtual physician were assessed.

RESULTS

Analog patients were able to distinguish dominance and caring dimensions of the virtual physician’s communication. Moreover, APs provided less medical information, spoke less, and agreed more when interacting with a high-dominant compared to a low-dominant physician. They also talked more about emotions and were quicker in taking their turn to speak when interacting with a high-caring compared to a low-caring physician.

CONCLUSIONS

Dominant and caring physicians elicit different emotional and behavioral responses from APs. Physician dominance reduces patient engagement in the medical dialog and produces submissiveness, whereas physician caring increases patient emotionality.

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References

  1. Griffin SJ, Kinmonth AL, Veltman MW, Gillard S, Grant J, Stewart M. Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Annals of Family Medicine. 2004;2:595–608.

    PubMed  Article  Google Scholar 

  2. Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26:657–75.

    PubMed  Article  CAS  Google Scholar 

  3. Roter DL, Hall JA. Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits. Westport: Auburn House; 2006.

    Google Scholar 

  4. Stewart MA. Effective physician–patient communication and health outcomes: a review. Can Med Assoc J. 1995;152:1423–33.

    CAS  Google Scholar 

  5. Krupat E, Yeager CM, Putnam S. Patient role orientations, doctor–patient fit, and visit satisfaction. Psychol Health. 2000;15:707–19.

    Article  Google Scholar 

  6. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–36.

    PubMed  Article  CAS  Google Scholar 

  7. Buller MK, Buller DB. Physicians' communication style and patient satisfaction. J Health Soc Behav. 1987;28:375–88.

    PubMed  Article  CAS  Google Scholar 

  8. Emanuel EJ, Emanuel LL. Four models of the physician–patient relationship. J Am Med Assoc. 1992;267:2221–6.

    Article  CAS  Google Scholar 

  9. Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W, Inui TS. Communication patterns of primary care physicians. J Am Med Assoc. 1997;277:350–6.

    Article  CAS  Google Scholar 

  10. Schmid Mast M. Dominance and gender in the physician–patient interaction. Men’s Health & Gender. 2004;1:354–8.

    Article  Google Scholar 

  11. Ben-Sira Z. Affective and instrumental components in the physician–patient relationship: an additional dimension of interaction theory. J Health Soc Behav. 1980;21:170–80.

    PubMed  Article  CAS  Google Scholar 

  12. Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann. 1983;6:185–210.

    PubMed  Article  CAS  Google Scholar 

  13. Roter DL, Frankel R, Hall JA, Sluyter D. The expression of emotion through nonverbal behavior in medical visits—mechanisms and outcomes. J Gen Intern Med. 2006;21:28–34.

    Article  Google Scholar 

  14. Williams S, Weinman J, Dale J. Doctor–patient communication and patient satisfaction: a review. Fam Practice. 1998;15:480–92.

    Article  CAS  Google Scholar 

  15. Cohen-Cole SA. The Medical Interview: The Three-Function Approach. St. Louis, MO: Mosby; 1991.

    Google Scholar 

  16. Burgoon JK, Pfau M, Parrott R, Birk T, Coker R, Burgoon M. Relational communication, satisfaction, compliance-gaining strategies, and compliance in communication between physicians and patients. Commun Monogr. 1987;54:307–23.

    Article  Google Scholar 

  17. Speedling EJ, Rose DN. Building an effective doctor–patient relationship: from patient satisfaction to patient participation. Soc Sci Med. 1985;21:115–20.

    PubMed  Article  CAS  Google Scholar 

  18. Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991;32:175–81.

    PubMed  CAS  Google Scholar 

  19. Hall JA. Some observations on provider–patient communication research. Patient Educ Couns. 2003;50:9–12.

    PubMed  Google Scholar 

  20. Blascovich J, Loomis J, Beall AC, Swinth KR, Hoyt CL, Bailenson JN. Immersive virtual environment technology: just another methodological tool for social psychology? Psychol Inq. 2002;13:146–49.

    Article  Google Scholar 

  21. Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR. Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol. 1999;17:371–83.

    PubMed  CAS  Google Scholar 

  22. Schmid Mast M, Kindlimann A, Langewitz W. Patients' perception of bad news: how you put it really makes a difference. Patient Educ Couns. 2005;58:244–51.

    PubMed  Article  Google Scholar 

  23. Shapiro DE, Boggs SR, Melamed BG, Graham-Pole J. The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: a simulated study. Health Psychol. 1992;11:61–6.

    PubMed  Article  CAS  Google Scholar 

  24. Schmid Mast M. Dominance as expressed and inferred through speaking time: a meta-analysis. Hum Commun Res. 2002;28:420–50.

    Google Scholar 

  25. Thimm C, Rademacher U, Kruse L. "Power-related talk". Control in verbal interaction. J Lang Soc Psychol. 1995;14:382–407.

    Article  Google Scholar 

  26. Kimble CE, Olszewski DA. Gaze and emotional expression: the effects of message positivity-negativity and emotional intensity. J Res Pers. 1980;14:60–9.

    Article  Google Scholar 

  27. Robinson JD. Getting down to business: talk, gaze, and body orientation during openings of doctor–patient consultations. Hum Commun Res. 1998;25:97–123.

    Article  Google Scholar 

  28. Mehrabian A. Nonverbal communication. Chicago: Aldine; 1972.

    Google Scholar 

  29. Roter DL, Larson S. The Roter Interaction Analysis System (RIAS): utility and flexibility for analysis of medical interactions. Patient Educ Couns. 2002;46:243–51.

    PubMed  Article  Google Scholar 

  30. Schmid Mast M, Hall JA, Roter DL. Disentangling physician gender and physician communication style: their effects on patient satisfaction in a virtual medical visit. Patient Educ Couns. 2007;68:16–22.

    PubMed  Article  Google Scholar 

  31. Tiedens LZ, Jimenez MC. Assimilation for affiliation and contrast for control: complementary self-construals. J Pers Soc Psychol. 2003;85:1049–61.

    PubMed  Article  Google Scholar 

  32. Ambady N, LaPlante D, Nguyen T, Rosenthal R, Chaumeton N, Levinson W. Surgeons' tone of voice: a clue to malpractice history. Surgery. 2002;132:5–9.

    PubMed  Article  Google Scholar 

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Acknowledgments

This research was supported by a grant from the University of Zurich and by a grant from the Swiss National Science Foundation (PP001-106528/1) to the first author. Parts of the data were presented at the International Conference on Communication in Healthcare 2006 in Basel, Switzerland. We thank Claudia Dietz, Nadine Steurer, Anja Barizzi, Andrea Luomajoki-Stierli, Nadja Abt, Evelyn Mosimann, and Florinda Zagaria for their help in data collection and coding. The virtual consultation room and the virtual physician were created through an Swiss National Science Foundation fellowship awarded to the first author.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Work and Organizational Psychology, University of Neuchatel, Neuchatel, Switzerland

    Marianne Schmid Mast PhD

  2. Northeastern University, Boston, MA, USA

    Judith A. Hall PhD

  3. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Debra L. Roter DrPH

Authors
  1. Marianne Schmid Mast PhD
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  2. Judith A. Hall PhD
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  3. Debra L. Roter DrPH
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Corresponding author

Correspondence to Marianne Schmid Mast PhD.

Electronic supplementary material

The following table displays the physician communication scripts varying in emotionality (high versus low) and in dominance (low versus high). The left side of the table shows the scripts for high emotionality and the right side of the table shows the scripts for the low emotionality. High and low emotionality each branch off on the right to low dominance and on the left to high dominance. The column in the middle indicates identical text for both low and high dominance conditions. The statements of the different conditions are on the same line.

ESM Table

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Schmid Mast, M., Hall, J.A. & Roter, D.L. Caring and Dominance Affect Participants’ Perceptions and Behaviors During a Virtual Medical Visit. J GEN INTERN MED 23, 523–527 (2008). https://doi.org/10.1007/s11606-008-0512-5

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  • DOI: https://doi.org/10.1007/s11606-008-0512-5

KEY WORDS

  • physician–patient communication
  • virtual medical visit
  • dominance
  • nonverbal communication