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House staff nonverbal communication skills and standardized patient satisfaction


OBJECTIVE: To examine the association of physician nonverbal communication with standardized patient (SP) satisfaction in the context of the “quality” of the interview (i.e., information provided and collected, communication skills).

DESIGN: Observational.

SETTING: One university-based internal medicine residency program.

PARTICIPANTS: Fifty-nine internal medicine residents.

INTERVIEWING: The 59 residents were recruited to participate in 3 SP encounters. The scenarios included: 1) a straightforward, primarily “medical” problem (chest pain); 2) a patient with more psychosocial overlay (a depressed patient with a history of sexual abuse); and 3) a counseling encounter (HIV risk factor reduction counseling). Trained SPs rated physician nonverbal behaviors (body lean, open versus closed body posture, eye contact, smiling, tone of voice, nod, facial expressivity) in the 3 encounters. Multiple regression approaches were used to investigate the association of physician nonverbal behavior with patient satisfaction in the context of the “quality” of the interview (SP checklist performance, measures of verbal communication skills), controlling for physician characteristics (gender, postgraduate year).

RESULTS: Nonverbal communication skills was an independent predictor of standardized patient satisfaction for all 3 patient stations. The effect sizes were substantial, with nonverbal communication predicting 32% of the variance in patient satisfaction for the chest pain station, 23% of the variance for the depression-sexual abuse station, and 19% of the variance for the HIV counseling station.

CONCLUSION: Better nonverbal communication skills are associated with significantly greater patient satisfaction in a variety of different types of clinical encounters with standardized patients. Formal instruction in nonverbal communication may be an important addition to residency.

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  1. 1.

    Burgoon JK. Nonverbal signals. In: Knapp ML, Miller GR, eds. Handbook of Interpersonal Communication. Beverly Hills, Calif: Sage Publications; 1985:344–90.

    Google Scholar 

  2. 2.

    Nardone DA, Johnson GK, Faryna A, Coulehan JL, Parrino TA. A model for the diagnostic medical interview. Nonverbal, verbal and cognitive assessments. J Gen Intern Med. 1992;7:437–42.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Koss T, Rosenthal R. Interactional synchrony, positivity, and patient satisfaction in the physician-patient relationship. Med Care. 1997;35:1158–63.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Bensing J. Doctor-patient communication and the “quality” of care. Soc Sci Med. 1991;32:1301–10.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Comstock LM, Hooper EM, Goodwin JM, Goodwin JS. Physician behaviors that correlate with patient satisfaction. J Med Educ. 1982;57:105–12.

    PubMed  CAS  Google Scholar 

  6. 6.

    Larsen KM, Smith CK. Assessment of nonverbal communication in the patient-physician interview. J Fam Pract. 1981;12:481–8.

    PubMed  CAS  Google Scholar 

  7. 7.

    Hall JF, 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 

  8. 8.

    Di Matteo MR, Taranta A, Friedman HS, Prince LM. Predicting patient satisfaction from physicians’ nonverbal communication skills. Med Care. 1980;18:376–87.

    Article  Google Scholar 

  9. 9.

    Roter DL, Hall JA, Katz NR. Relations between physician behaviors and analogue satisfaction, recall, and impressions. Med Care. 1987;25:437–51.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Goiter S, Rethans J, Scherpbier A, et al. Developing case-specific checklists for standardized patient-based assessments in internal medicine: a review of the literature. Acad Med. 2000;75:1130–7.

    Article  Google Scholar 

  11. 11.

    Friedman HS. Nonverbal communication between patients and medical practitioners. J Social Issues. 1979;35:82–99.

    Article  Google Scholar 

  12. 12.

    Smith RC, Lyles JS, Mettler JA, et al. A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Acad Med. 1995;70:729–32.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Tamblyn R, Abrahamowicz M, Schnarch B, Colliver JA, Benaroya S, Snell L. Can standardized patients predict real-patient satisfaction with the doctor-patient relationship? Teach Learn Med. 1994;6:36–44.

    Article  Google Scholar 

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Corresponding author

Correspondence to Charles H. Griffith III MD, MSPH.

Additional information

Supported by the Bayer Institute for Health Care Communication (grant 98-449).

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Griffith, C.H., Wilson, J.F., Langer, S. et al. House staff nonverbal communication skills and standardized patient satisfaction. J GEN INTERN MED 18, 170–174 (2003).

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Key words

  • doctor-patient communication
  • nonverbal communication
  • standardized patients