Authors:  Marianne Schmid Mast, Christina Klöckner Cronauer, Gaëtan Cousin

Background
Nonverbal behavior accompanies our social interactions. We cannot not express us nonverbally and even a blank face transmits a message, namely that the sender does not want to show any emotions. The role of nonverbal behavior in the medical encounter has not gained nearly as much research attention as the role of verbal behavior. The existing research on nonverbal communication in the physician-patient interaction has focused almost exclusively on the physician's nonverbal behavior and its effect on patients. How patients' nonverbal communication affects physicians, for instance, in their making diagnosis, recommending treatment, or interacting with the patient has not been researched much. One focus of the proposed research is to
investigate the direct effect of patient's nonverbal behavior on physician
decision making (e.g., diagnosis) and behavior. The other focus is on how physician nonverbal sensitivity affects patient outcomes. Physician nonverbal sensitivity is understood as the degree to which the physician is capable of correctly assessing the patient's nonverbal cues and his or her affective states. How well the physician is able to read the nonverbal behavior and affective state of his/her patient is crucial not only for diagnosis. Physician nonverbal sensitivity influences patient outcomes positively (DiMatteo, Hays, & Prince, 1986; DiMatteo, Taranta, Friedman, & Prince, 1980). The mechanism behind this link, however, is neither well understood nor investigated. The present research proposal addresses this oversight.

Research aims
Research aim 1 focuses on the question of how patient nonverbal behavior affects physician decision making (e.g., diagnosis) and physician behavior. Research aim 2 focuses on the question of how physician nonverbal sensitivity affects patient outcomes and behavior.
We address the question of how patient nonverbal behavior that conveys either dominance or affiliation affects physician diagnosis and treatment recommendations. More specifically we look at a) the effects of patient nonverbal behavior on physician verbal and nonverbal behavior and b) the relation between the quality of the diagnosis and the physician's verbal and nonverbal behavior. Moreover, we want to find out whether and how the physician's nonverbal sensitivity (how accurately he/she can assess the patient's nonverbal cues and emotional states) affects patient outcomes and behaviors.

Significance
Results as to whether and how patient nonverbal communication affects diagnosis, treatment recommendations, and physician behavior towards the patient are important because they can be used to improve physician communication training (e.g., how to avoid biases in diagnosis due to patient nonverbal behavior) and to educate patients on how to present their symptoms to receive optimal care. To corroborate existing research findings and to deepen our understanding for the mechanisms involved, we address how physician nonverbal sensitivity (e.g., how well he/she remembers the nonverbal behavior of the patient and how correctly he/she infers the emotional states of the patient during the medical encounter) is related to patient outcome (e.g., health status improvement, patient satisfaction, adherence to treatment plans and appointment keeping). Nonverbal sensitivity of the physician seems to be related to positive health outcomes of patients. Our research will reveal how physician nonverbal sensitivity affects physician behavior which could in turn explain the positive effects on patients. Knowing the mechanism behind the relation of physician nonverbal sensitivity and positive patient outcomes will enable us to suggest how to devise physician training and formation. The present research ultimately aims at improving patient outcomes (e.g., satisfaction, adherence, health status) by investigating (1) how patient nonverbal behavior affects the physician's decision making and (2) how physician nonverbal sensitivity (how accurately a physician remembers the nonverbal behavior of the patient and how well the physician is capable of inferring patient's affective states) affects patient outcomes.