Chapter 4: Emotion Dialogue in the Medical Encounter: When and How Often Does It Happen?

INTRODUCTION

There is evidence from nonverbal behavior research that a face can never be truly expressionless, emotionless, or neutral. Even if you ask someone to display a neutral face, they may still be feeling underlying emotion that leaks out in their expression through what is called a microexpression. Or, years of emotion-laden experiences may remain on the face through wrinkles or lines that make it appear expressive. Even when young adults’ faces are in repose and deliberately “neutral,” the features themselves connote emotion.¹ Similar to there being no truly neutral facial expressions, medical interactions can never be truly emotionless. Even if a doctor has a purely biomedical agenda or a patient only wants to know about the technical aspects of their diagnosis or treatment, they may still be feeling underlying emotion that leaks out in their verbal or nonverbal behavior. And even if on the surface what is being said does not appear to be emotional in nature, patients and doctors bring with them past experiences in medical interactions and in their personal lives that may impact how they feel, what they say, and how they behave.

Often, emotions in the medical dialogue are expressed in subtle ways and are not the focus of the interaction.² Some medical visits, on the other hand, are filled with intense emotion and are frequently one-sided, in that patients are the only ones expressing emotions. Stereotypes about which providers are good at dealing with emotions also likely influence the expression of emotion in the medical visit. For example, nurses are stereotyped as being able to handle and deal with patient emotions, and psychotherapists and palliative care physicians often have entire courses and supervision specific to managing, exploring, and coping with patient emotion. Because these providers are assumed to welcome emotion and be good at handling them, patients are likely to express their emotions more in these contexts and with these types of providers than with providers who are more biomedically focused and technical (e.g., surgeons).

While clinicians cannot ask about, recognize, or respond to every emotion that a patient has during the interaction (for the sake of time and energy), the current state of patient care lacks a crucial focus on emotion dialogue in the medical interaction. Emotions, not just of patients but also of physicians, must become a topic of learning in medical education and continuing education. This will benefit not only patients and their ability to cope, connect, and heal but also physicians in terms of their longevity in their career by potentially reducing the already high rates of burnout, depression, and suicide.

In this chapter, we discuss where emotions fit into conceptualizations of patient-centered care and patient-centered communication, why emotion dialogue matters in the medical interaction, how frequently emotion dialogue occurs and what facilitates or creates barriers in emotion dialogue, and finally make recommendations for educators and medical professionals to consider when ...