Chapter 5: Perception of Emotion in the Medical Visit

INTRODUCTION

The process of interpersonal accuracy can be defined as an accurate judgment about any verifiable characteristic of a person such as their affective states, personality traits, values, and intentions.¹ One of the more relevant dimensions of interpersonal accuracy to the medical encounter is that of emotion perception. Clinicians who notice and accurately interpret their patient’s emotional reactions will be better equipped to foster rapport and trust with their patients, as well as better able to tailor treatment plans and goals during the medical visit.² This chapter introduces the concept of interpersonal accuracy as it refers to emotion perception, discusses the outcomes associated with this skill, reviews psychometrically validated tests of emotion perception, and recommends ways to train and improve emotion recognition as a clinical skill.

EMOTION PERCEPTION ACCURACY

In order for clinicians to accurately assess their patient’s emotional state, they must first be able to detect and correctly utilize emotion cues expressed by their patients.^3–5 Emotional content is expressed by patients in a majority of consultations.^6–8 Moments within the exchange when a patient presents emotional content to a clinician have been operationalized and labeled in a variety of ways, as “windows of opportunity,”⁹ “clues,”^10,11 or “empathic opportunities.”^6,12–15 A group of researchers in this area agreed to call these moments “cues,”^16,17 which is the terminology we will use in this chapter. Chapter 4 (Emotion Dialogue in the Medical Encounter : When and How Often Does It Happen?) and Chapter 6 (Emotion Cues as Clinical Opportunities) in the present volume specifically address the use of verbal emotion cues in the clinical interaction.

Emotion cues can be both verbal (e.g., “I am scared that my treatment won’t work”) and nonverbal. These nonverbal cues can manifest as visual cues from the face or body (e.g., smiling or body posture) as well as vocal and speech-related cues (e.g., tone and intensity; see Table 5-1 for a list of possible nonverbal cues). Nonverbal cues are equally, if not more, fundamental to the process of emotion detection than are verbal cues. Indeed, nonverbal cues occur more often than verbal cues, and healthcare providers are more likely to use information from nonverbal cues than verbal cues when judging patient emotions.^18,19 Furthermore, patient anxiety is more easily diagnosed when providers have access to full video information in comparison to a simple transcript of the interaction, again suggesting the importance of nonverbal emotion cues.²⁰ However, patients’ nonverbal cues tend to be conveyed more subtly and can be more difficult to detect (e.g., they may tap their foot repeatedly or fidget while talking about what to expect during an upcoming test), in comparison to verbal cues (e.g., a patient may explain verbally, “I’m nervous about my upcoming test”). It is important to note, however, that verbal cues can still sometimes be ambiguous (as when a patient says, “I’m ...