Chapter 6: Emotion Cues as Clinical Opportunities

INTRODUCTION

How Do We Define a Cue and Why is it Important to Attend to Emotion Cues in the Clinical Setting?

In medical consultations, patients often feel vulnerable or emotionally tense due to their illness and the circumstances related to it. However, there is evidence that they seldom verbalize their concerns and emotions directly and spontaneously to their health providers.^1,2 Research has indicated that they rather tend to offer indirect cues and hints which suggest potential underlying concerns (“and then the pain really stabs me”; “I am starting to snap, I am starting to a little bit snap now…”).^3–5 These hints need to be further explored in order to be correctly understood. The danger of missing their significance is twofold: to overlook important issues brought by the patient or to make erroneous assumptions about the core message they want to bring into the consultation.⁶

As defined in Oxford Advanced Learner’s Dictionary a cue is “an action (also a few words) or event that is a signal for somebody to do something.”⁷ Similarly, a hint is defined as “something that you say or do in an indirect way in order to show somebody what you are thinking.” In the latter definition, the implicit aspect of the signal is underlined, suggesting how such verbal or nonverbal signals are ambiguous and vague by nature, making them difficult to detect. There is a nuance in the meaning of cue and hint: the term cue points to communication process rather than content, in that a cue is a signal from the patient to the clinician, directing the clinician’s attention to something. In some definitions of cue, it is specified that a cue from the patient requires a clarification by the provider.⁸ A hint, on the other hand, is more a reference to the content rather than the process.

Why are emotional issues introduced in an allusive and nonexplicit way rather than being explicitly expressed? Piccinelli et al. have suggested that patients most often prefer to express the organic components related to the reason for the consultation rather than emotional concerns.⁹ Moreover, physical symptoms and emotional distress frequently coexist, which can further muddle consultation priorities. The difficulty of making emotional issues explicit is also associated with several other aspects, both health provider and patient related: such as the clinician’s attitudes toward psychosocial themes,^10,11 gender,^12,13 the patient’s personality and life experiences,¹⁴ cultural expectations,^15–17 severity and type of medical illness,¹⁸ health beliefs of the patient,¹⁹ and a general tendency by patients to consider emotional aspects as a private and reserved aspect of personal life.

Therefore, very often patients seem to test the ground during medical consultations. At the outset, they cautiously introduce a vague or ambiguous expression to check how the health provider reacts. Then, on the basis of the interest and the attention ...