Imagine you’ve been experiencing a mysterious pain and you go to your doctor for testing. Understandably, you feel nervous when you go in to hear the results. Your doctor greets you, arms crossed; when you sit down, she settles behind her computer with her eyes focused on the monitor, telling you matter-of-factly that you’ll need surgery. You express trepidation at the idea of being anesthetized. Your doctor, now standing by the door and glancing at her watch, explains that the procedure is routine. How would you feel after this interaction?
Now imagine a second scenario: Your doctor says the same things, but this time her body language is noticeably different. She greets you with an outstretched hand and a smile. She sits down, faces you and maintains eye contact. When you express anxiety, her eyebrows soften and her face looks caring.
Think over both of these versions of the interaction. In which interaction is your doctor being nicer? We suspect nearly everyone would say the second. But in which is she doing a better job?
If you thought your doctor was nicer and doing a better job in the second interaction, then your intuitions aligned with ours when we set out to conduct an experiment, the results of which were recently published in PLOS ONE. Our experiment was built on the idea that there are two well-documented dimensions along which people perceive one another: warmth and competence. The scenarios above varied the empathy of your doctor’s nonverbal behavior, which you are likely to have perceived as warmth.
If you shared our intuitions, you thought the warmer version of your doctor was also more competent—that is, she was also doing a better job in the second version of the interaction. But if you didn’t share our intuitions, you are not alone. Past findings show that in certain cases, the more you think of someone as warm, the less likely you are to think of them as competent.
Imagine that prior to your appointment with your doctor described above you witness two hospital staffers talking in the waiting room. You can’t quite make out what they’re saying but there is a male doctor wearing an expensive watch and a white coat whose rapid staccato with a hint of a New York City accent is answered by the careful southern drawl of an older female nurse wearing colorful street clothes. Knowing nothing else about them, compare them on how warm and how competent you think they are.
If you are like participants in previous research, you may have thought that the doctor was higher on competence but lower on warmth whereas the nurse was opposite: higher on warmth but lower on competence. (In fact, the characters’ attributes in this scenario were selected based on evidence of stereotypes associated with warmth and competence.) This type of scenario—in which people are asked to make a comparison between two people (or groups)—is one situation in which the “warmth/competence trade-off” has been observed. Another involves impression management.
Now imagine you are the New York doctor and you are sitting down with your department chief for your annual performance review. This year you have often felt pressured to conduct your appointments quickly, and so you have tried to optimize your time by keeping your eyes on your patients’ electronic chart on the computer monitor while discussing their treatment options with them. Your department chief gives you feedback culled from patient surveys describing you as “cold” interpersonally and with patients’ reported trust in you as below average. What might you do to change your patients’ perceptions of you?
One solution might be to quickly review your patients’ charts prior to their appointments so you can swivel away from the monitor and maintain eye contact more consistently. (The southern nurse, unfortunately, faces a more uphill battle in counteracting the stereotypes working against her, which is itself a growing body of research.)
Thus, we arrive at our study’s central question: Is there a warmth/competence trade-off in people’s perceptions of doctors displaying empathic nonverbal behavior? This problem might sound like academic musing but it has major real-world impact. First and foremost, physician empathy (typically perceived as warmth) is associated with positive health outcomes, increased diagnostic accuracy and more patient adherence to treatment—for example, sticking to a cholesterol-lowering diet. Medical education has been much maligned for ignoring “soft” relational skills, but if empathy is associated with better patient health outcomes, there is a compelling case to include such training in formal curricula.
Second, physician empathy is associated with increased patient satisfaction. As a patient, you would thus probably have enjoyed the second version of the scenario above more than the first. Training doctors to be more empathic may thus benefit the “public good” in that we would all be slightly happier. But it benefits the private good, too. Health care reimbursement is increasingly tied to patient satisfaction surveys, and so it is in the economic self-interest of hospitals to ensure that their patients are satisfied. Ensuring their doctors are empathic can help them get there.
Here we arrive at what might be the horns of a dilemma: We know empathy in doctors is important, but if there is a warmth/competence trade-off in patient perceptions, could increasing perceptions of warmth cause a corresponding decrease in perceived competence? This was the motivation for our study.
To test whether there is a warmth/competence trade-off in people’s perceptions of doctors displaying empathic nonverbal behavior, we asked over 1,300 people online to imagine themselves as a patient in a scenario very much like the one above. We paired a patient−clinician dialogue with still photographs of doctors displaying nonverbal behavior that the academic literature has shown to be empathic (eye contact, equal patient−doctor eye level, no physical barrier, open posture, touch and concerned facial expression) or “unempathic” (no eye contact, unequal eye level, physical barrier, closed posture, no touch and unconcerned facial expression).
Participants only saw one of these conditions, so they were unable to directly compare the two conditions as you did here. We then asked for their judgments of the doctor’s warmth and competence. (For the methodologically astute, we also asked about their mood to ensure any effect we saw of empathic nonverbal behavior was not attributable to mood—it wasn’t.)
Our results provide evidence that doctors displaying empathic nonverbal behavior are perceived as both warmer and more competent. It appears the horns of the dilemma may be illusory and that there is no warmth/competence trade-off in this situation after all. Our findings might reflect a changing concept of the role of doctors in our society. No longer are they judged solely on their technical competence—that is, their ability to perform medical procedures. Rather they may increasingly be judged on their interpersonal competence—that is, their ability to navigate the difficult social interactions inherent in managing patients’ illness and wellness.
This is, of course, not the final word. Among many limitations of our study is that it is “analogue,” or hypothetical; a similar intervention of nonverbal behavior in a genuine medical setting would generate results that would provide a firmer foundation for policy change. Still, given the benefits of clinician empathy for both doctors and patients, our study provides further evidence in favor of making empathy training an integral part of medical education.
In sum, our results suggest emphasizing empathy in doctors does not diminish but instead promotes patient perceptions of competence. Soft skills and hard knowledge may go hand in hand.