Friends of the Nonverbal Communication Club, this week we present the paper “The Influence of Face Gaze by Physicians on Patient Trust: an Observational Study” by Jongerius, C.; Twisk, J. W. R.; Romijn, J. A.; Callemein, T.; Goedemé, T.; Smets, E. M. A. and Hillen, M. A. (2021), in which authors wonder whether the fact that the doctor looks at his/her patient affects positively or negatively to their relationship and trust.

Gaze is a very important element in nonverbal communication. Between other things, it is useful to transmit information about how we feel, if we are paying attention to what people are saying, and even we use it to direct a conversation.

If we consider it is so significant in relationship with others, it would also be relevant at the doctor’s, because that is a social meeting too.

For instance, it is known that during medical consultations, patients follow the physician’s gaze towards the computer screen. Plus, the physician’s gaze has also been related to better patients’ medication adherence and compromise.

The opposite has been related to a reduction of trust of patients in their physicians.

Why is important to study this topic?

Mainly, because we are using technology to an increasing extent to change our presential medical citations to remote meetings, just as we do with our friends or family. And if technological methods reduce eye contact between physician and patient, it may eventually harm patient’s trust in their physician.

One more question appears. In the past few years an increase of mental diseases has been observed, such as depression or anxiety. That is why authors want to give a brief insight of how face gaze between physician and patient could affect to people who suffer from social anxiety, which is the third most common mental disorder.

In order to study face gaze by physician on patient effects, authors made an experiment in which 16 doctors meet a hundred patients. These physicians wore glasses with eye-tracking technology.

After the consultation, patients made a series of questionnaires so authors could measure their trust in the physicians and the level of empathy perceived. They also answered a test to know if they suffered from social anxiety or not. Besides, before and after the consultation they were asked about their distress, to check if it had gone better or worse after the meeting with the doctor.

Results were surprisingly the opposite to the expected.

According to the experiment, more face gaze is associated with lower trust from patient to the physician.

Furthermore, no relation was found between physician face gaze and patient’s perception of physician empathy or patient’s distress.

It seems that social anxiety it is not a sufficiently relevant factor to shed significative information to the experiment, but authors point out that patients did not obtain high results in the anxiety test, so that may be an explanation. Further investigations should be made to study this aspect.

These results are shocking for the authors, and so they are for most of us. In popular beliefs it’s common the idea that when a doctor looks at his/her patient’s face, the bond between them is stronger and their relationship, better.

This was confirmed by previous research. However, these studies assessed face gaze using less objective methodologies, such as observer-based coding of video recordings.

One of the hypotheses that authors throw to explain these results is the so-called “eye contact effect”.

This means that perceived gaze affects neurobehavioral responses and cognitive processing. These responses to gaze would include higher bodily self-awareness and a decreased capability to perform cognitive tasks. Namely, the feeling of being observed could lead to decreased trust in the physician because the patient feels overly observed by him/her.

A couple of limitations are observed in the study, as the previously mentioned which was related to the anxiety. Another would be the possibility of a Hawthorne effect, meaning that the results may have been biased because physicians were aware of being observed. It must be mentioned that authors did not measure the face gaze of the patient towards the physician, because they did not want to burden patients. However, this should be studied in further investigations because the level of face gaze in a conversation depends on all people involved in the interaction.

These experiment’s results are against the society’s general belief, and scientific community’s in particular. It was believed that face gaze from physician to patient was, without doubts, beneficial for the latter and for improving their relationship and the trust between both.

Nevertheless, authors point out the need to delve into this question, making research that correct these mentioned limitations, so conclusions could be used to make better relations between physicians and patients.

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