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Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

Bensing, J.M., Verheul, W., Dulmen, A.M. van. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice. Health Education: 2008, 108(5), 373-383
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Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an attempt to learn more about how general practitioners' (GPs') communication can help patients to express their worries, the paper also aims to explore the relationship between physicians' communication and patients' articulation of concerns and worries during the consultation. Design/methodology/approach – From a representative sample of videotaped consecutive consultations of 142 Dutch GPs with 2,095 adult patients, 1,388 patients (66.3 per cent) completed the pre-consultation questionnaire, including state anxiety (STAI), subjective health (COOP-WONCA-charts) and the reason for encounter (ICPC). GPs assessed the psychosocial background of patients' presented problems on a five-point Likert scale. The videotaped consultations were coded with RIAS, including global affect measures. GPs' patient-directed gaze was measured as a time-measure. Findings: The results show that, on average, the patients had slightly elevated anxiety levels and one-third of the patients were highly anxious. As expected, the anxious patients seldom expressed emotional concerns directly, but did show a nonverbal and verbal communication pattern which was distinctively different from that of non-anxious patients. Whether or not patients expressed concerns verbally was significantly related to GPs' affective communication and partnership building. Nonverbal communication seemed to play a dominant role both in sending and receiving emotional signals. Practical implications: In more than half of the consultations worries were not openly expressed, even by patients with high levels of anxiety. Patients tended to express their concerns in a more indirect way, partly by verbal, partly by nonverbal signals. GPs can facilitate patients to express their concerns more openly, not by direct questioning, but by showing verbal and nonverbal affect to the patient. Originality/value: Focuses on the important role of verbal and nonverbal affect in physicians' communication. (aut. ref.)