Physician Cross-Cultural Nonverbal Communication Skills, Patient Satisfaction and Health Outcomes in the Physician-Patient Relationship

Recent empirical findings document the role of nonverbal communication in cross-cultural interactions. As ethnic minority health disparities in the United States continue to persist, physician competence in this area is important. We examine physicians' abilities to decode nonverbal emotions across cultures, our hypothesis being that there is a relationship between physicians' skill in this area and their patients' satisfaction and outcomes. First part tested Caucasian and South Asian physicians' cross-cultural emotional recognition ability. Physicians completed a fully balanced forced multiple-choice test of decoding accuracy judging emotions based on facial expressions and vocal tones. In the second part, patients reported on satisfaction and health outcomes with their physicians using a survey. Scores from the patient survey were correlated with scores from the physician decoding accuracy test. Physicians, regardless of their ethnicity, were more accurate at rating Caucasian faces and vocal tones. South Asian physicians were no better at decoding the facial expressions or vocal tones of South Asian patients, who were also less likely to be satisfied with the quality of care provided by their physicians and to adhere to their physicians' recommendations. Implications include the development of cultural sensitivity training programs in medical schools, continuing medical education and public health programs. 1. Background Patient A has been a patient of physician X for the past 6 months, but he has not had his first physical checkup since he immigrated to the United States from India. Though reluctant, he ultimately complies, yet, with just a single glance at his doctor, he begins to second guess his decision; he has been unexpectedly assigned to a female physician. In some cultures, it is a common cultural practice for patients to be paired up with physicians of their own gender. As the physician begins to ask him a variety of questions, he passively disobeys and responds in single word syllables (i.e., “yes” and “no”). By failing to provide the most accurate information about his medical history, he compromises the quality of his healthcare. The History and Physical (H&P) shows that the patient is in good health, but physician X encourages him to schedule a followup visit. Angry and upset at having been paired with a female physician, he has no intention to ever return for a followup. This example demonstrates how a clinician’s inability to adequately decode a patient’s nonverbal emotional expressions, particularly for a patient of a different