Shedding light on the dark side of doctor-patient interactions: verbal and nonverbal messages physicians communicate during error disclosures.

OBJECTIVE: Existing investigations on medical error disclosures have neglected the fact that a disproportionately large amount of the meaning in messages is derived from nonverbal cues. This study provides an empirical assessment of the verbal and nonverbal messages physicians communicate when disclosing medical errors to standardized patients.
METHODS: Sixty hypothetical error disclosures by a volunteer sample of attending physicians were videotaped, coded, and statistically analyzed.
RESULTS: Physicians used friendly, smooth, approaching and invested nonverbal styles as they disclosed medical errors to standardized patients. Female physicians smiled more and were more attentive to patients than male physicians, and physicians tended to exhibit more positive affect in the form of facial pleasantness toward angry female patients than toward angry male patients. Furthermore, physicians touched and smiled at patients more frequently at the beginning and at the end of their error disclosures, and displayed decreased attentiveness and interactional fluency.
CONCLUSION: Future research needs to examine which disclosure styles patients perceive as competent, and to assess their causal impacts on objective and relational disclosure outcomes. PRACTICE IMPLICATIONS: This study provides an important baseline understanding of medical error disclosures that is essential for the successful implementation of empirically based training programs.