Skip to main content
Log in

Patient-directed gaze as a tool for discovering and handling psychosocial problems in general practice

  • Published:
Journal of Nonverbal Behavior Aims and scope Submit manuscript

Abstract

In this study, one particular form of nonverbal behavior—patient-directed gaze—was examined in relation to the general practitioner's performance in psychosocial care. Data were available from a random sample of 337 videotaped consultations and accompanying questionnaires from both general practitioner and patient. The relevance of general practitioners' gaze in psychosocial care was demonstrated in several ways: (1) general practitioners' gaze was associated with affective verbal behavior and with instrumental behavior on psychosocial topics; (2) general practitioners' gaze was related to patients' share of talking and the number of health problems presented, especially as regards psychological and social health problems; (3) in consultations with a relatively high degree of patient-directed gaze, general practitioners were found to be more aware of patients' psychosocial history and were better at identifying patients suffering mental distress. Patient-directed gaze appears to be a useful technique, both for decoding people's mental problems and for showing interest in the patient's story. This may encourage the patient to talk about worries that would otherwise remain concealed. In medical education, nonverbal techniques should be taught as distinct from verbal communication strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Argyle, M. (1978).The psychology of interpersonal behaviour, 3rd ed. Harmondsworth, Middlesex: Penguin Books Ltd.

    Google Scholar 

  • Bensing, J. M. (1991a).Doctor-patient communication and the quality of care. An observation study into affective and instrumental behavior in general practice. Utrecht: Netherlands Institute of Primary Health Care.

    Google Scholar 

  • Bensing, J. M. (1991b). Doctor-patient communication and the quality of care.Social Science & Medicine, 32, 1301–1310.

    Google Scholar 

  • Bensing, J. M., & Dronkers, J. (1992). Instrumental and affective aspects of physician behavior,Medical Care, 30, 283–297.

    Google Scholar 

  • Bensing, J. M., Bakker, D. de, & Brink-Muinen, A van den. (1993). Gender differences in practice style: A Dutch study of general practice.Medical Care, 31, 219–229.

    Google Scholar 

  • Bensing, J. M., & Sluijs, E. M. (1985). Evaluation of an interview training course for general practitioners.Social Science & Medicine, 20, 733–744.

    Google Scholar 

  • Bensing, J. M., & Verhaak, P. F. M. (1994). Psychische Problemen in de huisartspraktijk veelvormiger en diffuser dan in de psychiatricNederlands Tijdschrift Geneeskunde, 138, 130–135.

    Google Scholar 

  • Bryk, A. S., & Raudenbusch, S. W. (1992).Hierarchical linear models: Applications and data analysis methods. Newbury Park, CA: Sage.

    Google Scholar 

  • Carkhuff, R. R. (1969).Helping and human relations: A primer for lay and professional helpers. Vol. II. Practice and research. New York: Holt, Rinehart and Winston.

    Google Scholar 

  • Cassell, E. J. (1991).The nature of suffering and the goals of medicine. New York: Oxford University Press.

    Google Scholar 

  • Collier, G. (1985).Emotional expressions. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • DiMatteo, M. R., Taranta, A., Friedman, H. S., & Prince, L. M. (1980). Predicting patient satisfaction from physicians' nonverbal communication skills.Medical Care, 18, 376–387.

    Google Scholar 

  • DiMatteo, M. R., & DiNicola, D. D. (1982).Achieving patient compliance. The psychology of the medical practitioner's role. New York: Pergamon.

    Google Scholar 

  • DiMatteo, M. R., Hays, R. D., & Prince, L. M. (1986). Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload.Health Psychology, 5, 581–594.

    Google Scholar 

  • Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine.Science, 197, 129–136.

    Google Scholar 

  • Engel, G. L. (1988). How much longer must medicine's science be bound by a seventeenth century world view? In K. L. White (Ed.),The task of medicine: Dialogue at Wickenburg. Menlo Park, CA: Henry J. Kaiser Family Foundation.

    Google Scholar 

  • Foets, M., & Stockx, L. J. (submitted). The Dutch National Morbidity Survey of General Practice compared with national morbidity surveys in England and Wales.

  • Fridlund, A. J., Ekman, P., & Oster, H. (1987). Facial expression of emotion: A review of literature, 1970–1983. In A. Siegman & S. Feldstein (Eds.),Nonverbal behavior and communication (pp. 143–224). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Friedman, H. S. (1979). Nonverbal communication between patients and medical practitioners.Journal of Social Issues, 35, 82–99.

    Google Scholar 

  • Gask, L., McGrath, G., Goldberg, D., & Millar, T. (1987). Improving the psychiatric skills of established general practitioners: Evaluation of group teaching.Medical Education, 21, 362–368.

    Google Scholar 

  • Gezondheidsraad: Beraadsgroep Geneeskunde (Health Council). (1991).Medisch handelen op een tweesprong. The Hague: Gezondheidsraad.

    Google Scholar 

  • Goldberg, D. P. (1972).The detection of psychiatric illness by questionnaire. London: Oxford University Press.

    Google Scholar 

  • Goldberg, D. P., & Bridges, K. (1987). Screening for psychiatric illness in general practice: The GP versus the screening questionnaire.Journal of the Royal College of General Practitioners, 37, 15–18.

    Google Scholar 

  • Goldberg, D. P., & Huxley, P. (1992).Common mental disorders: A biosocial model. London: Routledge.

    Google Scholar 

  • Goldstein, H. (1987).Multilevel models in educational and social research. London: Griffin & Co.

    Google Scholar 

  • Hall, J. A., Roter, D. L., & Rand, C. S. (1981). Communication of affect between patient and physician.Journal of Health and Social Behavior, 22, 18–30.

    Google Scholar 

  • Hall, J. A., Roter, D. L., & Katz, N. R. (1988). Meta-analysis of correlates of provider behavior in medical encounters.Medical Care, 26, 657–675.

    Google Scholar 

  • Hornsby, J. L., & Franklin, E. P. (1979). A model for communication skills: Development for family practice residents.Journal of Family Practice, 81–76.

  • Inui, T. S., & Carter, W. B. (1985). Problems and prospects for health services research on provider-patient communication.Medical Care, 23, 521–538.

    Google Scholar 

  • Katon, W., Korff, M. von, Lin, E., Lipscomb, P., Russo, J., Wagner, E., & Polk, E. (1990). Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs.General Hospital Psychiatry, 12, 355–362.

    Google Scholar 

  • Kerlinger, F. N., & Pedhazur, E. J. (1973).Multiple regression in behavioral research. New York: Holt, Rinehart and Winston.

    Google Scholar 

  • Lamberts, H., & Wood, M. (Eds.) (1987).The international classification of primary care (ICPC). Oxford: Oxford University Press.

    Google Scholar 

  • Maes, S., Spielberger C. D., Defares, P. B., & Sarason, I. G. (Eds.) (1988).Topics in health psychology. Chichester: John Wiley & Sons.

    Google Scholar 

  • Marks, J. N., Goldberg, D. P., & Hillier, V. F. (1979). Determinants of the ability of general practitioners to detect psychiatric illness.Psychological Medicine, 9, 337–353.

    Google Scholar 

  • Ormel, J., Brink, W. van den, Koeter, M. J. J., Giel, R., Meer, K. vander, Willige, G. van de, & Wilmink, F. W. (1990). Recognition, management and outcome of psychological disorders in primary care: A naturalistic follow-up study.Psychological Medicine, 20, 909–923.

    Google Scholar 

  • Pendleton, D. A., & Bochner, S. (Eds.) (1983).Doctor-patient communication. London: Academic Press.

    Google Scholar 

  • Prosser, R., Rasbash, J., & Goldstein, H. (1991).Software for three-level analysis. London: Institute of Education, University of London.

    Google Scholar 

  • Rogers, C. R. (1951).Client centered therapy. Boston: Houghton Mifflin.

    Google Scholar 

  • Roter, D. L. (1989).The Roter method of interaction process analysis. Baltimore: Johns Hopkins University (unpublished manual).

    Google Scholar 

  • Roter, D. L., & Hall, J. A. (1992).Doctors talking with patients/Patients talking with doctors: Improving communication in medical visits. Westport, CT: Auburn House.

    Google Scholar 

  • Skuse, D., & Williams, P. (1984), Screening for psychiatric disorder in general practicePsychological Medicine, 14, 365–377.

    Google Scholar 

  • Snedecor, G. W., & Cochran, W. G. (1980).Statistical methods. Ames, IA: The Iowa State University Press.

    Google Scholar 

  • Strecher, V. J. (1983). Improving physician-patient interactions: A review.Patient Counselling and Health Education, 4, 129–136.

    Google Scholar 

  • Truax, C. B., & Mitchell, K. M. (1971). Research on certain therapists interpersonal skills in relation to process and outcome. In A. Bergin & S. Garfield (Eds.),Handbook of psychotherapy and behavior, (pp. 299–344). New York: John Wiley & Sons.

    Google Scholar 

  • Tuckett, D., & Williams, A. (1984). Approaches to the measurement of explanation and information-giving in medical consultations: A review of empirical studies.Social Science & Medicine, 18, 571–580.

    Google Scholar 

  • Vasquez-Barquero, J. L., Diez Manrique, J. F., Gaite, L., Igleslias Garcia, C., Artal, J., Roberts, S. E., & Wilkinson, G. (1992). Why people with probable minor psychiatric morbidity consult a doctor.Psychological Medicine, 22, 495–502.

    Google Scholar 

  • Verhaak, P. F. M. (1988). Detection of psychological complaints by general practitioners.Medical Care, 26, 1009–1020.

    Google Scholar 

  • Verhaak, P. F. M., & Tijhuis, M. A. R. (1994). The somatizing patient in primary care,International Journal of Psychiatry in Medicine, 24, 163–183.

    Google Scholar 

  • Waitzkin, H. (1985). Information-giving in medical care.Journal of Health and Social Behavior, 26, 81–101.

    Google Scholar 

  • Waitzkin, K., & Britt, T. (1989). Changing the structure of medical discourse: Implications of cross-national comparisons.Journal of Health and Social Behavior, 30, 436–449.

    Google Scholar 

  • White, K. L. (1988).The task of medicine: Dialogue at Wickenburg. Menlo Park, CA: The Henry Kaiser Foundation.

    Google Scholar 

  • Wright, A. F., & Perini, A. F. (1987). Hidden psychiatric illness: Use of the General Health Questionnaire in general practice.Journal of the Royal College of General Practitioners, 37, 164–167.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Thanks are extended to Glynn Coates, John F. Dovidio, and Robin DiMatteo for their comments as reviewers on the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bensing, J.M., Kerssens, J.J. & van der Pasch, M. Patient-directed gaze as a tool for discovering and handling psychosocial problems in general practice. J Nonverbal Behav 19, 223–242 (1995). https://doi.org/10.1007/BF02173082

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02173082

Keywords

Navigation