Researchers in Italy conducted a study to measure patient expressions of emotion during outpatient consultations and neurologist responses to those expressions. Patient and neurologist characteristics likely to affect both outcomes were also explored. Levels of anxiety and depression were measured in 88 patients with MS (or suspected MS) before an initial consultation with a neurologist. Consultations with 10 neurologists at four MS Italian centers were recorded and later analyzed for patient expressions of emotional cues or explicitly expressed concerns, spontaneous or elicited, and doctor response.
During the 88 consultants, patients expressed 492 cues and 45 concerns (median 4 cues and 1 concern per consultation). The most common cues were verbal hints to hidden concerns (41%), followed by neutral expressions referring to stressful life events/situations (26%). Patient anxiety was directly associated with emotional expressions, while older age of patients and neurologists, and second opinion consultants, were inversely associated with patient emotional expression.
Most of the time neurologists reacted to patient expressions of emotions by reducing the opportunity to explore the emotion (by changing the subject, ignoring the content of the cue, or giving medical advice) for 58% of cues and 76% of concerns. Doctors were more than twice as likely to give these ‘space reduction’ type responses when speaking with anxious patients.
Emotional cues and concerns
‘Concerns’ are clear, unambiguous verbalizations of unpleasant current or recent emotions, with or without an indication of their importance. ‘Cues’ are hints (verbal or nonverbal) which suggest an underlying unpleasant emotion. Cues/concerns can be expressed spontaneously by the patient or elicited by the healthcare provider. When a patient expresses cues/concerns spontaneously, the aim is often to bring up topics that have been neglected, or not adequately explored.