title: Physicians' responses to patients' expressions of negative emotions in hospital consultations: a video-based observational study.
abstract: OBJECTIVE
  Patients express their negative emotions in medical consultations either implicitly as cue to an underlying unpleasant emotion or explicitly as a clear, unambiguous concern. The health provider's response to such cues and concerns is important for the outcome of consultations. Yet, physicians often neglect patient's negative emotions. Most studies of this subject are from primary health care. We aimed to describe how physicians in a hospital respond to negative emotions in an outpatient setting.
  
  
  METHODS
  Ninety six consultations were videotaped in a general teaching hospital. The Verona Coding Definitions of Emotional Sequences was used to identify patients' expression of negative emotions in terms of cue and concern and to code physicians' subsequent responses. Cohen's kappa was used as interrater reliability measure. Acceptable kappa level was set to .60.
  
  
  RESULTS
  We observed 163 expressions of negative emotions. In general, the physician responses to patients' cues and concerns did not include follow up or exploration. Concerns more often than cues led to lack of emotional exploration.
  
  
  CONCLUSIONS
  When patients expressed negative emotions or cues to such, hospital physicians tended to move away from emotional communication, particularly if the emotion was expressed as an explicit concern.
  
  
  CONCLUSIONS
  Medical training should enable physicians' to explore the patients' emotions in situations where it will improve the medical treatment.
authors: HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway. t.a.mjaaland@medisin.uio.no
authors: Trond A
authors: TA
authors: Mjaaland
authors: Arnstein
authors: A
authors: Finset
authors: Bård Fossli
authors: BF
authors: Jensen
authors: Pål
authors: P
authors: Gulbrandsen
mesh_terms: D000367:Age Factors; D003142:Communication; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009341:Negativism; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D012017:Referral and Consultation; D012737:Sex Factors; D014743:Videotape Recording