"Get the Shot, Now!" Disentangling Content-Related and Social Cues in Physician-Patient Communication

Physician-patient communication has 3 major functions: exchanging information, building a functioning relationship, and reaching shared decisions about treatment. This article reviews research into social and content-related aspects of physician-patient communication. Although both have received attention in the field individually, their interrelations are less well researched. This applies especially to how patients perceive cues in physicians' language in concrete interactions. To gain some insight into these phenomena, the authors first present findings from related fields, including instructional communication. From that, they derive the rationale for an empirical study they conducted in Germany to analyse the relationship of social and content-related cues in the context of physician-patient communication.

Regarding social variations of communication, previous research has shown that empathy on the part of the physician can improve patient satisfaction and compliance by way of improved information exchange, but also because patients perceive empathic physicians as knowledgeable partners whom they can trust. Regarding the effects of variations in the content-related aspects of communication, studies have found that when patients perceive an explanation as sufficient, they are more satisfied with the encounter and are more likely to follow the physician's advice. Linguistic variations in content-related and social aspects of communication have been found to interact in such a way that predominantly social variations tend to influence how the content of a message is understood and that the content of a message affects recipients' social perceptions of the communication partner. (One would think, then, that using the same language as a patient should lead to messages that are perceived as better understood and more appropriate. However, using technical language should clearly identify physicians as experts in their field and thus engender perceptions of competence.)

The researchers presented 53 persons (25 high school students and 28 university students, all of whom were native German speakers) with 4 different statements by fictional physicians concerning the measles-mumps-rubella (MMR) vaccine. The purpose was to disentangle how recipients judge what physicians say and how they say it: the content and the social connotations of their communication. In a 2 × 2 within-subject design, they manipulated politeness and the use of technical terms. "Face threats" (acts that in some way threaten the "face" or self-esteem of another person) were either phrased politely or explicitly (politeness manipulation) - example: "In your situation, it would probably be advisable to get vaccinated" versus "You should get vaccinated right away." Medical terms were lexically encoded using either everyday terms (ET) or technical terms (TT; terminology manipulation). The researchers analysed the effects of these variations on 3 levels: the perception of the sender (i.e. the physician), the perception of the statements he or she expresses, and the perception of the medical concepts contained in the statements.

Participants took part in the study in groups. Four sets of questionnaires were constructed in such a manner that each of the 4 statements (see Table 1) was realised with every combination of the independent variables of terminology and politeness (i.e., ET polite, ET explicit, TT polite, and TT explicit). Participants were asked to rate every statement, the physician who uttered it, and the technical concepts in it on both social and content-related measures.

The results show, in sum, that physicians who phrase their statements politely are judged as applying more facework (ways people cooperatively attempt to promote both the other's and one's own sense of self-esteem, autonomy, and solidarity in conversation), but there were no significant effects on perceptions of clarity, appropriateness, goodwill, expertise, or social relation. On the other hand, the terminology variation, representing the lexical encoding of medical terms, affected participants' perceptions on many levels: TT resulted in a lower feeling of knowing than ET, and statements with technical language were perceived as less clear and comprehensible. However, technical language also unexpectedly led to lower perceptions of facework, goodwill, and integrity, as well as a more negative score regarding social relation. Finally, the results on clarity showed an unexpected interaction: Although all statements with TT were considered relatively less clear than those with ET, when ET were used, explicit statements were perceived as even clearer than polite ones.

Thus, the results are in line with the notion that social and content-related variations in physicians' language will affect perceptions not only in their respective domain (social or content), but also in the other. One interpretation is that the different variations differentially influenced participants' more general perceptions of the interaction relating to aspects of communion and agency. The physician using TT threatens the patient's need for agency, because the physician's incomprehensible language forces the patient to ask about the confusing terms. In this case, the physician seems negligent in his or her choice of words and is hence perceived socially more negative. If, instead of a physician, it were a friend urging the recipient to get vaccinated, variations in politeness might have a different effect, because communion might be the more salient dimension. Future research could test this assumption by analysing how the same face-threatening messages are perceived when coming from speakers with different roles or relationships with the recipient.

The results of the study show that very technical language did not lead to perceptions of expertise but did seem less polite. One practical implication is that adapting technical language to a layperson's level of understanding might be important over and above ensuring successful information exchange. Also noted here: Appeals to vaccinate children (i.e., other-oriented appeals) might need a different approach than appeals for patients themselves to get vaccinated, because agency is processed preferentially in self-evaluations, while communion takes precedence in judging others.

Looking ahead, "Theoretical and empirical work needs to continue to differentiate the influence of language variations on social perceptions as well as patient learning and behavior and to clarify the role of basic [social] needs."