Document Type


Publication Date

Summer 8-23-2021


Student Research Opportunities Program


Nonverbal behaviors play a significant role in the patient-doctor interaction as it provides cues to underlying unspoken emotions and concerns from the patient (Silverman, 2010). Nonverbal behaviors are most significant when they can be used to reinforce or contradict verbal responses. Thus, it is important for medical students to learn to identify patient non-verbal behaviors through their speech patterns, facial expressions, and body posture, and be able to relate these responses to a positive or adverse patient-physician interaction.

Rising third year medical students were video recorded taking health histories from standardized patients (SP; n = 84) of all gender identities. A nonverbal behavior scale was adapted to rate 11 items that assess how patients react to LGBTQ microaggressions from medical students. For each microaggression, the patient’s nonverbal behavior was categorized as adverse/reactive or neutral/positive. Qualitative observations regarding the nonverbal responses were also recorded.

Self-touching, nodding, leaning away from the student, and gestures were the most frequent adverse/reactive nonverbal behavior across all gender identities. It was found that gender minorities, particularly transgender women exhibited a greater frequency for adverse/reactive responses. This may be because the most frequent microaggression coded was heteronormative and cis-normative assumptions (i.e., assuming patient SAAB, language for body parts, or sexual orientation and gender identity). Interestingly, transgender women, in the face of this type of microaggression would disclose their sexual orientation, gender identity, or sex assigned at birth as medical students would assume incorrectly. This suggests that transgender women would receive more accurate recommendations, screenings, etc., than transgender men who would often remain misgendered.

These findings implicate the need for providers to better understand patient nonverbal communication, especially in response to bias or uncomfortable interactions. Future research should address how patient nonverbal behavior affects physician follow-up questioning, diagnosis, and treatment plan. Future research should also explore relationship between physician and patient nonverbal behavior.

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Psychology Commons