How physicians communicate normal test results may influence whether patients feel reassured, seek out additional opinions, or insist on further testing, according to new research published in the Annals of Family Medicine.

The findings add to a growing body of research that perceived warmth and capability are key dimensions of trust in clinicians and may shape how patients follow treatment recommendations.

“Communication is not just the words that we say but also about how we say them…and is central to the relationship between a patient and their healthcare provider. The patient is really having to answer the question, ‘Do I trust this doctor?’” said Thomas Gallagher, MD, internist and professor at the University of Washington School of Medicine in Seattle, who was not associated with the study.

Researchers enrolled nearly 350 German adults (mean age, 30 years; 79% women). Participants were asked to imagine that a family member has recently been diagnosed with bowel cancer and had previously experienced gastrointestinal symptoms that the participant was now experiencing. They then watched a 2-minute video in which a physician presented normal test results with no abnormalities and explained that a diagnosis of a serious disease was very unlikely.

Clinicians expressed high or low warmth and high or low capability. Warmth was conveyed through behaviors such as making eye contact, smiling when appropriate, using an empathetic tone, using collaborative language, and sitting in an open posture. In the low-warmth videos, the clinician avoided eye contact, did not smile, used a cold tone, and crossed their arms.

Physician capability was conveyed through an upright posture, controlled movements, avoidance of filler words, and clear explanation of test results. In the low-capability videos, the clinician used filler words, fidgeted, searched through the patient’s file, and mispronounced words.

Before and after receiving the same message but with different manners of communication, participants rated how likely they were to have a serious disease on a 100-point scale. Researchers also assessed emotional concern, desire for a second opinion, and desire for a follow-up colonoscopy.

Both traits significantly influenced how participants interpreted their normal results. Participants who found their clinicians highly capable and highly warm were more likely to believe they did not have a serious disease or bowel cancer than those who watched videos without these traits.

Participants who rated their clinician as having high warmth and high capability had less emotional concern, less desire for a second opinion, and less desire for a colonoscopy than those who rated their clinicians as having low warmth and low capability. High warmth also significantly improved participants’ overall perception of their health (P = .005).

Participants who perceived their physician as warm tended to also think of the professional as more capable and vice versa, making the two qualities difficult to completely disentangle.

Trusting a clinician has implications beyond the exam room. Failing to communicate in a way that instills confidence “can lead to patient distress, additional doctor visits, and more testing, which comes with higher healthcare costs and potentially even harm to patients if they experience complications,” said Gordon Wood, MD, MSCI, associate professor of medicine and medical education at the Northwestern University Feinberg School of Medicine in Chicago.

Previous research has shown that physicians who display empathic nonverbal behaviors, such as eye contact and an open posture, were perceived as warmer and more capable than physicians who displayed less empathic behaviors, suggesting the two qualities may reinforce one another.

Wood reported being a strategic partner with VitalTalk, a nonprofit communication skills training organization. Gallagher reported having no disclosures.

Brittany Vargas is an independent journalist covering medicine, mental health, and wellness.