The Influence of Face Gaze by Physicians on Patient Trust: an Observational Study

BACKGROUND: Physicians’ gaze towards their patients may affect patients’ trust in them. This is especially relevant considering recent developments, including the increasing use of Electronic Health Records, which affect physicians’ gaze behavior. Moreover, socially anxious patients’ trust in particular may be affected by the gaze of the physician. OBJECTIVE: We aimed to evaluate if physicians’ gaze towards the face of their patient influenced patient trust and to assess if this relation was stronger for socially anxious patients. We furthermore explored the relation between physicians’ gaze and patients’ perception of physician empathy and patients’ distress. DESIGN: This was an observational study using eye-tracking glasses and questionnaires. PARTICIPANTS: One hundred patients and 16 residents, who had not met before, participated at an internal medicine out-patient clinic. MEASURES: Physicians wore eye-tracking glasses during medical consultations to assess their gaze towards patients’ faces. Questionnaires were used to assess patient outcomes. Multilevel analyses were conducted to assess the relation between physicians’ relative face gaze time and trust, while correcting for patient background characteristics, and including social anxiety as a moderator. Analyses were then repeated with perceived empathy and distress as outcomes. RESULTS: More face gaze towards patients was associated with lower trust, after correction for gender, age, education level, presence of caregivers, and social anxiety (β=−0.17, P=0.048). There was no moderation effect of social anxiety nor a relation between face gaze and perceived empathy or distress. CONCLUSIONS: These results challenge the notion that more physician gaze is by definition beneficial for the physician-patient relationship. For example, the extent of conversation about emotional issues might explain our findings, where more emotional talk could be associated with more intense gazing and feelings of discomfort in the patient. To better understand the relation between physician gaze and patient outcomes, future studies should assess bidirectional face gaze during consultations.