Health Care Providers’ Facial Appearances Shape Patient Expectations About Pain and Pain Treatment

First impressions of medical providers’ online images can impact people’s decisions and expectations about pain and health outcomes even before in-person clinic visits, according to a new study funded by the National Center for Complementary and Integrative Health (NCCIH). Led by researchers at NCCIH, the study was recently published in Social Science & Medicine.

Patient-provider interactions and medical providers’ behavior and characteristics, including warmth and competence, are known to play a central role in shaping people’s health care expectations and pain experience. With people increasingly using the web to select and interact with health care providers, an online headshot image, not an in-person interaction, might be a person’s first exposure to a medical provider.

Through five online experiments, participants viewed facial images of hypothetical health care providers, selected their preferred providers for an imagined medical procedure, and rated their expectations of pain level and use of pain medicine after the procedure. The first four experiments used computer-generated faces that had varied facial features associated with competence. The fifth experiment used real faces.

Across all five experiments, participants preferred to have medical procedures done by providers who appeared more competent. Also, participants expected to experience less pain and be less likely to use prescription-strength pain medicine after the procedure when it was done by providers the participants judged to be more competent, warm, and similar to themselves.

By conducting the study entirely online, the researchers were able to separate the impact of initial online impressions from those formed through in-person interactions in an actual clinic. The influence of provider facial appearance on patient expectations has important implications for the future of patient care, especially now, when telemedicine and in-person interactions involving masks occur more frequently. Future work, the researchers say, should measure expectations about actual clinicians and examine whether patients’ initial expectations persist throughout their actual medical experience and affect their pain levels.