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(Kraft-Todd + 2017)

Empathic nonverbal behavior increases ratings of both warmth and competence in a medical context
  • Gordon T. Kraft-Todd ,
  • Diego A. Reinero,
  • John M. Kelley,
  • Andrea S. Heberlein,
  • Lee Baer,
  • Helen Riess

May 15, 201


In medicine, it is critical that clinicians demonstrate both empathy (perceived as warmth) and competence. Perceptions of these qualities are often intuitive and are based on nonverbal behavior. Emphasizing both warmth and competence may prove problematic, however, because there is evidence that they are inversely related in other settings. 

We hypothesize that perceptions of physician competence will instead be positively correlated with perceptions of physician warmth and empathy, potentially due to changing conceptions of the physician’s role. We test this hypothesis in an analog medical context using a large online sample, manipulating physician nonverbal behaviors suggested to communicate empathy (e.g. eye contact) and competence (the physician’s white coat). Participants rated physicians displaying empathic nonverbal behavior as more empathic, warm, and more competent than physicians displaying unempathic nonverbal behavior, adjusting for mood. 

We found no warmth/competence tradeoff and, additionally, no significant effects of the white coat. Further, compared with male participants, female participants perceived physicians displaying unempathic nonverbal behavior as less empathic. Given the significant consequences of clinician empathy, it is important for clinicians to learn how nonverbal behavior contributes to perceptions of warmth, and use it as another tool to improve their patients’ emotional and physical health.

"Our findings suggest a clear practical implication: incorporate empathic nonverbal training into medical education."

"Study participants were shown photographs displaying either physician empathic nonverbal behaviors or physician non-empathic nonverbal behaviors and were asked to rate the physicians on scales of warmth, empathy and competence. "

"We define empathy as a social-emotional ability having two distinct components: 
  • one affective: the ability to share the emotions of others, and 
  • one cognitive: the ability to understand the emotions of others. This definition is supported by evidence that these two components have dissociable neurological substrates [1, 2]. 

This approach is broad enough to encompass elements of various components of empathy that have been proposed [3, 4]—
  • e.g. sympathy (or shared emotions) [5], 
  • perspective taking [6], 
  • and accurate interpersonal perception [7, 8]—
  • while distinguishing basic cognitive processes underlying them.
 It is necessary for an operational definition of empathy to focus on the cognition of the empathic subject (i.e. the person expressing empathy, such as a physician), but because empathy is fundamentally a relational ability, it is also useful to understand the cognition of the empathic object (i.e. the individual whose emotions are being empathized with, such as a patient). There is extensive evidence that empathy (expressed by the subject) is perceived (by the object) as warmth [e.g. 9]. In this paper, we therefore discuss empathy and warmth as two sides of the same coin (i.e. “empathy/warmth”), in that they are functionally linked in the context of social interaction."


Empathy is particularly important in the context of medicine, where evidence suggests it is related to numerous positive outcomes [for a review, see 10]
  •  including increased patient satisfaction [11], 
  • good patient rapport [12], 
  • increased adherence to treatment [13], 
  • increased diagnostic accuracy [14], 
  • reduced medical errors [15],
  •  and positive health outcomes [1618] (though see [19];