Abstract

Emotion and concealed motivation in the clinical interview

Author(s): Dr Philip Michael Gaughwin,Mr Steve Longford

Accurate understanding of a patient’s motivations and concerns by the physician improves patient satisfaction with a medical encounter. Conversely, discernment of concealed motivation is necessary to help identify potential malingerers, drug seekers or dissembling patients. However, physicians receive little training in emotion recognition or structured interview techniques that may help expose concealed motivations. Emotional expressions are powerful indicators of a patient’s motivation, and concealed emotional expressions may indicate the existence of information that may better inform the patient’s medical history. There is also significant potential for error when interpreting emotional expressions. Even amongst experienced interviewers, motivation, overconfidence and the mis-interpretation of non-verbal cues lead to the mistaken attribution of motivations to a subject. Techniques that improve recognition of patient motivations (emotion expression training, ‘micro-expression’ analysis and interview strategies) have significant potential for application in clinical medicine.