(1991) manipulated mood in a group of medical students and evaluated the effect of
induced positive affect on their decision-making processes. Positive affect was induced
by informing subjects in this group that they had performed in the top 3 per cent of all
graduate students nationwide in an anagram task. All subjects were then given a set
of hypothetical patients and asked to decide which one was most likely to have lung
cancer. The results showed that those subjects in the positive affect group spent less
time to reach the correct decision and showed greater interest in the case histories
by going beyond the assigned task. The authors therefore concluded that mood
influenced the subjects’ decision-making processes.2 The profile characteristics of the health professional. Factors such as age, sex,
weight, geographical location, previous experience and the health professional’s own
behaviour may also effect the decision-making process. For example, smoking doctors
have been shown to spend more time counselling about smoking than their non-
smoking counterparts (Stokes and Rigotti 1988). Further, thinner practice nurses
have been shown to have different beliefs about obesity and offer different advice to
obese patients than overweight practice nurses (Hoppe and Ogden 1997).
In summary, variability in health professionals’ behaviour can be understood in terms
of the factors involved in the decision-making process. In particular, many factors
pre-dating the development of the original hypothesis such as the health professional’s
own beliefs may contribute to this variability.
Communicating beliefs to patients
If health professionals hold their own health-related beliefs, these may be communicated
to the patients. A study by McNeil et al. (1982) examined the effects of health pro-
fessionals’ language on the patients’ choice of hypothetical treatment. They assessed the
effect of offering surgery either if it would ‘increase the probability of survival’ or would
‘decrease the probability of death’. The results showed that patients are more likely to
choose surgery if they believed it increased the probability of survival rather than if it
decreased the probability of death. The phrasing of such a question would very much
reflect the individual beliefs of the doctor, which in turn influenced the choices of the
patients. Similarly, Senior et al. (2000) explored the impact of framing risk for heart
disease or arthritis as either genetic or unspecified using hypothetical scenarios. The
results showed that how risk was presented influenced both the participants’ ratings of
how preventable the illness was and their beliefs about causes. In a similar vein,
Misselbrook and Armstrong (2000) asked patients whether they would accept treatment
to prevent stroke and presented the effectiveness of this treatment in four different ways.
The results showed that although all the forms of presentation were actually the same,
92 per cent of the patients said they would accept the treatment if it reduced their
chances of stroke by 45 per cent (relative risk); 75 per cent said they would accept the
treatment if it reduced their risk from 1 in 400 to 1 in 700 (absolute risk); 71 per cent
said they would accept it if the doctor had to treat 35 patients for 25 years to prevent
one stroke (number needed to treat); and only 44 per cent said they would accept it if the
treatment had a 3 per cent chance of doing them good and a 97 per cent chance of doing
DOCTOR–PATIENT COMMUNICATION 91