Explain practitioner communication and patient understanding
Compare non-verbal clothing cues and verbal medical language, then evaluate McKinstry and Wang’s questionnaire evidence without treating first impressions as clinical competence.
Section Paper 4 · Specialist Options: Application and Research Methods
Original StudyForA teaching mapped to Cambridge 9990 Health Psychology sections 3.1.1–3.1.3, 2028–2030 Version 1. Example studies illustrate a topic and are not official Cambridge materials or mark schemes. Do not use these lessons to diagnose or advise a real person.
Before you begin
- This lesson covers Cambridge Psychology 9990 Health Psychology section 3.1.1. Clothing ratings, confidence, comprehension and clinical competence are separate constructs.
Work on paper. Try each question before revealing help, and explain why your method works.
Quick readiness check
Which statement best describes the McKinstry and Wang (1991) evidence?
What you will learn
- Non-verbal communication, especially practitioner clothing; McKinstry and Wang (1991)
- Verbal communication and patient understanding of medical terminology; McKinlay (1975)
- Apply interpersonal communication to everyday health consultations and evaluate questionnaire evidence, quantitative ratings, individual variation and generalisability
Communication includes spoken words and non-verbal cues
Verbal communication includes the words a practitioner uses, the way an explanation is organised, and opportunities for a patient to ask questions. Understanding a medical term is not the same as hearing it: a clinician can check meaning by inviting the patient to explain the plan in their own words, without making the patient feel tested.
Non-verbal communication includes facial expression, posture, gesture, eye contact, pauses and clothing. A cue can shape an impression, but the same cue may be interpreted differently by different people. It does not prove that the practitioner is more skilled, that the diagnosis is accurate, or that the patient understood the discussion.
In a respectful consultation, a practitioner can use plain language, pause for questions, notice signs of uncertainty, and ask what matters to the patient. A patient may also signal confusion verbally or non-verbally. These are communication prompts, not a reliable way to infer someone’s thoughts without asking.
McKinstry and Wang investigated reactions to doctors’ clothing
The 1991 study surveyed 475 patients at five general practices in Lothian. Patients rated photographs showing different styles of dress for a male and a female doctor and answered questions about doctors’ clothing. It therefore measured reported impressions of photographs, not behaviour in an appointment or the quality of medical care.
Overall, more formal styles received more high ratings: a formal suit and tie for the male doctor and a white coat for the female doctor. Preferences varied between practices and were more formal among older patients and those in the higher social classes represented in the report. Twenty-eight per cent said they would be unhappy consulting one of the pictured doctors, usually one dressed informally; 41 per cent said appearance would give them more confidence in a doctor.
The findings suggest clothing can influence a first impression in this sample. They do not show that a more formal outfit makes a doctor more competent, improves treatment, or is preferred by every patient. Ratings of photographs are a questionnaire measure; actual consultations, cultural meanings of clothing, later patient groups and current practice could produce different results.
McKinlay’s example asks who understands medical terminology
McKinlay’s article, listed by Cambridge as an example study for verbal communication, challenges the assumption that difficulty with medical language belongs only to the patient. It directs attention to whether a practitioner knows what a patient understands and whether technical vocabulary is being explained clearly.
Use the study to frame a two-way question: what did the practitioner intend a term to mean, and what did the patient understand from it in this context? The word ‘negative’, for example, can be reassuring in a test result but may sound like ‘bad’ in ordinary conversation. Asking the patient to describe the explanation can reveal a mismatch without blaming either person.
Cambridge lists McKinlay as an example rather than a key study. Its 2028–2030 Reference List says example studies help illustrate a topic and are not directly assessed for detailed study-specific questions. This lesson therefore uses the example to explore communication and comprehension rather than presenting unverified sample statistics or claiming that one 1975 setting represents all patients.
Evaluate the evidence and apply it carefully
A questionnaire can collect comparable ratings from many people and describe group patterns. It can also be affected by social desirability, the wording of questions, the photographs chosen and whether participants imagine a first visit or their own doctor. A rating of confidence is subjective data; it is not an objective test of competence or understanding.
The 475 responses came from five practices in one Scottish region. That is broader than a single case but does not guarantee a representative sample of all ages, cultures, health systems or present-day patients. Practice-level differences also caution against treating one average preference as universal.
For an everyday consultation, test understanding directly and invite the patient’s preferences. For research, compare clearly defined communication conditions, recruit a varied sample, and measure impressions, comprehension and consultation outcomes separately. Individual interviews can explain why a cue mattered to someone; group ratings can show how common a response was in the sampled group.
Sources for this lesson
- Cambridge International AS & A Level Psychology 9990 syllabus, 2028–2030
- Cambridge International AS & A Level Psychology 9990 Reference List, 2028–2030
- McKinstry and Wang (1991), Putting on the style: what patients think of the way their doctor dresses
- McKinlay (1975), Who is really ignorant—physician or patient?
Pause and explain
A patient nods during a technical explanation. What is the soundest way to check understanding?
Worked example
A clinic sees that patients rated a formal-looking doctor more confidently in photographs and concludes that formal dress improves patient understanding. Evaluate the conclusion.
Show the worked solution
- Identify the outcome measured: reported confidence in a doctor shown in a photograph.
- Describe the 475-patient questionnaire and its five Lothian practices, then note variation between practices and groups.
- Separate confidence from comprehension and clinical competence; suggest measuring each directly in real consultations.
Answer McKinstry and Wang found that many of the 475 patients surveyed at five Lothian practices gave higher ratings to more formal clothing in photographs, but preferences varied. The study measured reported impressions, not comprehension or medical skill. A follow-up would observe or assess understanding in real consultations, ask patients about their preferences and report the limits of its sample.
Try a topic test
Choose Easy, Normal or Difficult. Save your answers and open worked review after finishing.
Test this topic →From guided practice to a new situation
Write your answer and reasoning first. Use a hint only if you are stuck. The model solution is for self-checking; your written work is not automatically marked.
A practice manager says patients will trust a new doctor because a photograph shows a white coat. Apply McKinstry and Wang carefully.
Give me a hint
Separate the impression measured from outcomes the study did not measure.
Compare my reasoning
- The study surveyed 475 patients in five Lothian practices using photographs of doctors in different clothing.
- More formal styles often received higher ratings, but preferences varied between practices and groups.
- The survey supports a claim about reported impressions in that sample, not trust in every patient, competence or better care.
The study suggests that clothing affected reported impressions for many respondents in those five practices. It does not establish that all patients prefer a white coat or that the outfit makes a doctor more trustworthy or competent in practice. The manager should ask the clinic’s own patients and assess communication and care separately.
Look for these in your work
- Method and sample named
- Variation retained
- Measured and unmeasured outcomes separated
A patient says a result was ‘negative’ and means the news is bad. Explain a communication response using the lesson concepts.
Give me a hint
Clarify the intended term in context, then check what the patient understood without assigning blame.
Compare my reasoning
- Ask what the patient understood ‘negative’ to mean in the result they heard.
- Explain the result in plain language and distinguish the clinical meaning from the everyday meaning of the word.
- Invite the patient to describe the next step and give space for questions or preferences.
The practitioner can ask what ‘negative’ sounded like to the patient, explain that it has a specific meaning in this test context, and check the patient’s understanding of the next step. This treats communication as a shared task rather than assuming that either person is ignorant.
Look for these in your work
- Meaning checked
- Plain explanation offered
- Patient participation respected
Design a small study of how patients respond to different appointment reminder messages. Include an individual perspective and a group comparison.
Give me a hint
Define each measure, use a varied sample and separate stated preferences from actual attendance.
Compare my reasoning
- Interview a small varied group to learn what the wording, language and timing mean to individual patients.
- Then compare clearly defined reminder versions with consent, recording preference ratings and attendance as different outcomes.
- Describe sampling, non-response, accessibility and setting; do not infer that one message caused attendance differences without suitable controls.
Begin with interviews to understand individual reactions, then compare reminder versions with an appropriately varied sample. Measure ratings and attendance separately, report who responded, and account for access barriers and other reasons for attendance. A preference is not itself proof that a reminder changes behaviour.
Look for these in your work
- Idiographic and group evidence used
- Outcomes kept distinct
- Sampling and causal limits stated
Common mistakes
- Treating clothing as proof of competence or good treatment
- Calling a photograph-rating questionnaire an observation of real consultations
- Assuming that every patient shares the average clothing preference
- Blaming the patient for misunderstanding an unexplained technical term
- Presenting unsupported sample statistics for McKinlay’s example as established facts
- Confusing confidence, comprehension, satisfaction and health outcome
What can you explain now?
What did McKinstry and Wang’s questionnaire measure, and what important claim did it not test?
Compare with the explanation
It measured patients’ ratings of photographs and reported views about doctors’ clothing; it did not test doctors’ competence, real consultation quality or patient understanding.
A measured first impression can support a bounded claim about impressions, not an unmeasured clinical outcome.
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Make it stick
Explain one verbal and one non-verbal communication cue, then state what McKinstry and Wang’s clothing survey measured and what it could not prove.
If you needed the solution, close it and solve the problem again from a blank page. A correct answer is stronger when you can explain the reason for each step.