Smiling versus resting B**ch face: patients’ evaluations of male and female healthcare providers’ facial expressions

ABSTRACT

Resting b**ch face (RBF) is described as an unintentional angry facial expression that is evaluated negatively and usually attributed to women. A 2 (smiling/RBF) x 2 (female/male provider) online experiment, guided by expectancy violations theory, investigated whether U.S. adults’ perceptions of a healthcare provider, medical care quality, and likelihood to make another appointment would be impacted by the provider’s facial expression and sex. Results indicated that RBF was an expectancy violation resulting in decreased liking and perceptions of care quality. The female provider with RBF was evaluated more negatively than the smiling female provider and the male provider with RBF on liking, caring, medical care quality, and likelihood to make a future appointment. Additional findings are further discussed in the paper. Patients may hold biases toward providers based on their facial expressions and biological sex.

KEYWORDS:

• RBF
• expectancy violations
• facial expressions
• nonverbal communication
• provider-patient communication

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. For the main study, the scenario was perceived as realistic: t(670) = 55.40, p < .001 (M = 6.12, SD=.99). For the main study, the doctor photo was perceived as realistic for all conditions (p < .001, means ranged from 5.08–5.87).

2. “Visit Same Provider and “Demographic/Similar” are infrequently occurring themes. Thus, only percent agreement is reported for these themes for the final round of training: 96–99% agreement.

3. Based on the recommendation of a reviewer, a post-hoc test was conducted consisting of a moderated parallel mediation model to further examine the influence of facial expression on willingness to make a future appointment as mediated by perceptions of liking, caring, and quality of medical care and moderated by sex of provider. Hayes’ PROCESS macro version 4.2, Model 14 was used. There was no significant direct effect of facial expression on willingness to make a future appointment nor any significant moderated mediation indices for liking: b = .25, SE=.20, 95% CI: [−.16, .63]; caring: b=-.06, SE=.10, 95% CI: [−.30, .11]; or quality of medical care: b = .05, SE=.13, 95% CI: [−.21, .33].

Additional information

Funding

The work was supported by the Purdue University Lamb School Doctoral Grant.

Notes on contributors

Grace M. Hildenbrand

Grace M. Hildenbrand, Ph.D. (Purdue University, 2021), is an assistant professor of leadership studies at Louisiana State University Shreveport.

Evan K. Perrault

Evan K. Perrault, Ph.D. (Michigan State University, 2014), is an associate professor of health communication in the Brian Lamb School of Communication at Purdue University.

Mia I. Switzer

Mia I. Switzer, M.A. (Johns Hopkins University, 2023), is a master’s student in communication with a concentration in health communication at Johns Hopkins University.