Competence beats warmth when delivering normal test results

Clinical takeaway: When reporting normal results, an unhurried, confident explanation of what was checked and what it rules out does more to settle worry than friendliness alone, and may curb requests for repeat testing and second opinions. 

Normal test results often fail to reassure. The patient stays anxious, asks what else could be checked, or arranges a second opinion, even though reassurance is one of the most common interventions in family medicine. 

Most explanations for these failures sit on the patient's side, such as feeling invalidated or misreading medical risk. What the doctor contributes in the moment has rarely been tested experimentally, because studying it means holding the medical information constant while changing only the delivery. A randomized experiment has now done exactly that, and found that how the results were presented changed what people came away believing. 

Patients who received normal test results from a physician portrayed as highly competent were less likely to believe they had a serious illness than those who heard the same information from a less competent physician. Physician warmth also improved reassurance, although to a lesser degree, and the effects of warmth and competence appeared to be independent. Similar findings were seen for perceived risk of bowel cancer.

High warmth and high competence each reduced emotional concern, desire for a second opinion, and desire for a colonoscopy, with competence showing medium to large effects on all three; the one outcome competence did not move was overall health perception, which responded to warmth alone. A mediation analysis points to why: participants who saw a hesitant, imprecise doctor discounted the diagnostic information itself, and that devaluation accounted for the effect of both behaviors on disease belief. 

The researchers randomized 349 adults from a German online convenience sample to one of four two-minute videos of the same doctor reporting identical normal results, with her warmth and competence each played high or low. Participants had first imagined weeks of gastrointestinal symptoms and a relative newly diagnosed with bowel cancer, and rated the likelihood of serious disease before and after the video. 

The authors note that physician communication may play an important role in whether patients feel reassured after receiving normal test results or continue seeking additional evaluation. However, the findings came from a simulated scenario in which participants imagined having symptoms and viewed videos of a single physician actor, limiting generalizability. Further studies involving real patients and a more diverse group of clinicians are needed.

For patients, diagnostic information does not speak for itself, the authors conclude; the doctor's behavior determines how they integrate it, and showing warmth and competence can help patients trust and update their beliefs accordingly. 

Source: Kube T, et al. (2026 Sep 21) Ann Fam Med. Influence of Physician Behaviors on How Patients Interpret Normal Test Results