Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

The Importance and Psychology of Facial Expression

The author with teammates.


Carefully noting your patient's facial expression consciously helps you "be" with your patient more effectively, to meet them where they are in their emotional state.

Facial expression is fundamentally important to humans, and we can really learn a lot about our patients by paying careful attention.


For example, there is something called “micro expressions” that are worth knowing about. Microexpressions are fleeting expressions that convey someone’s true emotional state – and may be in stark contrast to the emotional state that the patient is trying to maintain or communicate. So, confusion, fear, sadness, and anger may “flash” on someone’s face very briefly. These microexpressions may be very meaningful.


Natural or spontaneous emotion tends to be bilateral, and reasonably symmetric. One can learn to spot this, and distinguish between spontaneous and “forced” smiles, for example.


The most obvious clinical scenario for which these concepts are important are patients with disorders of facial nerve movement. These patients struggle socially, as others are confused by what they see. It makes communication very difficult. In addition, because of the bidirectional nature of emotion and facial expression, the inability to express happiness normally can lead to depression, or depressed mood.


Here are a couple of things to keep in mind when communicating with patients and colleagues:


1.) Watch others’ faces carefully, not just patients, but loved ones too, and see what you can notice that you haven’t before. Subtle movements convey a lot of information.


2.) Consider watching TV with the sound turned off, and notice what inferences you naturally make about the emotional state of others.


These practices will help you when you are in front of your patients. Carefully noting facial expressions consciously helps one “be” with your patient more effectively, to meet them where they are in their emotional state.