How Can Doctors Tell When A Patient “Looks Sick” ? Interview with: Jeffrey Allen Kline Vice Chair of Research Department of Emergency Medicine Interview with:
Jeffrey Allen Kline
Vice Chair of Research
Department of Emergency Medicine
Indiana University Health

Medical Research: What are the main findings of this study?

Dr. Kline: We believe that clinicians use information from their patients’ faces to make decisions about diagnostic testing.

This is particularly relevant in emergency medicine, where the clinicians make decisions rapidly with limited information. We videotaped patients’ faces who had chest pain and dyspnea and used the most well-known facial scoring system to assess their facial expression variability in response to seeing visual stimuli. We found that patients who ultimately had emergent problems tended to hold their faces in a neutral position and be less likely to show the expression of surprise. The investigators were not surprised at this, but we did find that patients with emergent problems also tended to have less negative affect as well as less positive affect. In other words, patients who were sickest even tended to frown less than patients with no medical problem.

We believe our findings reflect the fact that sick patients lack normal affect variability that healthy patients manifest. We believe this work provides some objective basis for the common phrase used by physicians that their patient “looks sick.”  Conversely, we hope to prove in future work that normal affect variability has a significant likelihood ratio negative for exclusion of pulmonary embolism and other emergent diagnoses.


Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting

Jeffrey A Kline, Dawn Neumann, Melissa A Haug, David J Kammer, Virginia A Krabill

Emerg Med J emermed-2014-203602Published Online First: 14 July 2014 doi:10.1136/emermed-2014-203602  

Last Updated on July 15, 2014 by Marie Benz MD FAAD