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How reading faces can diagnose disease

Teresa Tanoos's picture
Early results of study finds facial expressions linked to disease

Early results of a new study reveal that facial expressions may improve the rapid diagnosis of certain diseases.

The preliminary findings, published in the Emergency Medicine Journal, suggest that patients suffering from cardiopulmonary disease lack the usual variety of facial expressions, which may provide physicians an inexpensive diagnostic tool for rapidly deciding those patients who need prioritized for treatment.

Using quick diagnostic tools, such as facial expressions and other visual cues, has been proven to improve outcomes in patients who present with symptoms of potential heart and lung disease, as well as pneumonia, pulmonary embolism and heart failure.

Known as “the gestalt method”, using visual cues is a common way for doctors to quickly assess if a patient needs more aggressive and expensive testing in order to make a correct diagnosis. Such method depends more on processing physical expressions than looking up research on symptoms, which may cause concern for some.

However, a study in 2011 showed that using the gestalt method was about as reliable as more objective diagnostic tools – and that combining the method with other tools improved patient outcomes.

It goes without saying that the more clinical experience a doctor has using the gestalt method, the better the outcome will be, which is supported by evidence. By the same token, there are differences among doctors as it pertains to application of the method, which can cause some to feel apprehensive and less confident about using gestalt reasoning as a diagnostic tool for serious disease.

Accordingly, researchers of the study identified key elements of the gestalt method to improve accuracy and ease-of-use; thus, making it more like a standardized diagnostic process that’s easier to teach.

The team decided to explore facial expressions as a diagnostic factor, as doctors typically can “read” the emotional tension in a patient’s face, which is an element of the gestalt method and its reasoning process.

Moreover, evidence exists from earlier studies showing a link between facial muscles and cardiopulmonary disease, including serious heart and lung problems.

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For example, angry facial expressions in patients have been associated with myocardial ischemia, a heart condition that develops when blood flow to the heart is reduced. Patients with tension in the face have also shown a connection to reactive airway diseases that involve wheezing and allergic reactions.

For the study, 50 adults admitted to the emergency room with shortness of breath and chest pain were scanned for serious heart or lung disease and monitored for 2 weeks.

The researchers then tested the patients for diagnostic accuracy of reduced facial expression range, showing each of them three visual images that were created to get an emotional reaction while their faces were being videotaped at the same time.

The images they were shown included a funny cartoon, a close-up shot of a surprised expression on a person’s face, and a photo of an individual crying.

Using the "Facial Action Coding System (FACS)" to determine changes in facial muscle activity, the patients' reactions – as captured by a webcam – were then analyzed by the research team.

Next, the team compared the FACS results with the more objective diagnoses the patients were given at the hospital.

As a result, the researchers discovered that those patients’ who arrived at the hospital with chest pain and shortness of breath, and were potentially facing a serious heart or lung condition, also had a considerably reduced range of facial expressions while viewing the three images, compared with those who were not facing such conditions.

The study authors believe that the patients were lacking facial expressions “due to the gravity of their illness” and were therefore unable to process or react to the images designed to evoke an emotional response like those not facing heart or lung disease.

The authors added that their goal with the findings of the study is to provide health care professionals with a new diagnostic tool that can help them avoid unnecessary scans and other diagnostic tests that are often more time-consuming and expensive.

Pointing to the growing popularity of Skype – and the number of doctors using it for online consultations – the authors suggested that the results of their study could make Skype consultations even more common, but they again emphasized the importance of a physician being able to accurately read patient faces.

SOURCE: Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting, Jeffrey A. Kline, et al., Emerg Med J, doi:10.1136/emermed-2014-203602, published online 14 July 2014.