Face-Work and Rapport in Medical Consultations: A Scoping Review of Empirical Studies, 1987–2025

Abstract

Introduction: The ways in which doctors and patients safeguard each other’s face, foster rapport, and soften difficult messages influence trust, satisfaction, and adherence. Although research on politeness in medical encounters has expanded rapidly, it remains dispersed across linguistics, communication, and health journals and has not been comprehensively organized.

Objective: This scoping review charts empirical research on politeness, face, rapport, and impoliteness within doctor–patient communication, detailing their locations, methodologies, theoretical frameworks, and reported strategies.

Method: Using the Arksey and O’Malley framework alongside PRISMA-ScR guidelines, 21 structured searches and 16 related-record look-ups identified 298 records. After excluding 137 duplicates, 161 records underwent screening and 91 reports were evaluated. Only empirical studies of doctor–patient interactions published up to May 2024 with a registered DOI were included. Data were charted by year, country, setting, data type, framework, and main findings, then synthesized descriptively.

Results: A total of 34 studies were analyzed, with 26 (76%) published from 2020 onward. China (11 studies) and Nigeria (6 studies) made up half of the research, while only two studies originated from Pakistan. Most studies examined face-to-face consultations (18), whereas all eight studies on online consultations were published after 2019. Brown and Levinson’s model was the most common framework (19 studies), but all eight studies employing rapport management or relational work were conducted in China. No single communication strategy was predominant: negative politeness and mitigation appeared in 7 studies, positive politeness or rapport-building in another 7, bald-on-record directness was noted in 4, and 11 studies did not specify any strategy. Only five studies focused on patients’ own politeness, and just one tested a statistical link between strategies and patient satisfaction.

Conclusion: Politeness during medical interactions is heavily influenced by the environment, purpose, and cultural context rather than adhering to a universal standard. The field requires additional research from underrepresented areas, such as multilingual South Asian regions, with a focus on patients’ politeness, clear data reporting, and studies that connect politeness tactics to patient results.