You don't say: Patient-doctor nonverbal communication says a lot

A shoulder shrug. Lack of eye contact. A hand gesture. What patients don't say can be just as important as what they do, according to a study of nonverbal behavior published in a January issue of the Journal of General Internal Medicine.

According to the study by Richard Frankel, Ph.D., professor of medicine at the Indiana University School of Medicine and a research scientist at the Regenstrief Institute and the Center for Implementing Evidence Based Practice at the Indianapolis VA Medical Center, and colleagues from Johns Hopkins and Northeastern universities and the Fetzer Institute, nonverbal behavior can be an important diagnostic tool increasing the physician's comprehension of words spoken or thoughts left unsaid.

On the other hand, the nonverbal behavior of the physician can influence the patient's satisfaction with his clinic visit and affect his compliance with the doctor's instructions.

The study on this under-recognized communication tool, entitled "The Expression of Emotion Through Nonverbal Behavior in Medical Visits," was presented at the Ninth Biannual Regenstrief Conference and appears in the supplement to the January 2006 issue of the Journal of General Internal Medicine.

"Nonverbal behavior conveys the meaning of words," says Dr. Frankel, a medical sociologist. "The way someone gestures tells you the speaker's stance; words alone don't convey the full picture. Nonverbal behavior can be a duplication of the words or it can contradict what an individual is saying.

"To put it more eloquently, if the words are the musical notes on a Tchaikovsky score, then nonverbal behavior is the interpretation of those notes. A computer always plays the music in the same way without any nonverbal behavior, but Jascha Heifetz would play that score differently than Itzhak Perlman, each violinist conveying a different interpretation of Tchaikovsky's original intent," he said.

Nonverbal communication is a clue to the emotions underlying feelings. Does the patient look at the physician when describing symptoms or does he look down at his feet? Does another patient wring her hands and refuse to meet the doctor's gaze? Either or both patients may be exhibiting signs of humiliation or anxiety.

Does the physician repeatedly glance at her watch or answer his cell phone? Both actions send nonverbal messages to patients, probably messages the physician did not intend to transmit. Those scenarios are in contrast to yet another doctor who makes eye contact and tilts his head while the patient explains complaints of concern; that physician appears empathetic, said Dr. Frankel.

"From studies outside of medicine in the business world, for example - we know we can improve nonverbal sensitivity altering nonverbal cues from ourselves and others," he said. "Our own studies have shown that patients who are satisfied with their physicians perceive their visits were two minutes longer than they actually were and these patients are better at following the physician's instructions. We also found that patients who felt their physician was not empathetic, perceived their visit to be two minutes shortly than it actually was."

This study and the Regenstrief Conference where it was presented developed from the Regenstrief Institute's focus on relationship-centered care. "The mutual influence of patients on physicians and physicians on patients is part of a relationship rather than individual actions or behaviors," said Dr. Frankel.

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In addition to Dr. Frankel, the authors of the new study are Debra L. Roter, Dr.Ph. of Johns Hopkins; Judith Hall, Ph.D. of Northeastern, and David Sluyter, Ed.D. of Fetzer. The study was funded by the Fetzer Institute of Kalamazoo, MI.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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