Body Language and Doctor-Patient Communication

Physicians are trained to heal the body, but often, neglect to read the body. Body language, that is—theirs, and their patients’. And if you don’t think that’s important, consider that as much as 93% of all communication exchanges are non-verbal. Facial expressions, gestures, even the clothing we wear all convey messages that we are often unaware of. Physicians, say experts, are no exception.

“Most physicians don’t really understand the incredible impact and importance [body language] has,” says Karen Leland, author of Customer Service In An Instant (Career Press), and a patient relations consultant for Sterling Consulting Group (www.quality-service.com). “It’s mostly because they’re not taught it in medical school.”

It’s never too late to learn.

The eyes have it

Leland explains that eye contact is one of the most powerful of all the body language skills. Sounds simple, yet it’s a common omission. Take a typical doctor-patient office encounter. Leland says that during the verbal exchange that takes place, physicians are often looking at the patient’s chart and writing as opposed to making at least periodic eye contact. No connection is made. The better approach, she explains, is for physicians to listen, then tell the patient they’re going to write down what the patient just said as opposed to just writing the entire time and avoiding eye contact.

While the patient is speaking, it’s important for the physician to provide non-verbal cues that he or she is listening. “I often see that doctors listen very intently to what a patient is saying, but they don’t move their head,” says Leland. “They’re just sort of frozen. You want to let someone know that you’re paying attention by nodding. It lets the patient know you hear them, and you understand what they’re saying.”

In addition, says Leland, physicians should face the patient not just with their head but with their entire body. “Oftentimes physicians are multi-tasking—writing in the charts or setting up equipment—while they’re talking to the patient. But having your body turned to face the patient is another way of letting them know that you’re actually paying attention to them.”

What’s the rush?

Matt Eventoff, a partner in Princeton Public Speaking (www.ppsassociates.com), says that one of the “biggest sins” he observes is that physicians often rush into an examination room, look at the patient’s chart, make less than 2 minutes of eye contact with the patient, then look back at the chart before beginning the examination. “It’s the hurried pace, lack of a smile,” says Eventoff. “It’s the look of, you’re taking my time and there’s something else I have to get to. Physicians don’t intentionally send that message, but that’s what’s coming through.”

Eventoff says the problem stems from physicians too often not putting themselves in the patient’s shoes. He suggests physicians take a moment before entering an examination room and ask themselves, if I were sitting on the other end of this table and knew nothing, how would this look or sound to me? How would this make me feel?

Michael Blumenfield, MD, professor emeritus of psychology at New York Medical College, suggests that physicians be aware of a patient’s body language and take cues from that. “[Physicians] should always give the patient an opportunity to respond and to ask questions,” he says. “How the patient verbalizes is just as important as the content of what he or she says.”

Getting personal

Leland says it’s important for doctors to be aware of the three personal space zones when engaging a patient. The intimate zone is a distance of 0 to 2 feet and usually occurs during the examination. The personal zone is from 2 to 4 feet, where most conversations take place. And the social zone is 4 feet or more, typical of a teacher in a classroom. Leland says problems occur when doctors elect to stand 4 feet or more from their patient as a way of establishing their expertise. Instead, she suggests doctors stand in the personal zone during conversations.

“But here’s what every doctor should look for,” she cautions. “If your patient takes a step back, you are now too close to them, so you should maintain the distance they’ve now set. If the patient takes a step forward, it means you’re not close enough to them, so don’t back up again. Stay where you are, and follow the lead of the patient when it comes to physical distance.”

Leland says it’s also perfectly permissible, especially when delivering bad news, for a physician to put his or her hand on the patient’s hand, wrist or arm as a comforting gesture. The safe zone, she says, is from the elbow down to the hand. Touching a patient’s back or shoulder can be seen as more of an intimate gesture.

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at edwardr@frontiernet.net.