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The Message Without Words


Even when you are not speaking to your patient, you are conveying a message — a message that may impact them more than what you say.

Most research on nonverbal communication in health contexts has focused on patient satisfaction. A meta-analysis of this topic found that greater patient satisfaction is associated with warmer physician personalities. Specific aspects of physician nonverbal communication are particularly important, such as nonverbal behaviors indicating affiliation and those indicating dominance. Patients are more satisfied and are more engaged with physicians who display affiliation behaviors where the physician orients his or her body, gaze and responses to show interest, concern and respect for what the patient is saying. However, the common form of nonverbal communication physicians utilize is more of a dominant type. In this case, the physician takes longer speaking turns and uses more physical touch. In general, the most satisfied patients are the ones who were (nonverbally) given the opportunity by the physician to be active in the interaction. The physician would do this by adjusting his or her behavior to complement that of the patient so that each person’s input complements the other’s.

Nonverbal communication was also shown to be essential in transitions between certain phases of the patient visit. For example, a patient’s nonverbal cue such as uncrossing her legs or lying down on the exam table indicates to the physician the patient’s trust and cooperation allowing the physician to proceed easily with a physical exam. It has been suggested that if a physician is overly verbal, for example, by requesting an exam to be performed after both the physician and the patient had already transitioned into taking an exam, the patient is more likely to see this as something negative.

Though limited, some studies have pointed to the ability of a health professional’s nonverbal communication to influence the patient’s actual health outcomes. For example, the facial cues of the health care provider indicating care, concern and empathy can improve the physical and cognitive health condition of elderly physical therapy patients. In general, the more satisfied the patients were, the more likely their health condition was to improve, which has strong implications for future research looking at physician-patient interactions in other clinical settings. In addition, although it is not an empirical study, a published anecdote of Dr. Mitchell S. Cappell’s experiences with one of his patients who happened to be both deaf and mute provides an extreme example of how important a physician’s nonverbal communication can be concerning not just patient health, but even emergency situations. Dr. Cappell suggests that taking the time to understand the patient’s nonverbal cues can help the physician make the most effective decisions when treating the patient because the physician will understand when the patient is communicating apprehension, discomfort or cooperation, which can potentially lead to a decreased occurrence of complications in the patient’s care.

Just as physician nonverbal communication influences patient satisfaction, patients also give off nonverbal cues that may be helpful to the physician. Research focusing not just on the physician’s nonverbal cues, but on how physicians interpret nonverbal cues of their patients, can be quite valuable in the future of health care because we know that the patients who are most satisfied are the ones who do not need to describe their conditions in an excessively verbal way to have the physician understand them. It has been shown that a physician’s sensitivity toward the patient’s nonverbal cues, specifically via body language, is the best predictor of how satisfied the patient will be with that physician. These findings will help guide future research attempts to discovering how physicians can use the patient’s nonverbal cues to adapt their own nonverbal communication appropriately. Physicians would greatly benefit from formal training in decoding nonverbal cues because it may very well lead, for example, to better patient cooperation and adherence to treatment.

In conclusion, greater empirical evidence is needed on the relationship between the health care provider’s nonverbal communication and the patient’s overall health outcomes, possibly analyzing other variables such as patient personality and demographics. It is currently suggested that high nonverbal support behavior in a physician is associated with decreased perception of pain in their patients as well as having less intense memory of the pain when compared to patients whose physician showed lower nonverbal support. Future studies should aim to follow patients over a long period of time and document changes in their health management, especially patients suffering from chronic disease. With the information this growing field will provide, medical school and physician training facilities can provide a deeper kind of curriculum, making physicians aware of what patients are nonverbally communicating as well as how to adjust physician communication to make patients more comfortable and encourage adherence to treatment. As the medical community continues to bridge gaps in communication between provider and patient, the quality of health care for patients has the potential to improve drastically, which would positively affect the health of their surrounding communities.

Mark Halim (1 Posts)

Mark Halim is a 2nd year medical student at the University of California, Riverside School of Medicine. He is interested in clinical and public health research, and passionate about being involved in his community throughout his education and career. He always enjoys learning from his colleagues and peers, and hopes to take every opportunity as an opportunity for learning and growth. As he continues to learn, he hopes to contribute something that may benefit others.