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DISSECTING NON VERBAL CUES

TOUCH
• More than any other aspect of nonverbal • • •
communication ,touch is believed to serve the goal of practitioner-patient rapport. The idea of an association between healing and touch is ancient. Touch can be extremely soothing to ill patients and can communicate reassurance, comfort and caring. The pressure of touch in the form of massage usually induces relaxation accompanied by decrease in physiological arousal and stress hormones.

Assumption of touching patients is always good is not a correct one.the precise meaning of a touch cannot be known. • • • . or it can simply be an indicator of power. Touch can be a powerful indicator of caring. concern and solidarity. but depends upon the context in which touch takes place.• Touch can communicate some other not so • helpful messages as well. As with all metacommunication. Health professionals touch patients simply be an indicator of power.

Trained judges recorded. among other things whether and how much the physician touched the patient. After the visit each patient filled up a questionnaire regarding his or her satisfaction with the visit. .• A study analyzed the videotapes of 34 first time visits b/w patients and their new family physicians. Only the initial interview portion was studied. • The surprising finding was that the more patients were touched by the physicians the less satisfied was the visit.

. • A pleasant interaction in which the health professional is warm and understanding with a patient is likely to experience as positive when accompanied by eye contact. • An upsetting or threatening situation will be experienced as even more negative when accompanied by eye contact.EYE CONTACT • It can be a powerful nonverbal cue that can intensify the emotion present in a given situation .

less than that exhibited by some physicians rated as having a low rapport with their patients. almost constant staring at a patient can have a very negative interpersonal effect no matter what the context. excessive. Of course. .• If a patient is having a hostile interchange with the medical professional. chances are good that things will be worse if the health professional stares at him/her straight in the eye than if the health professional fails to make eye contact. physicians judged to have a high degree of rapport with their patients have been found to engage in only moderate eye contact. • In fact.

and what detracts from. They look at the chart or at the patient’s body more than at the patient’s face. • They tend to avoid the intimacy and immediacy that eye contact represents. health professionals fail to maintain enough eye contact.• Typically. in an effort to determine what contributes to. • Health professionals must gauge the effects of their behavior on patients. . good bedside manner. When the doctors do monitor their patients through gaze they are generally better able to identify their patients’ level of anxiety and distress.

• One thing is clear. . however that eye contact is a very powerful means of metacommunication. cultural’ background. it can significantly enhance the positive emotional impact of the therapeutic relationship and thus aid in promoting the wellbeing of the patient. and the level of emotional arousal are all factors that can influence receptivity to eye contact. • Used wisely. gender.• The patient’s personality characteristics.

But what makes facial expression intriguing and sometimes difficult to pin down is that. their patients are quite satisfied with the medical care they receive. . more than any other nonverbal cue.Facial expression • Facial expressions can tell a great deal about a person. • Fatigue may appear as along lasting expression . • Further. particularly his or her physical and emotional state. Research demonstrates that when physicians can control their facial expressions of emotion and convey what they intend.distrust as fleeting one. they can be controlled . medical professionals who can understand the meaning of others’ facial expressions of emotion have been found in research to be able to elicit greater satisfaction and cooperation with treatment.

emphasis and pacing of speech. • • .TONE OF VOICE • How a physician or a patient says something is perhaps as important as what is said.loudness . Variations in pitch . as well as stutters and pauses convey information about emotional states. They are called extra linguistic cues. the voice tone and the specific vocal quality of their medical practitioner does influence them. Although patients may be unable to identify precisely what cues they have heard.language related cues that are outside the verbal content of what is said. But emotional impact is rarely missed.

• • • . good and bad to their patients through their voice tone. Physicians’ voice tone has also been linked to patients’ ability to recall information. the degree of hostility judged to be in the voices of both physicians and patients reflected discomfort and interpersonal difficulties that resulted when patients attempted to ask questions. In another study.• One study found that the anger perceived in a physician’s voice when talking about alcoholics could predict accurately their rate of failure when trying to get alcoholics patients for a treatment program. Thus medical professionals convey a great deal. They can also learn a lot about their patients’ emotions by listening carefully to what is conveyed in their patients’ voice.

Emotional expressions have been found in research to leak unintentionally through the body movement channel.BODY LANGUAGE • Body movements and postures can convey a considerable amount of information about an individual's emotional state. People may monitor their facial expressions. but typically do not monitor their body movements. This is true particularly because body cues are typically the least controlled of all nonverbal messages. • • .

Particularly gestures of health professional tend to be perceived positively by patients. These behaviors may even signal efforts to deceive. • • • . may best be learned by watching patient walks. Fidgeting and self-touching may signify anxiety and individual’s unsureness about what she or he is stating verbally. A person’s stride may reveal self confidence and hopefulness about the outcomes of the medical condition. Body movements and postures do convey certain important messages.• A patient’s anxiety. and distress or conversely hid or her energy and positively. moves about. depression. changes position and so on.

Interactional synchrony which describes the coordinated interplay between the non verbal behaviors of two or more interactants.• Physicians judged to have a high degree of rapport with their patients were found in one study to exhibit more open arm and one leg positions. • • • . they are not awkward or difficult. High rapport physicians also sat closer to their patients. greater forward lean. Synchronized interaction feel comfortable and harmonious for the participants. and more orientation of their bodies toward the patient than physicians judged to have low degree of rapport.

Nine family practice residents were videotaped during the interview portion of each of the two interviews for each doctor. Several non verbal cues were found to differentially affect judgments of rapport. the physicians were evaluated by independent judges on a global measure of their rapport with the patient. • .• One study examined the combined impact of many non verbal cues by medical professionals in order to determine which were the most important in conveying an overall positive impression in interaction with a patient.

• Cues of bodily alignment tended to be more important in influencing the ratings than did specific non verbal actions such as smiles.and nods.gestures. although the latter were still important. body orientation towards the patient and open arm and leg positions tended to have a very strong effect on ratings of rapport. These conveyed immediacy and a strong emotional connection particularly when coupled with forward lean and mutual gaze. • .

Encouraging patients to voice their concerns and responding to these in an informative and supportive way can significantly decrease the anxiety of the patient. A practitioner may completely determine with his or her non verbal cues just how much information the patient is able to convey supportive messages with non verbal cues and the number and quality*-9+30 of questions the patient is able to ask. • • . • Entire medical interactions may be regulated by the non verbal cues of one or two interactants.Communication of emotion • Non verbal messages can be extremely powerful.

• Understanding patients’ non verbal communication can • give a medical practitioner an important advantage in caring for patients. . By identifying cues of dissatisfaction and negative affect in the body language of a patient. a practitioner can become aware of problems the patient has not articulated.

Bedside Manner • When patient’s do not feel understood. Hippocrates wrote in the 4th Century B.C the enormous power of bedside manner: The patient though conscious that his condition is perilous. • . they are more likely to be • • dissatisfied with their medical care. and its empathy that contributes greatly to good bedside manner. may recover health simply through his contentment with the goodness of the physician. Bedside manner is a broad and informal term used to refer to a medical practitioner’s interpersonal behavior towards patients. Understanding requires a certain level of emotional connection on the part of the listener. it typically refers to the physician’s ability to instill trust and respond to patients’ emotional needs.

• . Many believe that good bedside medicine was once common and that it has largely fallen by the wayside As medicine has become dominated by technology. heat fact becomes quite clear to us.• Bedside manner is viewed by some as magical. a large part of bedside manner involves being polite. callous apprentices. On the other hand." certain something”. “ special • • edge". Intensive. callous teachers turn out insensitive. somehow their students learn it. too often in medical profession it is dispensed off. or even “ the right chemistry. Research shows that when medical educators emphasize bedside manner. when teachers consider bedside manner unimportant.

. and the assessment of their effects on patient satisfaction with care. • one important research method for studying medical practitioner-patient interactions involves the recording of the behaviors that actually occur in medical interaction. the careful analysis of these behaviors. • Considerable emphasis is being placed on patient –related psychological issues in training of primary care doctors during residency programs.• The increasing incidence of long term chronic illnesses is tending to move issues of communication in the forefront of medical practice.

• • . more positive talk. Training doctors to be more effective communicators certainly can have an effect on the behavior of both physicians and their patients.• One review of the many studies using this approach examined various aspects of bedside manner and their effects on patient satisfaction and patient compliance with medical regiments. among the most important aspects of bedside manner were the specific positive and supportive non verbal cues of the medical professionals. Patient satisfaction with medical care was found in this review to be higher when physicians provided more social conversation. and less negative talk.

and friendly.• In one study.responsive. • • • . Furthermore. the trained physicians were more facilitative of communication with their patients as they asked more open –ended questions. Further their patients used more positive talk and gave more information when compared to the untrained group of physicians and their patients. trained observers judged the trained physicians to be more interested and friendly and their patients to be more dominant. responsive and friendly. In this study. researchers found that doctors who took a brief training session in communication were better at eliciting active participation from their patients than those who did not have the training. These patients were also more positive.

• .• Another study found that providing intensive training to residents on communicating and understanding patients led their patients to be more confident in them and to have a higher level of satisfaction with their care. But in reality less than half of the average medical visit is spent dealing at all with psychological or psychosocial issues related to illness. the medical practitioner must overcome the purely biomedical view of the patient as a collection of parts needing an adjustment and approach the patient as someone whose feelings are worth understanding. • The basis of practitioner’s bedside manner is his or her recognition of the importance of psychosocial issues in treating a patient.

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