dissecting non verbal cues

8/3/2019 Dissecting Non Verbal Cues

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DISSECTING NON VERBAL

CUES


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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 isancient.

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.


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Touch can communicate some other not so

helpful messages as well.

As with all metacommunication,the precise

meaning of a touch cannot be known, but

depends upon the context in which touch takes

place.

Touch can be a powerful indicator of caring,

concern and solidarity; or it can simply be an

indicator of power.

Health professionals touch patients simply be an

indicator of power.

Assumption of touching patients is always good is

not a correct one.


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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. 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 hersatisfaction with the visit.

The surprising finding was that the more patients

were touched by the physicians the less satisfiedwas the visit.


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EYE CONTACT

It can be a powerful nonverbal cue that canintensify the emotion present in a given situation .

A pleasant interaction in which the health

professional is warm and understanding with apatient is likely to experience as positive when

accompanied by eye contact.

An upsetting or threatening situation will beexperienced as even more negative when

accompanied by eye contact.


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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.

Of course, excessive, almost constant staring at a

patient can have a very negative interpersonaleffect no matter what the context.

In fact, physicians judged to have a high degree

of rapport with their patients have been found toengage in only moderate eye contact, less than

that exhibited by some physicians rated as having

a low rapport with their patients.


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Typically, health professionals fail to maintain

enough eye contact. They look at the chart or at

the patients body more than at the patients face.

They tend to avoid the intimacy and immediacy

that eye contact represents. When the doctors do

monitor their patients through gaze they are

generally better able to identify their patientslevel of anxiety and distress.

Health professionals must gauge the effects of

their behavior on patients, in an effort todetermine what contributes to, and what detracts

from, good bedside manner.


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The patients personality characteristics,

cultural background, gender, and the level of

emotional arousal are all factors that can

influence receptivity to eye contact.

One thing is clear, however that eye contact is a

very powerful means of metacommunication.

Used wisely, it can significantly enhance the

positive emotional impact of the therapeutic

relationship and thus aid in promoting the well-

being of the patient.


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Facial expression Facial expressions can tell a great deal about a person,

particularly his or her physical and emotional state.

Fatigue may appear as along lasting expression ,distrust asfleeting one. But what makes facial expression intriguingand sometimes difficult to pin down is that, more than anyother nonverbal cue, they can be controlled . Researchdemonstrates that when physicians can control their facialexpressions of emotion and convey what they intend, theirpatients are quite satisfied with the medical care theyreceive.

Further, medical professionals who can understand themeaning of others facial expressions of emotion have beenfound in research to be able to elicit greater satisfaction

and cooperation with treatment.


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TONE OF VOICE How a physician or a patient says something is perhaps

as important as what is said. Variations in pitch

,loudness ,emphasis and pacing of speech, as well as

stutters and pauses convey information about emotional

states. They are called extra linguistic cues- languagerelated cues that are outside the verbal content of what

is said.

But emotional impact is rarely missed.

Although patients may be unable to identify preciselywhat cues they have heard, the voice tone and the

specific vocal quality of their medical practitioner does

influence them.


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One study found that the anger perceived in a

physicians voice when talking about alcoholics could

predict accurately their rate of failure when trying to get

alcoholics patients for a treatment program. In another study, 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.

Physicians voice tone has also been linked to patients

ability to recall information.

Thus medical professionals convey a great deal, goodand bad to their patients through their voice tone. They

can also learn a lot about their patients emotions by

listening carefully to what is conveyed in their patients

voice.


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BODY LANGUAGE

Body movements and postures can convey aconsiderable amount of information about an

individual's emotional state. This is true particularly

because body cues are typically the least controlled of all

nonverbal messages. People may monitor their facial expressions, but

typically do not monitor their body movements.

Emotional expressions have been found in research toleak unintentionally through the body movement

channel.


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A patients anxiety, depression, and distress or

conversely hid or her energy and positively, may best be

learned by watching patient walks, moves about,

changes position and so on. A persons stride may reveal self confidence and

hopefulness about the outcomes of the medical

condition.

Fidgeting and self-touching may signify anxiety and

individuals unsureness about what she or he is stating

verbally. These behaviors may even signal efforts to

deceive. Body movements and postures do convey certain

important messages. Particularly gestures of health

professional tend to be perceived positively by patients.


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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, greater forward lean,

and more orientation of their bodies toward the patientthan physicians judged to have low degree of rapport.

High rapport physicians also sat closer to their patients.

Interactional synchrony which describes the coordinated

interplay between the non verbal behaviors of two or

more interactants.

Synchronized interaction feel comfortable and

harmonious for the participants, they are not awkwardor difficult.


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One study examined the combined impact of many non

verbal cues by medical professionals in order to

determine which were the most important in conveyingan overall positive impression in interaction with a

patient.

Nine family practice residents were videotaped duringthe interview portion of each of the two interviews for

each doctor, the physicians were evaluated by

independent judges on a global measure of their rapport

with the patient. Several non verbal cues were found todifferentially affect judgments of rapport.


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Cues of bodily alignment tended to be more important

in influencing the ratings than did specific non verbal

actions such as smiles,gestures,and nods, 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.

C i ti f ti


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Communication of emotion

Non verbal messages can be extremely powerful.

Entire medical interactions may be regulated by the nonverbal cues of one or two interactants.

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 verbalcues and the number and quality*-9+30 of questions the

patient is able to ask.

Encouraging patients to voice their concerns and

responding to these in an informative and supportive

way can significantly decrease the anxiety of the patient.


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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 canbecome aware of problems the patient has not

articulated.


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Bedside Manner When patients do not feel understood, they are more likely to be

dissatisfied with their medical care. Understanding requires a certain level of emotional connection on

the part of the listener, and its empathy that contributes greatly to

good bedside manner.

Bedside manner is a broad and informal term used to refer to amedical practitioners interpersonal behavior towards patients; it

typically refers to the physicians ability to instill trust and

respond to patients emotional needs.

Hippocrates wrote in the 4th Century B.C the enormous power of

bedside manner: The patient though conscious that his condition

is perilous, may recover health simply through his contentment

with the goodness of the physician.

i i i i i


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Bedside manner is viewed by some as magical, special

edge"," certain something, or even the right

chemistry.

a large part of bedside manner involves being polite, toooften in medical profession it is dispensed off.

Research shows that when medical educators emphasize

bedside manner, somehow their students learn it. On the

other hand, when teachers consider bedside manner

unimportant, heat fact becomes quite clear to us.

Intensive, callous teachers turn out insensitive, callous

apprentices. 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.

i i i i f i


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The increasing incidence of long term chronic

illnesses is tending to move issues of

communication in the forefront of medical

practice.

Considerable emphasis is being placed on patient

related psychological issues in training of

primary care doctors during residency programs.

one important research method for studying

medical practitioner-patient interactions involves

the recording of the behaviors that actually occurin medical interaction, the careful analysis of

these behaviors, and the assessment of their

effects on patient satisfaction with care.

O i f th t di i thi h


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One review of the many studies using this approachexamined various aspects of bedside manner and theireffects on patient satisfaction and patient compliancewith medical regiments.

Patient satisfaction with medical care was found in thisreview to be higher when physicians provided moresocial conversation, more positive talk, and less negativetalk; among the most important aspects of bedsidemanner were the specific positive and supportive nonverbal cues of the medical professionals.

Training doctors to be more effective communicatorscertainly can have an effect on the behavior of bothphysicians and their patients.

I t d h f d th t d t h t k


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In one 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. In this study, the trained physicians were more

facilitative of communication with their patients as they

asked more openended questions.

Further their patients used more positive talk and gave

more information when compared to the untrained

group of physicians and their patients. Furthermore,

trained observers judged the trained physicians to bemore interested and friendly and their patients to be

more dominant, responsive and friendly.

These patients were also more positive,responsive,and

friendly.

A th t d f d th t idi i t i t i i t


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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.

The basis of practitioners bedside manner is his or her

recognition of the importance of psychosocial issues in

treating a patient. 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 worthunderstanding.

But in reality less than half of the average medical visit

is spent dealing at all with psychological or psychosocial

issues related to illness

dissecting non verbal cues

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