When discussing communication skills, we nearly always think of verbal communication skills. However, non-verbal communication is just as important, if not more important, for good communication skills. A study published in the British Journal of General Practice suggested that patients respond more to nonverbal communicative behaviours than verbal communicative (Little et al.).
Interestingly, this is not a new finding. Language experts estimate that 70-93% of all communication is nonverbal. Mehrabian’s communication theory suggests that 7% of all communication is through words, 38% through tone and voice and 55% through body language. In an interesting and somewhat amusing TED talk, Joe Navarro, an author and former FBI agent, discusses the power of nonverbal communication from his experience. It is a 12-minute watch but worth a look: The Power of Nonverbal Communication | Joe Navarro | TEDxManchester
Why is non-verbal communication important during clinical consultations?
During a clinical consultation, the healthcare professional is often seen as the person in a position of power. This influence sometimes causes patients to say things they think the healthcare professional wants to hear. For example, in some of Lynn’s research, she has observed people be
- say they understand what the health care professionals have told them and
- agree with what is said, even if they don’t
So the healthcare professional needs to be able to
- ask the right questions to check understanding (for example) and
- pick up on nonverbal cues that may give a fuller view of the story
Watching non-verbal communication from patients can help clarify how they are genuinely feeling. For example, patients may describe their abdominal pain as “mild”. However, they are wincing in pain during an abdominal exam, indicating that the pain is worse than they are saying. That is why it is important to use all forms of communication, including nonverbal behaviours, to make a fully informed decision on a patient’s physical state.
This is particularly important if a patient has for an example a physical disability or some form of cognitive impairment, which impacts on the way they communicate. Also, clinical consultations can be very stressful for some patients. Consequently, their emotion can be shown in how they talk or through their body language.
What to look out for in non-verbal communication
Closed or avoidant body language
This can be a tricky one to interpret because some people will say a closed off position is someone sitting with their arms and legs crossed. But this may just be a comfortable position for some people. I tend to do this when I am thinking. But if they sit like this and turn away from you and won’t engage in any eye contact, then this might mean that they aren’t comfortable with you, for one reason or another.
2. Avoiding eye contact
In some cultures it is seen as a sign of disrespect to share eye contact with another person. But it Western society, if someone doesn’t give us eye contact, it can be a sign that they are feeling uncomfortable, anxious and/ or trying to avoid telling us something. If we notice that a patient isn’t giving much eye contact then we might need to spend a bit of time trying to establish a rapport with them and build their trust.
3. Self-comforting body language
Self-comforting body language can include the patient “hugging themself” as depicted below or rubbing themselves in a comforting motion. This is a clear indicator of unhappiness or distress and should be addressed by the healthcare professional if exhibited during a consultation.
4. Emotive body language
Emotive body language can show how someone may be feeling. For example, holding their head in their hands when distressed, making a fist when feeling angry or pointing a finger, shuffling about in their chair or wringing their hands when anxious.
5. Facial expressions
Observing facial expressions and interpreting them, can be difficult. But if we try, it can give us some insight into what the other person is thinking or feeling. If we do this well, it can help us demonstrate an empathic response to another human being. If we aren’t sure what a facial expression means, we can ask. For example, ‘when I told you that you needed to have a scan, I noticed an anxious look on your face, is that right? Can you tell me what you are thinking? If you get it wrong, the person can tell you and explain how they are feeling in that moment.
If we see these signs we can recognise them. By this we mean, you might want to say something like ‘ When you said that you were feeling okay just then, I noticed that you looked uncomfortable. Could you tell me what you are thinking or feeling?’
Healthcare professional non-verbal communication
Not only do we have to consider our patient’s non-verbal communication, we have to consider our own too. We can give off lots of cues that we are too busy to listen or are distracted and want to move on to the next person. So we need to think about how we communicate and how we leak information to patients, without us necessarily knowing. To help us improve our non-verbal communication we need to consider the following points:
1. Open Body Language
Focus on the patient, by facing them and having an open body posture. Use eye contact, use minimal prompts such as nodding of your head to show you are listening or to encourage people to go on. A smile when used appropriately can make the world of difference and help put someone at ease. If you do have to turn away to take notes, or access the computer, make sure that doesn’t become your primary focus. Return your attention to the patient when you can.
2. Spatial Awareness
Where we sit in a room and position ourselves can speak volumes to a patient. If we get it wrong it can act as a barrier. Watch how your patient responds if you sit too far away from them or sit too close. If they draw nearer or pull away, take note of this and try not to react. If you end up sitting too close, they may feel uncomfortable and can only focus on moving away. If this is the case, they won’t be listening fully to what you are saying.
3. Showing Empathy
When a patient is sharing some sensitive information with us, or is expressing a higher level of emotion, we need to really listen to them and give them our attention. We can demonstrate empathy through speech, but we can also show it through our non-verbal communication. Sometimes, leaning towards them, sitting still, maintaining eye contact can help demonstrate you are connecting with them. If you feel comfortable with touch and think the patient is too, then you might want to gently put a hand on a knee or arm to make a physical connection.
These are just some tips to help you consider non-verbal communication from a patients perspective and from our own. If you want to know more about non-verbal communication then watch this space. Over the summer we will be launching some e-learning courses about different aspects of healthcare communication.