Watch your language – literally. Physician coaching helps doctors communicate with more than words

Doctors feature prominently in many movies, but perhaps nowhere as pointedly as in the 1991 movie, The Doctor. In this film, William Hurt plays Dr. McKee, a busy cardiothoracic surgeon who prides himself solely on his surgical skills and emotion-free decision making ability. That is, until he becomes a patient himself. As he is diagnosed with and treated for laryngeal cancer, he sees another side to patient care – the human side. As movie watchers, we are gifted with the ability to see ourselves in action – in one scene, Dr. McKee’s own doctor uses the same words that he previously used with one of his patients. On the receiving end, the words sound strikingly different. However, even more disturbing than the words is the body language as they are delivered.

Research tells us that only 7% of what we communicate comes from our words. 38% is our intonation. And the majority, 55%, is conveyed through our body language. The famous actress, Mae West, knew this when she commented, “I speak two languages, Body and English.”

As Dr. McKee’s surgeon enters the recovery room with the news that “the tumor is malignant,” she smirks while apologizing for an unintentional enema her patient has just received, remains standing, crosses her arms across her chest, and looks down at her fingernails after delivering the bad news. Her tone is arrogant and dismissive. We can easily see that none of her body language or vocal tone conveys any sense of caring, compassion or an interest in partnership.

Can we be more skillful in our communication?

The answer is a resounding yes – and it doesn’t have to take much time or effort at all.

The most important thing we can do is the easiest, by far. We can make and maintain eye contact. Although we now struggle with how to look at both a computer screen and our patients at the same time, we can intentionally make eye contact at the beginning of each patient interaction, and then consciously come back to it whenever we want our words to make an impact or when our patients are telling us something important or emotional. There is nothing that gets across our concern quite as well as eye contact. Conversely, we can deliver the most compassionate message, but without eye contact it will not be received the way we intend.

By keeping our upper body open, we convey approachability and sincerity. When we cross our arms or hold a chart over our chest, we appear defensive and closed off to others’ opinions and concerns. While sitting, keep each arm at a different level, and lean forward a bit to indicate your interest in what your patient is saying. Especially when delivering bad news or discussing something emotional or difficult, sitting down communicates your sense of its importance.

Maintain openness between your mouth and your patient – covering your mouth is often interpreted as being deceptive, mistrustful, unsure or withholding information. If you are in the habit of putting your hand on your face, try cupping your chin in your hand, which implies that you are actively listening.

Beware of head nodding – most women interpret this as being caring, while men generally believe it indicates agreement. Too much of it can also be interpreted as impatience. On the other hand, occasional head nodding along with facial expressions (smile, frown, look of concern or surprise) are important factors in helping our patients feel our concern and attention.

An additional 38% of communication is carried in our tone of voice, so it’s useful to use that tool as well. In general, ending a statement on an up-note (common is some cultures and among women in the west) implies a sense of uncertainty. To convey confidence and some authority, end your statements either on a level or down note.

While much research has been done on body language, I’d like to invite you to do some of your own. Next time you are in a hospital or clinic, pay attention to the body language of your colleagues, staff and patients. You may be surprised at how much unspoken communication goes on. I encourage you to try some of the above suggestions – be the master of your own communication and see what a profound difference it makes.

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About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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