Nonverbal Communication between Doctors and Patients by Catriona Freeman on Prezi
One might expect this to lead to improved communication between doctor and. You Don't Say: Patient-doctor Nonverbal Communication Says A Lot. Date: January 30, ; Source: Indiana University; Summary: What patients don't On the other hand, the nonverbal behavior of the physician can influence the patient's. Traditionally the impact of gender on healthcare First, physician gender or patient gender has been studied as a main effect. Research to date in this area suggests that.
Doctors'non-verbal behaviour in consultations: look at the patient before you look at the computer
General practitioners may feel reluctant to use touch other than procedural touch, because of the fear of misinterpretation of such behavior however, many patients believe that, particularly in distressing situations, expressive touch is acceptable [ 12 ]. A study conducted in Canada on female patients concluded that, as compared to males, females were more tolerant of comforting touch [ 10 ].
Eye contact is another important nonverbal behavior and is especially essential for building good rapport with elderly individuals [ 13 ]. It is mostly taken as a sign of respect, care, and attention from a doctor [ 1 ]. However, if eye contact is coupled with attentive listening it inclines the interaction towards more patient-centered communication [ 14 ].
Nowadays, the use of computers and especially the electronic health records HERduring medical interviews, is a big obstacle in using eye contact as an effective way to communicate [ 15 ].
We therefore directed our study to explore the expectations and perceptions of patients, in a developing Asian country, regarding touch and eye contact by physicians during consultancy, as most of studies on nonverbal communication were conducted in West and we consider that responses in our part of the world would differ. On an average, family practice patients with mostly primary and secondary care level problems were seen daily by 12—16 family physicians at the clinics.
These clinics were chosen to obtain a diverse sample belonging to various socioeconomic strata. An interview based questionnaire was developed by the researchers through literature search for validated questionsinput from colleagues and from experts in the field of family medicine. The questionnaire was then translated from English version to Urdu language and was back translated in English to check for reliability and any discrepancies found were removed.
The questionnaire was pretested on 10 participants data not included in the results before finalizing it. Interviewers two medical graduates were trained for data collection and on the use of the questionnaire to ensure uniformity of application.
Patients were chosen randomly and interviewed in the waiting area, before their consultancy with the physician, irrespective of their age, gender, educational status, and the reason for their visit. Those who were willing to participate did not receive any monetary compensation and were asked to sign a written consent form and the provision of confidentiality was ensured to them.
The questionnaire was composed of two sections. Section 1 included demographics like age, gender, religion, education, marital status, and occupation.
Other questions were directed to know which part of the body they would allow the physician to touch and the duration of eye contact. Proportions were calculated for all the variables of interest and chi-square test was used to assess relations of gender and educational level with nonverbal communication modalities. Results A total of patients were approached, out of which patients agreed to participate and were interviewed.
The mean age of the participants was years, out of which Among nonverbal behaviors, eye contact, laughing, and gesturing were most frequently categorized as Asymmetrical-Physician Convergence. Differences were predominantly non-significant in terms of accommodation behavior between pre and post-communication skills training interactions. Only gesturing proved significant, with post-communication skills training interactions more likely to be categorized as Joint Convergence or Asymmetrical-Physician Convergence.
No differences in accommodation were noted between gender concordant and non-concordant interactions. The importance of accommodation behavior in healthcare communication is considered from a patient-centered care perspective. Many have offered conceptual and operational definitions of patient-centered care e. Stewart and colleagues developed a model of patient-centered competence that consists of six components: Mead and Bower posited five distinct dimensions of patient-centered care: Epstein and Street place communication at the core of patient-centered cancer care.
McCormack and colleagues built upon this work to develop a comprehensive inventory of the domains and subdomains that characterize the functions of patient-centered communication in cancer care. Patient-centered communication measures, and much of the literature on healthcare communication, have been criticized for lacking a solid theoretical foundation e.
Further, healthcare communication research often follows an interpersonal approach. Communication Accommodation Theory CAT is a theoretical approach that can help improve our understanding of healthcare communication, and patient-centered care, by providing a framework for the interplay of intergroup and interpersonal factors.
Further, the Nonverbal Accommodation Analysis System NAASa measure of nonverbal accommodation behavior, provides a theoretically grounded method for examining patient-centered communication. Communication Accommodation Theory CAT is a general theory of communication that examines interpersonal interactions from an intergroup perspective.
CAT seeks to explain the attitudes, motivations, intentions, and identities that interface with social and contextual factors to impact communication choice and outcomes. CAT proposes that speakers and listeners modify communication behavior to become more similar or different from their partner in interpersonal interactions.
Such behavioral strategies can be understood as a means of conforming or expressing identification. Tajfel and Turner introduced the distinction between interpersonal and intergroup encounters with the development of Social Identity Theory SIT. SIT proposes that individuals categorize the social world and self, in part, based on group membership. This includes the respective value and emotional significance attached to particular identifications.
Nonverbal Accommodation in Healthcare Communication
Therefore, a distinction is made between interactions influenced by personal characteristics and mood states versus those impacted by social group memberships such as race, religion, geographic region or nation of origin, sexual orientation and so on. While SIT explores motivations for social group membership and intergroup encounters, CAT aims to predict and explain many of the behavioral adjustments that individuals make to create, maintain, or decrease social distance as personal and social identities emerge and are negotiated while communicating.
For example, individuals who strongly identify with a particular religion will likely express tenets of that religion and communicate expectations of others and situations based on this identification.
As posited by Watson and Galloisin shifting the focus to the patient-as-central, there is a need to examine when and how physicians communicate in intergroup as well as interpersonal terms. To begin, the communication behavior observed between physicians and patients is influenced strongly by the norms attached to their respective roles.
(PDF) Nonverbal communication in health settings
Research has demonstrated the power differential between physicians and patients e. Emanuel and Emanuel provide a framework through which power relations are expressed in medical visits. Next, Cooper-Patrick and colleagues investigated the role of race in physician-patient interactions. African American patients rated their consultations as significantly less participatory compared to White patients.
Further, patients in race-concordant interactions rated their visits as significantly more participatory compared to those in race-discordant interactions. In another study, international physicians reported using several means of convergence when interacting with patients in order to account for intergroup differences. Experimental studies suggest that when caregivers adopt affiliative nonverbal behaviors such as doing moderate to high eye contact with the patient, rarely looking at the patient chart, using concerned facial expressions, smiling frequently, leaning forward, and sitting relatively close two feet to the patients, patients are more satisfied with their caregivers, trust them more, and recall more medical information than when caregivers adopt less affiliative behaviors e.
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In the same way, when physicians touch their patients gently on the forearm for one to two seconds at the end of the visit while stressing the importance of following the medication, patients were more likely to actually take their medication as prescribed i. Also, surgeons whose tone of voice is more dominant have more malpractice claims.
Conversely, patients seem to show more satisfaction when male physicians show more controlling behaviors such as talking with a louder voice and showing postural expansiveness, probably because controlling behaviors are in accordance with the male gender role stereotypes.
Nonverbal Accommodation in Healthcare Communication
For instance, soft touch increases patient adherence, while touch perceived as dominant or controlling seems to have a negative effect on patient outcomes; the effect of physician touch thus probably depends on the kind of touch slight tactile contact vs. For many behaviors, moderation seems better than extremes.
For instance, too much or too little of physician gazing seem equally detrimental to patient satisfaction, and moderate levels of gazing are related to the highest satisfaction rates. For instance, patients who are anxious as judged from their voice by independent raters are more tolerant, or even prefer, physicians who sound angry than patients who are less anxious. Also, nonverbal behavior might have different effects on patient outcomes depending on the type of healthcare provider who expresses it.
Research shows for instance that patients tend to mirror affiliative behaviors in the physician e. This might be explained by the fact that mirroring is associated with greater perceived rapport and liking between the interaction partners. Physicians might lack nonverbal sensitivity when it comes to recognizing affective states in their patients or to evaluating patient satisfaction and liking of the physician. Female medical students show more nonverbal sensitivity than male medical students.
Lack of nonverbal sensitivity in physicians is potentially a problem, notably because this skill is associated with more patient satisfaction and better appointment keeping in the patients. Nonverbal sensitivity is important in the psychotherapeutic domain as well. Patient nonverbal behaviors can be used for diagnosis by therapists because nonverbal characteristics accompany most psychopathologies e. Individuals suffering from depression or from schizophrenia typically show reduced emotional expressiveness e.
Finally, nonverbal training can be part of the therapy, for instance when patients with nonverbal deficits e. Methods and perspectives Most research in the field of caregiver-patient communication is correlational.