What your body language reveals to your patients

Alistair Gardiner | November 17, 2021

Impatience, trouble focusing, exhaustion, lack of compassion—you might try to keep these feelings hidden from your patients, but evidence suggests nonverbal cues have the power to betray how you really feel. What’s more, body language can give a patient an inaccurate impression of what’s going through your mind, and this can be disastrous.

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Stern looking doctor with arms folded

What does your body language say about you in the exam room?

According to a review of curricula for training in medical education published in PLOS One, teaching a physician to adopt certain behaviors can enhance how patients perceive a doctor’s compassion and empathy. And many of these behaviors are nonverbal—ie, sitting versus standing during a consultation, facing the patient, and maintaining eye contact. This language helps assure the patient that the physician is present, focused, and offering their full attention and support.

Studies suggest that empathetic and compassionate care is associated with improved clinical outcomes for patients and better adherence to prescribed therapies. The way you communicate with your body language can affect the way patients experience depression and anxiety, and can improve a patient’s quality of life. Evidence suggests that effective nonverbal communication is even linked with lower rates of physician burnout because practicing compassion activates reward pathways in the brain. 

While your body language could be leading to positive patient outcomes and improved personal well-being, it could also be leading to the opposite. Here’s a breakdown of the kind of body language to avoid when speaking with patients, along with some of the nonverbal cues you should adopt in the clinic, according to research.

What your body language may betray

According to the authors of a study published in Health Professions Education, “effective doctor-patient communication is required for building a therapeutic doctor-patient relationship.” But this remains challenging for physicians, as evidenced by the thematic prevalence of poor communication in malpractice claims.

Doctors tend to overestimate how effective they are at communicating with patients, the authors wrote. A recent survey found that, while 75% of orthopedic surgeons believed they communicate well with their patients, only 21% of patients felt the same way. 

The survey examined 38 cases of negative patient feedback regarding junior doctors, with researchers identifying four communication error themes. One of these was nonverbal communication, which encompassed eye contact, facial expression, and paralanguage. Authors used the term paralanguage to refer to characteristics of tone, like volume, pitch, rhythm, and speed. 

Researchers found that patients responded negatively to a lack of eye contact, with one patient commenting, “He didn’t check on me at all, and merely check(ed) his screen for an appointment to arrange for a CT scan.” Researchers also found that negative facial expressions led patients to doubt the physician’s abilities, and that subtle expressions of disinterest were interpreted as the doctor not caring. 

The study found that some patients felt that their doctor's “expressionless tone” indicated that they were bored or weren’t providing personalized care. The volume of one physician’s voice prompted a patient to comment, “She is (the) worst doctor I (have) ever met in my life. She yelled at (me) twice on two different days.”

Researchers concluded that paralanguage is “crucial but often overlooked.” Speaking to patients with a flat and tired tone can convey feelings of disregard and boredom. 

Interestingly, researchers found that a lack of eye contact was linked to a doctor's use of computers, concluding that “screen gaze is disruptive to psychosocial inquiry and emotional responsiveness from the doctor.” While digital tools are useful in modern medicine, it’s worth considering how much time you’re spending looking at your device, as opposed to your patient.

Paying attention to these nonverbal cues is particularly important when it comes to end-of-life care. A study published in the Journal of Pain and Symptom Management examined whether differences in doctor/patient communication account for the fact that Black patients are more likely than White patients to die in the intensive care unit with life-sustaining treatments.

Researchers concluded that doctors tended to communicate verbally with Black patients and White patients in roughly the same manner. However, when it came to nonverbal communication, doctors scored significantly lower with Black patients, in comparison with White patients. This included nonverbal behaviors like eye contact, body positioning, and touch. 

A physician’s disengaged nonverbal communication is hypothesized to lead to greater patient dissatisfaction, worse patient compliance, and “may contribute to racial disparities in patients’ health outcomes,” the authors noted.

How to build trust

The aforementioned PLOS One review analyzed the findings of 52 studies and identified several effective physician behaviors, which can help convey compassion and build rapport with patients. Of these, the nonverbal behaviors are:

  • Sitting, instead of standing, while consulting with a patient

  • Positioning yourself close to the patient

  • Nonverbal expressions of caring, like holding eye contact for at least 90% of the time

  • Ensuring that your whole body is facing the patient

  • Using a calm tone when speaking

  • Using appropriate hand and arm movements

  • Engaging in supportive touching

An article by Khushminder Chahal, MD, published in Current Psychiatry, provides a few more specific pieces of advice. Chahal notes that keeping arms or legs uncrossed has been associated with higher levels of patient satisfaction. He also notes that clinicians who smile, nod, and maintain eye contact tend to have better patient outcomes.

The power of nonverbal communication

Training yourself to employ compassionate body language can not only lead to better outcomes for your patients, but it can also improve your quality of life, too. Evidence cited in the PLOS One review indicates that compassionate patient care may “enhance physician resilience and resistance to burnout.” The Health Professions Education study posits that it can help to reduce work-related stress and can lead to “positive effects on health care costs, including decreased diagnostic tests, referrals, and length of hospital stay.”

The research is clear: Emphasizing positive nonverbal communication with patients has mutual benefits. Moreover, it could profoundly change the relationships you have with your patients. 

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