Doctors Urged to Heed Non-Verbal Signs of Patients’ Body Language

Physicians need to “listen” with their eyes, according to a doctor who believes patients sometimes say “yes” while their bodies are really saying “no, no, no” to treatment.

The doctor who understands body language can deal with the conflict and try to help instead of sending the patients away unhappy, said Dr. Cecile Carson, chief of behavioral and psychosocial medicine at Genesee Hospital.

“It’s not what we say but how we say it and how a patient hears it that makes a difference,” agreed Dr. Robert E. McAfee of Portland, Me., a member of the American Medical Assn. Board of Trustees. “It goes to the question of who you want for your doctor. If you come to me and keep coming back to me, it’s probably because I, quote, tend to hit off with you, unquote.”

Carson, supported by a grant from the National Fund for Medical Education, has adapted non-verbal communication theories--shrugs, folded arms and glances--and is teaching medical students and lecturing around the country.

A Mixed Message

Suppose a doctor believes that her patient should change medication to lower his blood pressure. The doctor notes all the potential benefits, explains why she thinks it would be a good idea and asks her patient what he thinks.

The patient crosses his arms, raises his shoulders slightly and leans back in the chair. His eyes get noticeably wider and he holds his breath as he says, “It sounds like a good idea to me.” The mouth said yes, the body said no.

“The important thing is to notice that you’re getting a mixed message. Then I ask, ‘Which message do you think would predict that patient’s behavior.’ The answer is the non-verbal one, and you have to know that,” Carson said.

“You may not have time to work it all out at that visit, but you need to note it so you’re not frustrated or angry when they come back and say they haven’t taken it,” she said.

To better read body language, a doctor must “calibrate” the patient by asking particular questions and watching the physical response. The doctor also should be aware that sitting behind a desk to give a prognosis can be perceived as uncaring and distant and that standing over a patient in a hospital bed and talking can make a patient feel weak and unsafe, Carson said.

‘Pacing’ for Doctors

She also emphasizes “pacing”--adjusting body movements to a patient’s movements in order to make a patient feel more comfortable. “So if a patient has her arms crossed, the doctor might want to cross his arms. If the patient is leaning forward, the doctor might want to lean forward.”

Carson believes that non-verbal communication is a skill that can be acquired with practice and that even people who recognize and respond to many non-verbal actions need to be taught.

“Some people are sort of innately better at this, but they may not be doing this consciously. People who do this as a matter of style, even they hit snags,” she said.

Generally, when the doctor-patient interaction falls apart, she said, the first thing doctors say is that they’ve got a hostile or an uncooperative patient on their hands. “They don’t ask if there’s something they can do.”