BECAUSE PATIENTS JUDGE YOUR SKILLS BY YOUR BEDSIDE MANNER
Most people want health-care providers who communicate well and offer some level of conversation. Despite this obvious fact, some doctors don’t converse with their patients, and more importantly they don’t communicate at a most critical moment: when the patient is in distress or in pain. While every doctor responds to the screaming patient, only the perceptive observer reads body language to help him or her respond to less clearly expressed patients’ needs.
Body language is a form of nonverbal communication ranging from the easy-to-read (laughing and crying: both of which could represent happiness, fear, apprehension or pain) to the more subtle manifestations that require astute observation and impeccable interpretation. It is the understated messages that require a higher level of awareness.
For health-care providers the most important messages conveyed by body language regard pain, fear, anxiety, confusion, mistrust, financial concerns, and the acceptance or refusal of treatment options. Failure to read these signs can adversely affect your relationship with your patients.
The doctor who can tell when patients don’t understand them, don’t trust their opinion, or have no intention of following their treatment plan have a tremendous advantage. They can adjust their conversation in order to address and remedy patient concerns. Doctors who know how their patients feel practice at a higher level of competence.
Body Language Considerations
Body language doesn’t always tell you what you think it does. Laughter may be a friendly gesture, an expression of joy or a manifestation of fear and anxiety. The doctor must find out what patients are experiencing in order to help them effectively. You can use simple greetings to open the door for dialogue that gets your patient to offer more information.
Fear And Pain
When you walk into a room and the patient is wiping tears from their eyes, establish immediately if they are in pain, and if so, how much of the tearing is pain and how much is fear. Ignoring the tears all together is interpreted as a lack of compassion and not the way to practice medicine.
Consider a humorous greeting to establish an immediate bond and it will help to alleviate patient apprehension:
“Are those tears of joy because you’re so happy to see me?”
This allows the patient to explain the tears without feeling pressured and opens the door for gentle questioning. If the patient is in pain, they will usually proceed to tell you how much pain they have.
If they are tears of fear and apprehension, they will usually chuckle through the tears, ignore you, or begin to tell you how frightened they are to see you.
With one humorous question you respond to the patient’s obvious body language in a compassionate manner.
A variation for the tear-wiping patient:
“Correct me if I’m wrong, but tears like that tell me you’d rather be somewhere else right now.”
You walk in the room and the patient has their head in their hands. This tells you the patient is in pain, fearful, annoyed, miserable, or praying. It is your job to find out what they are experiencing:
“If you’re in the middle of praying that you were somewhere else right now, I can come back later.”
“It looks like I caught you in the middle of some deep meditation. I can come back later if you wish.”
The Miserable Patient
The patient doesn’t respond. Others may offer an unfriendly response to your greeting. That’s their subtle way of telling you they are angry. You continue:
“You don’t seem very happy to see me. Is it the color of my scrubs?”
By asking a direct, funny question, the patient will be forced to respond, and they will often chuckle and explain why they are miserable. The answer usually involves pain or fear, but be ready when they say:
“Well, you kept me waiting two hours.”
Make sure you have a catchy response for such complaints to regain the patient’s goodwill:
“So it isn’t the color of my scrubs. I am terribly sorry I kept you waiting. Unfortunately, we had many emergencies and every patient gets my fullest attention before I can move on.”
Most patients will accept an apology, but realize that there are some patients who will continue to grunt, act moody, or stay uncomfortably quiet. You can’t please everyone.
Other humorous options include:
“I would have been in here sooner if my parole officer just stopped asking all those questions.”
Actually, I am terribly sorry I kept you waiting. Unfortunately, we had many emergencies and every patient gets my fullest attention before I can move on.
“I would have been in sooner, but you know how hangovers can last longer than you expect.”
“Actually, I am terribly sorry I kept you waiting. Unfortunately, we had many emergencies and every patient gets my fullest attention before I can move on.”
These lines will soften the angry patients or they will get up and walk out. If they walk out, you’re lucky. You didn’t want to see that person anyway.
Of course, you can respond with just an apology if you don’t wish to try the bold comedic style:
“I’m terribly sorry to keep you waiting. Unfortunately, I had a patient who was up all night in pain and they needed some extra attention. I’m sure you’d want me to provide you with the same level of service.”
Even when the patient doesn’t tell you they are mad because you made them wait, you have to read the body language. You know you are an hour late and if the patient acts cold, that’s enough for you to use the apology without them saying they are upset.
During the course of a routine procedure or injection, patients often make a face, squirm, wince, or otherwise tell you they are uncomfortable. It is imperative that you acknowledge their statement. While you may have prepared them for the procedure, you still need to respond to their nonverbal statement. A thoughtful, “I know this hurts,” or “I’m sorry this is so uncomfortable,” or “We’re almost done,” is the acknowledgement the patient wants to hear.
They now know you are the best doctor because you responded to their statement, unlike those other doctors who ignore them.
You mention the fee for a procedure that isn’t covered by the patient’s insurance and they roll their eyes, or you may see a less perceptible facial movement such as the eyes opening wide, or the eyebrows rising. Now is the time to respond to their nonverbal communication.
“Mary, I know that’s a lot of money, but the benefit…”
By responding to the unspoken word, you acknowledge that you understand Mary’s concern, and that you are compassionate to her financial considerations.
When you get good at reading body language, you will be able to tell when the patient is not interested in accepting your treatment plan, and this affords you the opportunity to add some commentary that might change their mind.
After a lengthy explanation of your proposed treatment, the fact that a patient doesn’t say much isn’t necessarily a rejection of your plan. Patients are often quiet as a result of fear, confusion, or they may just have limited personality. You have to ask them if they have any questions. Don’t be afraid to ask:
“So, what would you like to do?”
If they are noncommittal and tell you they need to “think it over,” you should show your concern by concluding the visit:
“That would be best. I want you to make your decision when you have had a chance to think it over so you won’t feel that you are rushing into this. If you have any questions, I want you to give us a call and we’ll try to clarify anything to help you make the right choice.”
That sounds a lot nicer and more compassionate than, “I think you’re making a mistake by not choosing to do this right now.” The only time to give a stern warning about starting a procedure is when the patient’s health is in immediate jeopardy by delaying treatment.
Patients who are undecided very often despise the pushy doctor and will never return. They interpret the pushy doctor as greedy and more concerned with self-interests. High-pressure tactics will not convince the fiscally responsible patient who can’t afford treatment, and they will not return when they can.
You have to be sophisticated in your interpretation as reading body language is an art and takes years to learn to do well. It offers you a tremendous advantage in knowing what your patients want to tell you, but don’t in the conventional manner.
While patients don’t actually recognize all the reasons they like certain doctors, the doctor who addresses fears, anxiety, treatment choices, and financial concerns they don’t have to verbalize is the doctor they want to see all the time.
Don’t forget that body language is a two way street. You may be sending the wrong signals when you make a facial expression, smirk, sneer or even look at your watch. You may inadvertently tell the patient you are disinterested, annoyed, impatient or running behind. Don’t make repeated eye contact with your assistant or nurse. This could make the patient think your assistant is making negative gestures about them. These are just a few of the messages better-kept private. Patients may sense that you have no interest in their care or that you are burned out. Try to communicate to your patients that you love what you do. Try to act enthusiastic about every case. Compliment your work and make sure your staff knows that when they compliment an outcome the patient appreciates it. Never let a patient see you sweat or struggle. Make every effort to make everything you do look easy, even if you have to take acting lessons.
• Craig C
• A. Vo
• Andrew V
• Craig C