Exploring the body language of the medical encounter
When you talk to your doctor during a health examination, what do you see-and what does your doctor see when he or she is talking to you? More importantly, how do what doctors see affect the decisions they make about their patients' health care, or the advice they give?
A study recently published in the Journal of Evaluation in Clinical Practice i provided insights on these questions—and offered ideas on ways medical decision-making can be improved.
"Our findings show that both doctors and patients identified tacit clues involving the behavior or appearance of the other, but they were not always able to articulate precisely how these clues informed their judgments and assessments," says lead author Stephen G. Henry, MD. "Not surprisingly, patients and doctors discussed these clues very differently."
Henry, a Robert Wood Johnson Clinical Scholar at VA's Ann Arbor Healthcare System and the University of Michigan, and his co-authors used a method called video elicitation in their study. They videotaped 72 one-on-one discussions involving 18 doctors and 36 patients, and then interviewed doctors and patients separately while they watched and reflected on the videotapes of those discussions.
The 18 physicians who participated were from six different practices located in southern Michigan. All of the patients who took part agreed to be recorded ahead of time, and the video camera was placed in an unobtrusive area of the examination room. The study was funded by VA and the Robert Wood Johnson Foundation.
Patients, they found, looked for body language and other non-verbal clues that appeared to tell them whether their doctor looked hurried or at ease when they talked to them. Other clues they looked for included whether the doctor's body language made them feel comfortable and put them at ease-and whether the doctor seemed to be a good listener and made eye contact with the patient.
One physician, who received favorable comments on examination demeanor, said: "It's nice to see that I don't look rushed in the room. Although, in my mind, I'm whirling…I try to relax and look relaxed."
Some doctors, on the other hand, used their observational skills to help to diagnose their patients. They used non-verbal communication to look for signs that a patient might be depressed—or that he or she was not revealing everything about his or her health status in response to questions.
The article's unusual title, "'How do you know what Aunt Martha looks like?' A video elicitation study exploring tacit clues in doctor-patient interactions," was derived from the comment of one physician, who explained how experience informed the ability to read non-verbal clues.
"How do you know what Aunt Martha looks like?" the doctor said. "Because you know what she looks like, you've seen her lots of times. I can't detail as to why I know that, but I've been down the road long enough to know."
Doctors varied widely in how frequently they mentioned tacit clues in their comments about the videotapes. Just 5 of the 18 doctors contributed 64 percent of all the comments physicians made. Specific clues they mentioned included body language, eye contact, physical appearance, and tone of voice. Many were unsure of precisely how they arrived at an opinion based on these clues, however.
Michael Fetters, MD, MPH, MA, associate professor of family medicine at the University of Michigan Medical School and the senior author of the study, says: "Our findings are consistent with research from the social sciences suggesting that doctors' and patients' judgments in the examining room are often complicated and take into account many subtle, unspoken clues. In the future, we hope this method of recording and reviewing these types of interactions can inform interventions designed to improve medical decision-making and doctor-patient interaction by providing a more complete understanding of the kind of signals upon which doctors and patients rely."
i Henry SG; Forman JH; Fetters MD. "'How do you know what Aunt Martha looks like?' A video elicitation study exploring tacit clues in doctor-patient interactions." J Eval Clin Pract. 2011 October 17(5): 933-9, dol: 10.1111/j.1365-2753.2010.01628.x