What doctors say without talking ?

Teaching good communication skills has been mandatory for medical schools because of research showing that good patient-doctor communication can lead to improved patient satisfaction and better health care outcomes. To this end, medical educators have developed a host of communication courses and workshops that combine lectures, self-assessments, video recordings and “standardised patients,” or actors in the role of patients.

More recently, many schools have broadened their courses to include “cultural competency,” or the ability to communicate with those from different racial, ethnic and social backgrounds. Studies have shown that while a patient’s race and ethnicity can be linked to sharply different treatment courses and quality, better communication between doctors and patients of different backgrounds can reduce the disparities.

Despite these efforts, there is one area of communication to which few schools have devoted significant time: body language and facial expressions.

Now, a small but growing body of research is revealing that the non-verbal component of the patient-doctor interaction — the subtle gestures, body positions, eye contact, touch and expressions that pass between individuals — is as critical a part of communication as verbal expressions. And non-verbal cues may, in fact, be more reflective of the biases faced by doctors and patients.

In a recent study, medical sociologists analysed the interactions between 30 primary care doctors and more than 200 patients over age 65, and found that white physicians tended to treat older patients similarly, regardless of race. Black physicians, on the other hand, often gave white patients contradictory signals, mixing positive non-verbal behaviours, like prolonged smiling or eye contact, with negative ones, like creating physical barriers by crossing the arms or legs.

The finding was reminiscent of earlier studies on interactions between female doctors and male patients, in which the doctors tended to give the patients conflicting non-verbal cues, combining, for example, smiles with a negative or anxious tone of voice. These mixed signals,   are a result of dealing with “a status in our society that is devalued.” Rather than being expressed explicitly, biases regarding race and gender tend to be expressed “in behaviours not consciously controlled.

Some doctors believe that greater emphasis on non-verbal communication can help medical educators address some social biases that affect patient care. But they acknowledge that the process is challenging. Research in this area is still relatively sparse, and few medical educators are well-versed in this topic. Moreover, even experts are unsure of how researchers and educators can measure the nuances and complexities of non-verbal communication accurately, consistently and efficiently.