It’s not always what you say that counts

Non-verbal communication makes a difference

Two new studies are highlighting the importance of non-verbal communication and the ways in which appropriate use of a gesture or a note can help improve a patient’s perception of his or her care. And since perception of care can translate into how that patient rates your hospital and even how that patient feels physically, improving those perceptions matters.

The first study, published in the Journal of Participatory Medicine¹,looked at the use of eye contact and other social niceties. Enid Montague, MD, and her team looked at eye contact, pats on the back, and handshakes, and compared the number of social touches to empathy scores the physicians received. The interesting news is that doctors who used more than three such niceties had their scores decrease. But a pat, good eye contact, and a handshake goodbye? The trifecta.

Jie Xu, one of the coauthors and an engineering professor at the University of Wisconsin in Madison who worked on the project with Montague, says they were trying to figure out what kind of training would influence the perception and trust of providers. "There are a lot of things that are not in the control of the clinical world — insurance, family. What can they influence? What can they change?"

Paying attention to the patient is one thing, and it’s something that is increasingly hard to do, given the short time spent with patients and the diversion that smartphones, tablets, and computers can have on a provider’s attention when he or she is in a room with a patient.

But these things make a difference, he says. The first thing it changes is how patients think of the physician, the clinic, and the hospital, which can impact patient satisfaction scores. But that’s not the end. It can also potentially affect whether a person trusts the doctor and what he or she is telling the patient to do, Xu says. So if eye contact and a simple touch are things that make the patient more likely to comply with a medication regimen post-discharge, why not?

The group based its work on a study from the 1980s, which found that how a patient and physician talked to each other affected how the patient acted after that and whether he or she followed the treatment plan. Xu says times have changed so much, they wanted to see what would have that impact now. The answer is a look and a touch. Words are less important.

The group will continue to work on this project to see if outcomes are better or worse with patients whose providers engage in these social niceties. Meanwhile, Xu says that providers should be coached in making good eye contact, even when other things are tempting them to look away. If they are having to look at a laptop or tablet device because they are unfamiliar with it, they should be given remedial help until they can use it accurately with just a glance. "Patients need to feel attended to."

Pads of paper

The second study, in the October issue of the Journal of Hospital Medicine², looked at the impact a pad of paper can have on how a patient feels about his or her care. Aaron Farberg, MD, now a plastic surgery resident at the University of Michigan in Ann Arbor, thought of the project while he was a medical student. Assigned to follow around a chronically ill patient to see how they experienced the medical system, he wondered why he saw pads of paper everywhere, but not at the patients’ bedside. He and one of his classmates started using their printing allocation to create pads of paper for patients to leave questions and comments on.

That led to a project that provided notepads modeled after prescription pads with three prompts on each page for questions about diagnosis and treatment; tests and procedures; and medications. There was a prompt at the bottom to ask other questions on the back, with a box to check if there was further reading on the back.

The pads were left with patients on one unit over three months, and surveys were matched with those in a control group who didn’t get the pads. Most of those who got notepads used them — nearly 80%. Of those who got the notepads, almost two-thirds said they used them to take notes on their hospital stay, while just over a fifth of the control group took notes. And patients who used the notepads all felt that it enhanced their communication with their providers.

Farberg says they didn’t have enough of a group to determine if they could move an actual patient satisfaction number up with their results. But the implication is that this works to make patients feel better about their communication with their doctor. That it also helps them keep track of their hospitalization is even better, since there is plenty of data that show people aren’t usually at their mental best when they are hospitalized.

"This is one more thing that we can do to show we care for our patients," he says. "When you pick an airline, you assume they won’t crash. So you choose based on other things. The same with a hospital. You have to move them based on other things. And if one of those things is that their doctors communicate better with patients, I think that’s an important point to put across."

While a quick focus group of patients, family and friends helped them determine what questions to put on the note, others in the hospital are now using their own — a cardiology unit has different questions, and a children’s ward has a blank pad.

"The coolest thing about this is that it’s easy, it’s cheap, and it’s very effective. We had to limit what we could extrapolate in print because this is a peer-reviewed article. But there is an obvious link you can make that having your questions answered and improved communications will improve the way you feel about a hospital in general."

References

Montague E, Chen P, Xu J, Chewning B, Barrett B. Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. J Participat Med. 2013 Aug 14; 5:e33.
Farberg, A. S., Lin, A. M., Kuhn, L., Flanders, S. A. and Kim, C. S. (2013), Dear Doctor: A tool to facilitate patient-centered communication. J. Hosp. Med., 8: 553558.

For more information on this topic, contact:

Jie Xu, Ph.D., University of Wisconsin, Madison. Telephone (608) 609-8894.
Aaron Farberg, MD, Department of Surgery, University of Michigan, Ann Arbor, MI. Email: [email protected]