Mastering nonverbal communication can be an elusive task, but the fact remains: what’s unsaid leaves a significant footprint in any interaction. Nowhere is this more palpable than in the medical exam room, where trust and connection between physicians and patients often hinge on subtle, nonverbal cues.
So, how can one build trust through facial expressions and tone of voice alone?
In this episode, we break down how to silently establish rapport, effective use of pauses, the curious role of your eyebrows, impact of end-of-sentence inflection, how to convey uncertainty with confidence, and why learning a patient’s eye color can pay dividends.
Guest bio: Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician’s Guide to Doctoring Podcast. He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician’s Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb’s Cycle.”
Mentioned in this episode
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We Discuss:
The “Interest and Authority” Framework for Nonverbal Communication
- Nonverbal communication has two primary goals: showing interest and demonstrating authority/expertise. The “Interest and Authority” framework originated from poker player Blake Eastman.
- Interest is conveyed through facial expressions that show empathy and attentiveness; authority is communicated through vocal tonality that projects confidence and knowledge.
- This framework ensures meaningful connection by balancing genuine care with professionalism.
Facial Expressions: Conveying Interest
- Facial expressions are essential for demonstrating genuine care. A motionless or inexpressive face can signal disinterest to patients, even if you care deeply.
- Facial movement should reflect internal emotions naturally but deliberately. Amplify the natural expressions of engagement rather than performing or faking emotions; disingenuous expressions are often detectable.
- The “minimum effective dose” of facial expressions focuses on the brows and eyes. Use eyebrow movements like furrowing or raising to show engagement or thoughtfulness. Squint slightly when concentrating, conveying that you are focused on what the patient is saying.
- Avoid overused gestures like excessive nodding. Nodding can sometimes appear dismissive or routine, while animated brows and attentive eye movements convey active listening more effectively.
- Incorporate a degree of theatricality. Small, deliberate actions like leaning in or adjusting your expression help patients feel valued and heard. Theatricality isn’t deception; it’s about intentionally ensuring your genuine concern is visible to the patient.
Humor and Likability in Patient Interaction
- Use expressions of care like “I’m so glad you came in today” to reassure patients and build connection. While these phrases may feel performative at first, they become genuine with practice.
- Show interest in patients as individuals by asking simple, personalized questions or commenting on something unique about them. This approach fosters trust and enhances likability.
- Incorporate humor thoughtfully to reduce anxiety and strengthen rapport. Opt for light, situational humor or self-deprecating remarks that uphold professionalism, avoiding anything at the patient’s expense.
- Balance humor with professionalism, ensuring jokes are appropriate and lighthearted, such as playful exaggerations, rather than complex or overly elaborate humor. This maintains trust while enhancing the interaction.
Making Eye Contact and Noticing Eye Color
- Patients often complain about doctors not looking at them due to computer distractions.
- Make intentional eye contact using the “eye color” trick. Look at the patient long enough to notice their eye color. This ensures you’ve engaged meaningfully without making the interaction uncomfortable.
- Balance screen time with patient engagement. Acknowledge the necessity of computer use during visits, but avoid making it the focal point.
- Dictating notes in the patient’s presence allows you to maintain eye contact while summarizing the visit. And patients can hear and confirm their story.
- As ambient AI technologies advance, the need for manual note-taking may diminish, allowing for more direct patient interaction.
Attitude and Authority in Patient Care
- Accept that some days will feel overwhelming, and be forgiving of yourself while aiming to bring the best energy you can to patient encounters.
- Use facial expressions and active listening to establish care during history-taking, then transition to authority during the assessment and plan. Vocal tonality, cadence, and clarity establish authority in assessment and treatment discussions.
- Express uncertainty confidently, pairing it with actionable plans to maintain patient trust.
Effective Communication Techniques
- Pauses give patients time to process important information, especially when delivering news with gravity or explaining something complex. Replace filler words with pauses to enhance clarity and engagement.
- Repeat key points for emphasis. Repetition reinforces critical messages, helping patients retain and understand essential information.
- A steady and authoritative tone, avoiding up-speak (ending sentences like questions) or vocal fry, which can undermine confidence in your message.
- Address vocal fry with proper breath support. Improve posture, take deep breaths, and project from your chest rather than straining vocal cords to maintain a strong, clear voice.
- Avoid rapid, robotic delivery. Speaking too quickly can overwhelm patients and hinder understanding.
- Adapt your delivery to patient concerns. While your clinical routine may feel repetitive, recognize that each patient’s concerns are unique. Slow down and address any underlying anxieties.
Addressing Patient Concerns and Fears
- Patients may not openly voice their deepest worries, such as fears of cancer. Use clear, empathetic questions like, “What about this concerns you?” or “What are you worried this might be?” to give them permission to share.
- Engage patients in their evaluation process. Use tools like a shared exam screen to help patients see what you see during diagnostic procedures. While they may not fully understand the visuals, the act of showing builds transparency and trust.
- Balance honesty with hope when delivering bad news. Ensure you provide a clear next step, such as referrals, imaging, or follow-up appointments. Offering a plan helps patients feel supported, even amid uncertainty.
- It’s important to acknowledge when a definitive answer isn’t possible. Be transparent with patients about next steps or second opinion options, emphasizing your commitment to their care.
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